Michael Byrd and Linda A. Clayton
New York,
NY, Routledge, 2000; 588 pp., with illus.
Review by
John Price
In the world’s
richest society—boasting the best medical technology on the planet—the
question begs asking: Why are Black folks in such poor health? An American
Health Dilemma examines this oft-ignored question by probing into the
history of medicine and the U.S. health delivery system through the prisms of
race and class. Authors W. Michael Byrd and Linda A. Clayton, both
African-American physicians who teach at Harvard University, tell us that
today’s crisis of Black health disparity is not new, nor is it adequately
explained by oversimplified health sermons about poor lifestyle and bad
behavioral choices.
An American
Health Dilemma explains how the Western construct of race gave rise to
today’s two-tier health system, where 50 percent of Blacks are uninsured, or
underinsured, and where another 25 percent depend solely on second-class
health resources, including Medicaid, city hospitals, public health clinics,
and overcrowded emergency rooms. Byrd and Clayton argue that today’s Black
health crisis—where African-Americans account for a staggering 90,000 “excess
deaths” each year—is essentially an American health crisis that grew straight
from the antebellum roots of the old “slave health deficit.” The crisis also
grew from society’s historic and ever-growing acceptance of poor health status
for Black folks.
This ambitious
work—588 meticulously-documented pages in the first volume alone—traces race
and the historical development of medicine from antiquity to 1990. It maps the
origins of scientific racial classification schemes, the development of the
concept of race, and the connection between race and health through three
historical periods. Part 1 spans prehistory through the English colonial
period, shedding light on the racializations that dominated early Western
medicine and that eventually led to the medical profession’s support of the
Atlantic Slave trade. It is impossible not to appreciate the authors’
historical references to the cherished works of Ivan Van Sertima, Cheik Anta
Diop, J.A. Rogers, and Molefi Kete Asante. Indeed, An American Health
Dilemma marks an unusual and welcome intellectual advancement for the
medical and scientific community that is usually steeped in Eurocentric
paradigms.
Part 2 covers
the American period 1619-1812. The squalid health care and poor nutrition
afforded to slaves during the Middle Passage—the period when mortality rates
hit 80 percent and continued at 30-50 percent during the “breaking-in period”
upon arrival in North America—established the model of substandard health care
for slaves, and set the American paradigm of diminished societal expectations
for Black health. Byrd and Clayton argue that these conditions, and the fervor
of white physicians to stratify humans by race and scientifically defend
theories of racial inferiority, shaped the social milieu in which Blacks would
be exploited for medical experimentation and systematically excluded from
becoming members of the mainstream medical profession. These issues are
explored in depth in Part 3.
Unfortunately,
there is only the briefest mention of the role of traditional healers in
Volume 1, such as the critical work of Black midwives in the South and
their eventual elimination by the White medical establishment, which has been
well-documented by other medical historians. Nonetheless, the authors escort
the reader on a rather impressive historic journey from ancient Egypt’s
Imhotep to the late 19th century origins of the National Medical Association,
the professional group of Black physicians that now numbers over 25,000
members.
This is hardly
a sanitized history, but a rigorous, compelling, and unabashed examination of
the historic origins of Black health disparity. The book contains a treasure
chest of over 40 tables, charts, and illustrations. Wisely avoiding the
pitfalls of statistical immersion or scientific jargon, the authors compile a
coherent, accessible, and revealing history of the relationship of race and
science and the “historic tradition of self-serving behavior by Eurocentric
organized medicine.”
In the face of
today’s Black health crisis, An American Health Dilemma is good
old-fashioned medicine for those who might otherwise succumb to historical
amnesia. The book is an important read for anyone interested in understanding
how African-Americans came to lead the nation in poor health, topping the
charts in 14 of 16 leading health indicators. Indeed, nothing seems to advance
the growing debate for reparations with such scientific persuasion as does the
evidence of the slave health deficit and its present-day manifestation of
Black health disparity. In the coming Supreme Court argument over reparations,
An American Health Dilemma should be Exhibit A.
Volume II
is due in the fall. It will cover the chronology from 1900 to the Black health
crises of the 1980s and 1990s, and it will explore the formation of a
permanent health underclass in the 21st century. Z
