An American Health Dilemma. Vol. 2, Race, Medicine, and Health Care in the United States, 1900-2000 (review)

Anyone who has considered offering a course on the history of African American health in the twentieth century probably has lamented the absence in the existing literature of an interpretive survey text. Most of the literature in the field is no more than a quarter-century old, and it is growing remarkably. Yet most of the books are monographs or edited collections of essays, and few of them have offered an interpretive sweep of the twentieth century.¹ In this volume, we finally have a vision of the twentieth century and what it meant for the health of black people. For Michael Byrd and Linda Clayton, the history of black health is one of struggle and political dissent against the "blind spots" in U.S. medicine.

The sheer length of Byrd and Clayton's work (the second volume contains 854 pages) gives some indication of why no one until now has belled the cat. Both Byrd (an obstetrician gynecologist) and Clayton (an obstetrician gynecologist and gynecologic oncologist) are senior research scientists and instructors at the Harvard School of Public Health, and collectively they bring more than sixty years of practice, research, publication, and instruction to this scholarly offering. If historians have lacked a cohesive explanation for the development of health deficits among black populations, the authors were acutely aware that medical training, similarly, lacked "instruction on medical and public health remedies to understand and correct these inequitable health status, health system structural, and outcome deficits" (p. xxxi).

The growth in interest in the history of black health may be traced to two distinct, though related, intellectual and social-political trends. One group of scholars, many of whom were trained as historians, have recently found considerations of black health and health politics largely to have been left out of public health and medical history and African American history. Slavery, migration, segregation, and white supremacy, they have pointed out, historically have produced distinctive physical effects on black people. Of course, that American apartheid emerged over the twentieth century as a densely latticed and constantly shifting system of political, economic, geographic, sexual, and social relations—all variously informed by the equally complex ideological underpinnings of the mythology of race—is not new to individuals of the second intellectual trend. Black health-care practitioners (not to be confused with health-care professionals) and social scientists knew the health effects of racism firsthand well before the emergence in public health of the multifactorial environmentalist approach in the 1920s and 1930s. One need only peruse the pages of the early volumes of the Journal of the National Medical Association, for example, to find the protests—sometimes aggressive, sometimes tentative—of African American health workers. W. E. B. Du Bois, who is known to most of us for his observations regarding the psychical costs and burdens of the color line, is less known for having waged an extended battle against white physicians, statisticians, and anthropologists who claimed black physical inferiority without taking serious account of the political economy of white supremacy as a factor in lower life expectancy and health status.

This second trend informs Byrd and Clayton, and the urgency of their work places them within a long tradition of intellectual protest. Of course, a physician's-eye view will lack certain insights that many scholars would believe to be important to a book on "Race, Medicine, and Health Care." While, for example, black physicians appear as heroes for Byrd and Clayton, we find little acknowledgment of the role of nonprofessional and not institutionally trained health practitioners in protest and health maintenance. Susan L. Smith's 1995 work detailing black women's roles in public health in the South in the first half of the twentieth century, for example, remarkably does not appear in the bibliography, although she has securely placed nurses, clubwomen, midwives...