Karen Kruse Thomas, Deluxe Jim Crow: Civil Rights and American Health Policy, 1935–1954

Extract

In Deluxe Jim Crow, her meticulously researched new study of health policy and race in the mid-twentieth century South, Karen Thomas makes the compelling case that federal health policy from 1935 to 1954, despite its refusal to challenge segregation directly, led to great gains in black health and ultimately, created the infrastructure that enabled integration. The book begins in the early 1930s, when regional and racial disparities in health were widening as a result of the agricultural crash and improving health outcomes in northern tenements. The mid-century South was the ‘crucible of American health policy’ (p. 4), since both northerners and southerners could agree that racial and rural disparities needed to be closed for the good of overall white health, regional pride and—with World War Two—national defence. Kruse charts how these concerns led to the creation of federal programmes, including the expansion of federal public health matching programmes incorporated into the Social Security Act and the 1946 Hill–Burton Hospital Survey and Construction Act. While these programmes did not challenge southern segregation head-on, they insisted on racial parity within segregated facilities. Although civil rights leaders were divided about whether to accede to a policy of equalisation over integration, Kruse demonstrates that the policies she calls ‘deluxe Jim Crow’ led to real improvements in black health.