When Your Skin is the Highest Copay: A Brief History of Healthcare Disparities in Black America

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Here’s a piece of not-so-breaking news: Black folks in America are in a dire predicament because of the coronavirus pandemic. And after months of data highlighting the physiological imbalance between communities of color and white Americans with regards to the devastating impact of the virus, ABC News announced the broadcasting of a three-night special titledPandemic: A Nation Divided”, intended to “examine the racial/ethnic and socioeconomic disparities stemming from the coronavirus pandemic”.

The timing of the special aligned with a persisting conversation around the casualties and recoveries of COVID-19, just as the nation eased stay at home orders from coast to coast. Public officials and business leaders have spent weeks scrambling to temper public anxiety in the name of restoring normalcy. Scientists and medical professionals have worked around the clock in efforts to advise U.S. citizens with proper guidelines to navigate our ‘new normal’. And now, with all 50 states reopened and poised to move forward in the wake of nearly 100,000 lives lost, ABC likely concluded that America, though still deeply in the throes of the pandemic, was ready to have a cultural reflection about race and class and equity in relation to what has transpired this spring.

Let’s never withhold their gold star for trying.

It is not that “Pandemic” as a special is uninteresting in its premise, it is that it’s premise, unfortunately, is rehashed information under a different heading. Whether ABC or any other mainstream outlet was airing a special called Diabetes or Hypertension or HIV, the disparity between white sufferers of these illnesses and Black sufferers of the same illnesses would highlight similarities consistent with what we now see with COVID-19. Much like any and every American social inequity, the disparities in our healthcare system’s treatment of marginalized people are anchored in a troubled past. Because high-quality healthcare has historically been tethered to good socioeconomic standing as opposed to being an inalienable human right, Black Americans have historically been on the dying end of outbreaks, transmissions and handed down genetic deficiencies.

When did this kind of inequity in public health begin? It began at the same time as most measures of unjust and disparate treatment of Black American citizens began to take shape, during the tail end of the 19th century and the dawn of the 20th century.


When Rebecca Lee Crumpler was studying to become the first Black woman to ever receive an M.D., one of her primary goals was to be of service to newly freed slaves after the Civil War.

Crumpler, a graduate of New England Female Medical College, relocated to Virginia after working as a nurse for eight years in Massachusetts, compelled to do “proper field for real missionary work”, that would “present ample opportunities to become acquainted with the diseases of women and children,” according to her bio. She joined the Medical Division of the Freedmen’s Bureau, along with other Black physicians to care for freed slaves who otherwise would not have access to medical care. One of the most daunting tasks of the physicians affiliated with the Freedmen’s Bureau was treating Black patients infected with smallpox, the pandemic of its time. Crumpler and her colleagues were not only battling the infectious disease, they were also battling a racist theory of biological inferiority championed by white scientists that suggested that Black people were biologically inferior and not suited to live outside the confines of slavery, therefore making them incapable of overcoming smallpox.

Needless to say, this oppressive theorizing resulted in a severely under resourced population of Black patients, as their survival was deemed improbable and their humanity disposable. Dr. Crumpler was able to publish the A Book of Medical Discourses, one of the first medical publications by an African American to serve as a reference of medical advice for women and children who were not only enduring the smallpox crisis, but as a source of professional guidance for vulnerable populations who may not have been able to easily access a physician.


The American South has traditionally been the host site for Black subjugation. It was the home of chattel slavery, the geographic manifestation of Jim Crow and generally a region characterized by its anti-Black hostility.

Of the myriad of ways the American South attempted to dehumanize its Black citizens post slavery, was its abysmal treatment of Black folks in need of medical care. For decades, the south faced a deficit in the number of hospitals available to its citizens and the hospitals that were available were segregated. Jim Crow laws did not allow white nurses to treat Black patients, specifically Black male patients, which was a response to “The Birth of a Nation style fear mongering that depicted Black men as violent sexual deviants.

Toward the middle of the 20th century, President Harry Truman made a nationwide attempt to introduce the earliest form of universal health care. Truman’s efforts were ultimately defeated at the behest of an aggressive campaign by the American Medical Association (AMA), which at the time consisted of all white doctors who felt that Truman’s plan would irreversibly socialize the healthcare industry and force them to treat patients who were economically disenfranchised. The AMA railed intensively against Truman’s plan, adopting the slogan “Keep Politics Out of Medicine” as rationale to conceal the underlying racism and classism of their agenda.

Truman would eventually find an ally in William Montague Cobb, a professor of medicine at Howard University, board-certified physician and the editor of the National Medical Association, which was the nation’s first organization of African American physicians and health care professionals. Cobb would go on to be a leader in advocating for Medicare and was instrumental in the fighting for the passage of the Medicare and Medicaid Act of 1965, a pivotal victory for Civil Rights era legislation. It was that very act that would force southern hospitals to desegregate, as federally distributed Medicare funds were tied to those hospitals adhering to anti-discrimination Civil Rights legislation. It was also that measure of legislation that would set an early precedent for the Affordable Care Act (Obamacare) that conservative leadership has tried to completely decimate, as they are fully aware that any semblance of wide covering health care is of benefit to the most marginalized of Americans.


So where does this history leave us in the context of present-day America amidst the coronavirus pandemic? The data tells us that much like inequalities faced in the criminal justice system, housing market, education and so on and so on, Blackness with respect to healthcare still pays the highest cost and gets virtually the lowest return on its humanity. For example, Black residents in Illinois are nearly three times more likely to die from COVID-19 than white city residents. In Georgia, more than 80% of COVID-19 hospitalizations are African Americans, and in New York City, African Americans are twice as likely to die of the virus than white residents. If we look beyond the scope of the coronavirus (which is a lot to look beyond right now), there is still the mortality rate of Black women during pregnancy to consider, the disparity in causation and treatment of diabetes to consider, the prevalence of asthma, hypertension and difference in cancer treatments to consider and a whole host of other health concerns.

Therefore, we have no choice but to be vigilant in our pursuit of equitable healthcare at all times. The only alternative is to be slowly sang about at a memorial service that could have waited for our bodies to be its guests of honor.