Health Care Divided

David Barton Smith offers a complete chronicle of racial segregation and discrimination in health care in the United States using vivid first-hand accounts as well as current evidence of inequity in patterns of use and outcomes. Smith details judicial and federal efforts to address these disparities, discusses their persistence in more subtle forms, and offers possible strategies for ending them.

Health Care Divided tells the story from 1920 to the present by distilling a narrative from archival records and interviews with key participants. The book traces the decisive role race has played in shaping our system of medical care and explores the effect of this legacy on long-term care for the elderly and prenatal care for infants.

Identified here are lessons largely overlooked by health services leaders, researchers, and policy analysts. Smith examines how this divided health system persists, both exacerbating and distorting racial disparities. He asserts that in spite of federal efforts to end segregation, health care remains, at best, more than half the distance between a fully separate and an integrated system.

David Barton Smith is Professor and Program Director of the Healthcare Management Program, the School of Business and Management, Temple University. The research for this book was supported by a Robert Wood Johnson Health Policy Investigator Award.

Praise / Awards

• "Health Care Divided is a fascinating and often distressing history of our racially divided health care system."
  —Ruth Roemer, J.D., UCLA School of Public Health, and Past President, American Public Health Association
  
• "A must for all who seek to develop an ethical healthcare system, this detailed and thoroughly researched account of the parallels between the Civil Rights Movement and the changes in the health care delivery available to all races, provides an intriguing, though disturbing, look at the history and parallels of race relations and health care in this country."
  —V. B. Byers, SUNY Health Science Center at Syracuse, CHOICE, Volume 37, No. 4, December 1999
  
• "In a helpful dissection of the literature on racial disparities in health care and health status, Smith treads carefully among competing assessments of cause and effect, at the same time indicating where gaps have and have not been reduced. What his discussion makes clear, above all, is why these disparities simultaneously inspire both intense chatter and considerable caution. . . . "
  —Christopher H. Foreman Jr., Health Affairs, September/October 1999
  
• "This book offers a wealth of information to stimulate dialogue about strategies for policy change. Educators, policy-analysts, and researchers involved in health professions, social studies, business, political science, and anthropology will find that this well-written and accessible book offers both a historical perspective and a vision for change. This vision, created from lessons learned from the past, will prepare its readers for the next phase of the Civil Rights struggle in a health care system that remains embroiled in racial dilemmas."
  —Mary Abrums, University of Washington, Social Science & Medicine, Volume 52 (2001)