The wound of my people: Segregation and the modernization of health care in North Carolina, 1935--197

In North Carolina, race was the crux of a forty-year debate over the quality, accessibility, and efficiency of health care delivery. This debate shaped the course of reform at the regional and national levels in the areas of federal health insurance, hospital construction, and medical education. In the context of liberal efforts to link racial equality and medical treatment as essential rights of citizenship, federal health initiatives during the New Deal and World War II strengthened the connections between black and public health. Such broad-scale programs threatened North Carolina's white physicians, whose opposition to public health and "socialized medicine" was based in a strong desire to protect segregation and fee-for-service practice. North Carolina played a key role in defending and later dismantling the doctrine of "separate but equal" in the federal Hill-Burton hospital construction program. Black medics led local movements to desegregate hospitals, schools, and businesses, and succeeded during the 1950s in removing racial barriers in training opportunities and professional organizations. But federal health policy continued to uphold segregation until the 1963 Simkins v. Cone decision ruled Hill-Burton's "separate but equal" provision unconstitutional. In medical education, the first black student to enter a historically white Southern university without a court order enrolled in the University of North Carolina School of Medicine in 1951. The political repercussions of desegregating medical education continued into the 1970s, when the General Assembly erupted over competing plans to establish a second state-funded medical school at East Carolina University or to make UNC-Chapel Hill the center of a state-wide network of health education centers. Throughout the postwar era, black activists pressed for equality for black patients and professionals. White physicians and policymakers valued efficiency , working to modernize and systematize health care while maintaining their power in white-dominated hospitals, medical schools, and professional organizations. These goals were compatible only as long as blacks remained patients but not decisionmakers. Thus, African Americans have been operated on, in both senses of the word, they have won vastly improved access to medical treatment, but have gained little control over the system that dispenses it.