Jim Crow may have been legally outlawed in 1964, but many of its health effects may only now be emerging for black Americans who lived under its racist rule in their early childhoods.
That’s the conclusion of epidemiologists and economists who have studied the impact of Jim Crow laws, first adopted as racist backlash in the decade after emancipation—and its abolition by the 1964 Civil Rights Act—on infant health, infant mortality, life expectancy, and premature mortality.
What researchers increasingly believe is that “health in adulthood is shaped by the environment experience early on in life,” says Douglas Almond, an economist at Columbia University who has studied the under-provision of basic medical care due to segregation in Southern hospitals.
Though legally blessed overt racism may seem distant, researchers are quick to remind us that black Americans born when Jim Crow was in effect in 21 states and DC are as young as 53 years old.
We will never know the full extent of the destructive health effects of Jim Crow in its time, because data on racial disparities was not collected until the first National Health Interview Survey in 1958. What we do know is that it was perfectly legal for white nurses to refuse to treat black patients and integrated rooms in mental health facilities were against the law. Segregation also existed in the blood supply. Hospitals that treated black patients may have been far from the people who needed them; only six hospitals in Mississippi would treat black patients in 1929 and none were in the Delta. No wonder, by 1946, fewer than 10 percent of all births of black children in Mississippi took place in a hospital compared with nearly 70 percent of white births.
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When black Americans made their way to a white doctor, it did not mean they were treated as full human beings. W. E. B. Du Bois, one of the great sociologists of the twentieth century, lost his two-year old son to a treatable infection because “no White physicians [were] willing to treat a Black child,” a story that he recounts in his classic The Souls of Black Folk. Even in cases of child rape, many white doctors refused to examine black girls, as Ruth Thompson-Miller and Leslie H. Picca have shown.
While a 1963 Supreme Court decision made segregation illegal in hospitals, and the Civil Rights Act the next year outlawed Jim Crow altogether, the damage may have already worked its way into the bodies of those forced to live under its racist rule. As Almond indicated, since our health as adults is shaped, in part, by early experiences in life, we may only now be seeing the effects of the state-sanctioned racism in the 1960s and earlier. “That history is alive now in people’s bodies,” says Nancy Krieger, a professor of social epidemiology at the Harvard T.H. Chan School of Public Health who has been at the forefront of this research.
A new study on the connection between breast cancer and Jim Crow adds to this growing body of literature. Krieger and her colleagues found black women born before 1965 in Jim Crow states were more likely to have estrogen-receptor-negative breast cancer, which tends to be more aggressive and more difficult to treat. But black women born after the abolition of Jim Crow showed no such Jim Crow effect, a finding that suggests the racial disparity in more aggressive breast cancer is the product of racism. “The history of Jim Crow in the USA is not remote,” the study authors write, “but instead remains embodied, within and across generations.”
The Jim Crow health effect harms not only individuals, but also their children, as the infants of black women born in the late 1960s have a much lower risk of low birth weight than the infants of black women born in the early 1960s. That is a clear example of how the effects of structural racism pass between generations. “We’re seeing the legacy of early-life exposure to Jim Crow and compromised childhood health,” says Almond, an author of the study.
Though researchers place a bold asterisk on any suggestion that the abolition of Jim Crow vanished racial health disparities altogether, their work repeatedly shows a connection between the abolition of the racist laws and improved health for black Americans, a finding that suggests the promise of addressing structural determinants of racial health disparities. “Understanding health in the United States requires grappling with the history of the country,” Krieger says. “You carry your history with you in your body.”
Today, we know that de facto segregation is very much alive and has serious health consequences—hospitals are more likely to close in segregated areas, pharmacy deserts are more likely to exist, and living in certain neighborhoods is associated with having your life cut short by more than a decade. And yet research funding continues to prioritize the search for the cause of racial disparities in the genome rather than the environment. “There has been a lot of time and a lot of public resources spent on researching racial differences as though they have any weight in comparison to structural inequality,” says Samuel Roberts, director of Columbia’s Institute for Research in African American Studies and author of Infectious Fear: Politics, Disease, and the Health Effects of Segregation.
Why black Americans are more likely to die in childbirth or from infectious diseases has long been explained with biological theories rather than social ones, a way of thinking that underpinned Jim Crow policies of higher insurance rates for black people and racial miscegenation laws. The American tradition of blaming black people for having something wrong with them, rather than something wrong with society, may go all the way back to religious explanations for why different races exist and how that reasoning worked its way into scientific racism, according to Terence Keel’s work of intellectual history, Divine Variations: How Christian Thought Became Racial Science. But what the Jim Crow health effect shows is that black Americans do not suffer from worse health outcomes because of race, but because of racism.
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