Emancipation

In 1865 Emancipation released southern whites from the responsibility of providing limited health care to blacks. Beginning on March 3, 1865, the federal government became involved in health care with the passage of the Freedmen Bureau legislation. The Freedmen Bureau operated 90 health care facilities throughout the South. With the expiration of the Freedmen Bureau bill, self help and philanthropic support were the only means by which localities and communities could begin or continue health care.

Early 20th Century

In the absence of federal provisions, many African Americans experienced decades of inadequate or non-existent health care. This was made worse by the refusal of southern health institutions, most of which were privately owned, to provide health care to blacks.

Emergence of Black Hospitals

With donations from numerous private individuals and philanthropic organizations, both white and black, efforts were made from the early 1900s through the 1930s to build hospitals. The largest white contributor was the Julius Rosenwald Fund, but their gifts were given primarily to a handful of black hospitals in large cities, mostly in the North.

Provident Medical Center in Chicago (founded as Provident Hospital and Training School) was the first, opening its doors in 1891 through the efforts of Dr. Daniel Hale Williams, the open heart surgery pioneer.

Provident Medical Center

The next oldest black hospital was the Frederick Douglass Memorial Hospital in Philadelphia, founded by Dr. Nathan Mossell and three other black physicians in 1907. By 1900, there were 40 black hospitals and eleven black medical schools in the nation (with Howard University Medical School being the first).
Hubbard Hospital was founded in Nashville in 1911 while Tuskegee Institute Hospital was founded in 1913. In 1932, there was only one black hospital for every 100,000 blacks (or 1 hospital bed for every 1,000 black patients). For whites, it was 1 to 19,000 ratio (or 1 hospital bed for every 110 white patients). Most black hospitals were located in the South where services for blacks were at a minimum. Additionally, widespread segregation and inequity in hospital care, as administered by the state-wide boards, resulted in the high mortality rate of African Americans nationwide.

New Deal

The first attempts at a national health program which would seek to partially alleviate these inequities were made during the New Deal, with the South being the primary beneficiary. This allowed for the creation of a permanent mechanism to distribute programs and assistance related to health concerns. Funds were provided by the Federal Emergency Relief Administration, the Civilian Conservation Corps, the Civil Works Administration, the Federal Emergency Relief Administration, the Federal Housing Administration and the Works Progress Administration. For example, it was in 1915 that what would later be called Norfolk Community Hospital was founded. However, not until the Public Works Administration funded its facilities did it actually open for business in 1939. Even with PWA funding, the black Masons, black churches, the UNIA, the black Elks, and numerous private individuals subsidized the institution with private donations. 

World War II

Perhaps World War II had the greatest role in improving health care in the South because, wherever large numbers of troops were stationed, resources from the federal government were provided to address any health care concerns. This included building additional hospitals, establishing military instruction on hygiene, and sponsoring educational programs on nutrition and the importance of a balanced diet.

Integration and the 1960s-70s

The advent of integration in the 1960s has forced the closing of many black hospitals, especially those identified as the traditional black hospitals. In 1984, only 32 black hospitals were still in existence (a decrease from 40 in 1983). Between 1961 and 1988, 71 black hospitals were closed, merged, consolidated or converted.