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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 It is impossible not to appreciate the authors' historical references to the cherished works of Ivan Van Sertima, Cheik Anta Diop, J.A. Rogers, and Molefi Kete Asante.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