The Fight to End Healthcare Discrimination

June 15, 2023

Panel Discussion Highlights the Fight to End Healthcare Discrimination

When many Americans think about segregation in the United States, education, housing and employment are usually the first areas that come to mind. Healthcare doesn’t always make the list, though health discrimination was one of the most sinister features of the pre-civil rights Jim Crow regime.

In the documentary film, The Power to Heal, based on the book by David Barton Smith, producer Barbara Berney explored the vicious structural inequalities that limited Black Americans’ access to healthcare, as well as the glaring outcome disparities the system created.

She also showed how a group of bold civil rights activists faced down intimidation and violence to enforce the federal government’s desegregation efforts and ensure equal access to healthcare in the communities that suffered most.

Healthcare Was at the Heart of the Civil Rights Movement

In a panel discussion hosted by Beth Israel Lahey Health (BILH) Chief Diversity, Equity and Inclusion Officer Juan Fernando Lopera after a screening of the film for BILH employees, Berney talked about how she was inspired to turn this story into a film after learning about the desegregation of one hospital in Marshall, Texas.
 
She had a colleague who was sent to the town to help hospital administrators desegregate. He received an outright refusal, and it looked like his efforts were dead. But Marshall happened to be the hometown of Claudia “Lady Bird” Johnson, the wife of then-President Lyndon B. Johnson, who was part of the charge to end segregation in healthcare.
 
If only to avoid embarrassment, the president had a direct interest in desegregating Marshall’s healthcare organizations. The health administrator in question received a phone call from Johnson reiterating the case he was making at the national level: Only hospitals that desegregate will receive newly minted Medicare funding. The effort both in Marshall and across the United States was ultimately successful.
 
“I had been in civil rights and public health for decades,” Berney said. “I had never heard about how Medicare was used to desegregate hospitals.” She knew she couldn’t have been the only person who didn’t know this story, so she decided to make it the central narrative of her film.

The Destructive Impact of Segregation in Healthcare

Decades after emancipation, all-white hospitals still refused to treat Black patients, while even those that did packed their nonwhite patients into underfunded wards. The impact on the community was disastrous; infant mortality among Black babies was significantly higher than their white counterparts, and Black Americans died of treatable conditions like hypertension at alarming rates. Many Black Americans went their entire lives without ever seeing a physician.

To help fill the void, some Black doctors started their own hospitals to serve the country’s most marginalized communities. Although this growing network of facilities provided care to those who needed it, they were limited by their inability to get the necessary medications and equipment—suppliers were still predominantly white and didn’t sell to Black facilities.

Berney was joined on the panel by BILH Executive President of Hospital and Ambulatory Services Michael Rowan. Rowan witnessed much of this history firsthand.

“My father was a physician,” he said. “When I was young, I was always amazed that all the African American physicians in the Ohio community where I lived knew each other—they knew each other well—and I never quite understood it. But it was because, indeed, 85% of African American physicians in the country were educated in one of two medical schools.”

The Fight to End Health Inequity Continues

By the end of the 1960s, the alliance of grassroots organizers and federal officials had managed to desegregate most of the country’s healthcare facilities; more than 70% of Southern hospitals heeded President Johnson’s warning and opened their organizations to nonwhite patients. Black Americans had won equal access to healthcare. 

But as Rowan reminded his listeners, the history of segregation still casts a long shadow on American society.

“I worked at a hospital [in Savannah, Georgia,] that had been around for 150 years,” he recounted. “I was the first African American male working there who ever had a reason to wear a tie and a sport coat. And that was in the eighties. A lot of the things we see in the film are not ancient history.”

Despite the remarkable work and achievements of a generation of civil rights activists, Black Americans still experience significant care disparities, while other institutional barriers limit equal access to care. The solutions to these challenges will require creativity and determination, but Rowan and Berney agreed that coverage and cost reforms will be central to closing those gaps and expanding healthcare access to everyone.