Deluxe Jim Crow

In November, the Centers for the Comparative Study of Metropolitan Growth and Law, Health & Society, together with the School of Public Health and Georgia Health Policy Center, hosted Karen Kruse Thomas, staff historian for the Johns Hopkins Bloomberg School of Public Health, for a lecture and book signing event. Thomas presented “Deluxe Jim Crow Health Policy in Atlanta and Baltimore.”

The author of Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954 (University of Georgia Press, 2011), Thomas discussed the complex and sometimes contradictory history of health care and both the impact on and role of African Americans. She described the policies that allowed segregation in health care to continue throughout the beginning of the 20th century.

“In the 1938 case of Gaines v. Missouri, the U.S. Supreme Court declared that the government had to show that separate systems were demonstrably equal or they could not be separate,” Thomas said. “In health care, how this played out is that rather than save money by integrating systems, southern states infused money into black hospitals. Thus ‘Deluxe Jim Crow’ took hold.”

The Hill-Burton Act of 1946, which provided funding to build additional hospitals, further entrenched the Deluxe Jim Crow concept by prohibiting discrimination in services provided by the facilities but allowing separate but equal facilities to meet this requirement.

Initially some African-Americans were supportive of these policies which increased resources and access and thus improved care, despite continuing segregation. “You can’t imagine two more different groups than Southern Segregationists and African American Civil Rights leaders coming together on any other topic, but they were able to get a consensus on health care,” Thomas said. “There were different groups advocating for the same policies for very different reasons.”

Eventually, however, younger African-American physicians, many of whom were middle class and in solo practices where they did not have to fear being fired, argued for integration, seeing segregation in health care, as in education and all other arenas, as never being truly equal.