Getting King's Words Right

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

These often-invoked words attributed to Rev. Dr. Martin Luther King Jr. offer moral sustenance to many persons working toward health equity today. Scholars, practitioners, and activists in health care and in public health commonly quote this powerful claim thus aligning the health equity movement with the civil rights movement. In fact, historian John Dittmer opens his account of the early fight for social justice in health care with these words.¹ Yet, these words are not the precise words that King spoke more than a half century ago.

On March 25, 1966 in Chicago at a press conference before his speech at the second convention of the Medical Committee for Human Rights (MCHR), King said (in part):

"We are concerned about the constant use of federal funds to support this most notorious expression of segregation. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.

"I see no alternative to direct action and creative nonviolence to raise the conscience of the nation."

It is intriguing that no prepared text or transcript exists of either King's remarks at this press conference or his speech at the MCHR meeting. Multiple serious efforts to locate such documents have been unsuccessful.^2,3,4,5 A short Associated Press (AP) news story about the press conference was published in several newspapers, in California, Michigan, Illinois, and Wisconsin, the following day and is the most reliable account we have of King's words there.³ This brief passage helps to contextualize King's ideas and signal their implications; thus each sentence is deserving of discrete comment given its relevance to the whole.

"We are concerned about the constant use of federal funds to support this most notorious expression of segregation."

Here King joins voice with MCHR to oppose the federally sanctioned racial segregation in virtually all, Southern and Northern, hospitals: African American patients were commonly denied access to care and given substandard care in substandard hospital rooms. This racial discrimination put hospitals in violation of not only the Civil Rights Act of 1964 but also a 1963 Supreme Court ruling striking down the sanction of "separate but equal" health care facilities in the Hill-Burton Act. Signed into law by President Truman in 1946, the Hospital Survey and Construction Act—i.e., the Hill-Burton Act—provided federal funds to states for the construction and expansion of local hospitals. It had included a Jim Crow provision written by one of the bill's key sponsors, Senator Lester Hill of Alabama, that permitted the "equitable provision" of services "in cases where separate hospital facilities are provided for separate population groups." Furthermore, this racial segregation violated the recently passed 1965 Medicaid and Medicare legislation that soon would channel substantial federal monies to health care providers for patient care.¹

"Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death."

This documented quote differs from the more common "quote" in three striking ways. First, King spoke of injustice in "health," not in health care.* While it is impossible to know whether there was a meaningful difference between health and health care for King, his unfailing attention to poverty, racism, education, and housing—what we now often call social determinants of health—makes clear his moral concern beyond health care alone. Second, King said that injustice in health is "inhuman," not inhumane. The distinction here is likely significant as a matter of degree. Inhumane suggests a lack of compassion for human suffering or pain whereas "inhuman" is more extreme, suggesting a denial of humanity so egregiously cruel that it is, or should be, beyond human action. The final difference in King's actual words compared with the more popular version is perhaps the most important as it reveals King's belief about why health injustice is inhuman. Injustice in health is "the most inhuman" form of inequality, says King, "because...