May 8, 2020
Healthcare Disparities: A Long View
18 th Century through Today
Depiction of 18th century African American healthcare workers
COVID-19 has caused us to look more closely at America’s healthcare system and its disparities. When it comes to African Americans, these disparities must be viewed through a long lens. 
Richard Allen
Jones’ & Allen’s report on the yellow fever, 1794
Absalom Jones
Evelynn Hammonds , Barbara Gutmann Rosenkrantz Professor of History of Science and professor of African and African American Studies at Harvard University, explained how the 18th century yellow fever epidemic is an early example of health disparity rooted in racism: “ when yellow fever rates in the U.S. were higher among whites than blacks, physicians assumed that racial differences in immunity were the cause. In fact, those blacks who were immune had most likely contracted the disease as children in the countries from which they were enslaved. When a yellow fever epidemic broke out in Philadelphia in 1793, blacks were expected to stay to tend to the white population .” [1] It was Dr. Benjamin Rush , a signer of the Declaration of Independence and a leading medical authority of the day, who “ wrote to Richard Allen and Absalom Jones and implored them to step in and help the sick… Allen, Jones, and many other African Americans agreed to help the sick, working as everything from nurses to gravediggers... in the end blacks died from Yellow Fever in similar percentages to whites… Rather than being regaled as heroes, Allen, Jones, and the black community were vilified .” [2] Richard Jones and Absalom Jones later founded the historic African American Episcopal (A.M.E) Church and the Free African Society. 
Former slaves in a “contraband camp” post-Civil War where many contracted disease
Following the end of the Civil War and Emancipation, the United States was battling smallpox and other diseases which hit former slaves the hardest. Reports on this are eerily similar to today: “ By 1869, the chairman of the Committee of Freedmen’s Affairs estimated that smallpox had infected roughly 49,000 freed people throughout the postwar South from June 1865 to December 1867… Records of Freedman Bureau physicians in the field suggest that the numbers in their specific jurisdictions were, in fact, much higher. From December 1865 to October 1866, when the epidemic reached its peak, bureau physicians in Georgia, Louisiana, North Carolina and Virginia estimated that hundreds of freed people a month became infected with the virus .” [ 3 ] The continued disparities led to activism from the African American community: “ free blacks after the Civil War were the first advocates for federal health care. They argued that the right to health care should be among the benefits of being a citizen of the United States .” [ 4]
Booker T. Washington addressing a crowd at the Tuskegee Institute
By 1915, Booker T. Washington made it known that this was still a central issue to the African American community by citing at the Conference on Improvement of Health Conditions Among Negroes in Tuskegee, Alabama that " 45 percent of all deaths among Negroes were preventable; there are 450,000 Negroes seriously ill all the time; the annual cost of this illness is 75 million dollars; that sickness and death cost Negroes annually 100 million dollars ." [ 5 ] Sixty-four years later in 1979 there were still many disparities as stated in the book Healthy People , which actually sought to downplay disparities, but nonetheless reported: “ blacks between the ages of 25 and 64 have a stroke rate almost 2.5 times that of whites… black infants are nearly twice as likely to die before their first birthday as white infants… Black American children ages one to 14 have a 30 percent higher mortality rate… the high incidence of stroke deaths at younger ages among blacks is probably due in large measure to the increased prevalence and severity of hypertension which occurs in black Americans …” [ 6 ]
The Medical Committee for Human Rights marching with civil rights activists, c.1960s
Decades later, African Americans are being hit harder than everyone else yet again, and African American healthcare workers are now on the frontlines of a global pandemic. Founding dean and president of Morehouse School of Medicine, Dr. Louis W. Sullivan , in an April op-ed piece in the Atlanta Journal Constitution , cautioned that the COVID-19 pandemic has “ found us inadequately prepared ,” [ 7 ] especially in minority-dominated facilities where funding and resources are often scarce.
This warning holds true at Chicago’s Southside Roseland Community Hospital where the president and CEO Tim Egan reported Roseland Hospital as  “ outgunned, outmanned, underfunded, and no one is coming to help us .” [ 8 ] At the start of the pandemic, “ Roseland did not have enough temporal thermometers to handle the crush of patients. Nurses brought their own and let the hospital keep them until new ones could be purchased ,” and, after “ a kitchen employee exhibited COVID-19 symptoms, the hospital shut down its food service operation and scrambled to find meals for both patients and staff members. Local churches sent dinner after homemade dinner, while employees asked their social circles for help .” [ 9]
Dr. Louis Sullivan
Dr. Sullivan explained the racial disparities of those at higher risk of exposure and becoming infected, which is reflective of past outbreaks: “ Blacks have higher incidences of diabetes, high blood pressure and other diseases which increase their vulnerability to COVID-19 infections. Also, a higher percentage of Blacks work in lower-paying service jobs such as home care, delivery services, and other occupations where there is less opportunity for working from home. With generally lower incomes, many Blacks live in housing where it is more difficult for the social distancing recommended by public health officials .” [ 10 ]
Because health issues can present themselves differently in the African American community, which is at a higher risk of seeing an influx of cases, it is important to have healthcare workers that know the community. Former YWCA national president Alexine Jackson (1936 - ) said: “ You find in these racial ethnic communities there are some, sometimes some cultural things about who goes to see the doctor. A lot of times, it's not the women or the children. And it's around money, costs of health care, access, getting there, getting to a doctor, getting to a facility .” [ 11 ]
Dr. Augustus A. White III at the operating table  
Harvard Medical School’s Dr. Augustus A. White, III (1936 - ), further explained: “… a doctor may be a Caucasian male doctor and may be relating to a lesbian Latina woman and these are two degrees of difference of cultures. And without any insight, understanding, concern, empathy or knowledge, this doctor may express conscious or unconscious bias and may provide inferior care to that individual… these groups of people experience health disparities because in part of conscious and unconscious bias or lack of training to attend to appropriately addressing whatever differences of perspective may be existent .” [ 12 ]
Mercy Hospital School of Nursing in Philadelphia, class of 1929
Additionally, African American healthcare workers historically and at present face discrimination while attaining their educations. Delores Brisbon (1933 - ) recalled the racism she faced while becoming a nurse at the University of Pennsylvania, where she later served as director of planning and systems before being named COO: “ most often I had offensive notes left on my locker. My stockings… would just disappear. And people would make, what they thought were polite, but they were offensive comments to me… one woman said to me, you know, I've never ever met anybody black doing anything other than taking care of children in my community .” [ 13 ] Cardiologist and healthcare executive Dr. Christopher Leggett (1960 - ), who entered the healthcare field several decades after Brisbon, recalled discriminatory incidents with patients during his residency at the Johns Hopkins Hospital: “… he was on a respirator, an African American patient who had throat cancer, couldn't even talk… he was mouthing out, in his words, ‘You ain't qualified…’ what he was struggling with, which is an internal cultural pathology at times, is that: I'm used to a white doctor taking care of me and I can't conceptually get my mind around having a black doctor take care of me… and it is funny, because I had just taken care of a Jewish individual earlier that day in the intensive care unit who had said the exact opposite; he said, ‘Dr. Leggett I want you to take care of me,’ and I said, ‘Why?’ He said, ‘Because if you're here, that means you're probably three times as qualified as some of the other doctors walking around .’” [ 14 ]
Coronavirus testing site outside Roseland Community Hospital, Chicago
The current pandemic is once again highlighting disparities not only in those being infected by the disease, but also with the inequality of clinic and hospital resources. African Americans face many barriers while training for these roles, and the barriers do not end once their careers officially begin. During a time such as this, it is critically important that we understand these disparities from a historical perspective to understand that they represent not just the current situation, but centuries of horribly racist policies that have gotten us to where we are now. It will take collective and sustained action to fix after a COVID vaccine has been found and the society has returned to “normal.”
In his op-ed piece, Dr. Sullivan concluded with a call for change: “ When we examine the human and economic impacts of a public health crisis such as the COVID-19 pandemic, it is clear that there is a strong correlation…Investing in the development and maintenance of a stronger public health system for our nation – in all 50 states, our territories and tribal lands, would be the beginning of a positive, logical response to this crisis… Reducing the educational costs for students pursuing a career in the health professions will support efforts to increase the racial and ethnic diversity of our doctors, nurses, and other health professionals… The health of our population and the health of our nation’s economy will be much stronger in the future if we begin to make these investments now. The health of America’s people and America’s economic health are both needed to ensure a healthy nation .” [ 15 ]
[1] Amy Roeder. “Understanding slavery’s legacy in health and medicine,” . May 8, 2017.
[2] “The Yellow Fever Epidemic,” Historical Society of Pennsylvania
[3] Jim Downs. “Freed Slaves Battle Small Pox and Other Diseases,” . June 2013.
[4] Roeder.
[5] Hoag Levins. “Struggling to Escape Poor Health: 120 Years of Health Disparities Reports,” University of Pennsylvania Leonard Davis Institute of Health Economics eMagazine . April 2019.
[6] Ibid.
[7] Louis W. Sullivan. “Opinion: COVID-19 shows healthy economy requires a healthy nation too,” The Atlanta Journal Constitution. April 11, 2020.
[8] Stacy St Clair; Joe Mahr; Gregory Pratt. “'Outgunned, outmanned and underfunded': Inside Roseland hospital's battle against the coronavirus,” Chicago Tribune . April 19, 2020.
[9] Ibid.
[10] Ibid.
[11] Alexine Jackson (The HistoryMakers A2003.156), interviewed by Larry Crowe, July 15, 2003, The HistoryMakers Digital Archive. Session 1, tape 3, story 10, Alexine Jackson talks about her work with the Intercultural Cancer Council and the disparities in cancer rates within minority communities. 
[12] Dr. Augustus A. White, III (The HistoryMakers A2005.107), interviewed by Robert Hayden, April 21, 2005, The HistoryMakers Digital Archive. Session 1, tape 4, story 9, Dr. Augustus A. White III describes healthcare disparities.
[13] Delores Brisbon (The HistoryMakers A2005.042), interviewed by Larry Crowe, February 8, 2005, The HistoryMakers Digital Archive. Session 1, tape 3, story 2, Delores Brisbon remembers encountering racial discrimination at the Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania.
[14] Dr. Christopher Leggett (The HistoryMakers A2007.253), interviewed by Denise Gines, February 26, 2008, The HistoryMakers Digital Archive. Session 2, tape 8, story 1, Dr. Christopher Leggett recalls his experiences of discrimination at The Johns Hopkins Hospital in Baltimore, Maryland.
[15] Sullivan.
Hot Comb Newsletter Corrections
We would like to thank Kirkland Burke and Ted Manuel for offering corrections and additional insight on last week's newsletter on hot combs.

Kirkland Burke reported: Poro Company founder Annie Malone has been credited by some sources with receiving the first patent for this tool in that same year but the Official Gazette of the U.S. Patent Office does not list her as a holder of a hot comb patent in 1920. Madame C.J. Walker never claimed to have invented the hot comb, though often she has been inaccurately credited with the invention and with modifying the spacing of the teeth, there is no evidence or documentation to support that assertion. During the 1910s, Walker obtained her combs from different suppliers, including Louisa B. Cason of Cincinnati, Ohio, who eventually filed patent application 1,413,255 on February 17, 1921 for a comb Cason had developed some years earlier. The patent was granted on April 18, 1922 though Cason had been producing the combs for many years without a patent. 

Ted Manuel explained: In France, monsieur  Marcel invented not the hot comb, but the heated curling iron to curl European hair temporarily. (The permanent wave had not yet been invented). This is the more logical version of the history when you think about it: Some European hair is naturally curly, but only less than 5% of the population at most. The vast majority is straight. When curly hairstyles were wanted, what good is a hot comb good only for straightening? Only 5 women or fewer out of 100 would be candidates for such a beauty treatment, and considering that only the affluent could afford hairdressers, even that number would be insufficient to make the comb commercially viable. Marcel would have starved to death with so few clients needing their hair straightened. A hot comb would have been a mere curiosity except for the occasional wealthy curly head wanting a straight style. On the other hand, a curling iron (made by an iron worker) could be sold as a do-it-yourself item on a much broader basis, to a much broader market, giving it commercial viability. 

In the U.S., hair care pioneer Madame C.J. Walker came along soon after discovering Marcel's curling iron and, pondering how to make it work on black women's hair, devised the hot comb to first straighten it, then used Marcel's invention to curl it. Combed out, hairstyles in fashion of the moment could be created on super-curly hair as was done on naturally straight hair. Even today, the curling iron carries the name Marcel iron. The straightening hot comb is never referred to as a "Marcel comb," but merely as a "straightening comb," giving further credence to this version of the development of these utensils. The electric straightening comb became the ultimate, because it provided thermostatic control of the degree of heat used, for minimal damage to hair. 

Chemically speaking, European hair and African hair is identical. Only the configuration is different, due to the shape of the hair follicle (the growth bulb inside the scalp). The hair shaft is composed of two chemical bonds holding the molecules together: 

  1. Weak hydrogen bonds, which can be broken temporarily by heat or by water. (Maybe you've heard of "spit-curls"?) A sudden rain shower can destroy a freshly-coiffed-by-heat hairstyle in minutes. In the 1960's, string-straight hair was popular among white teen females,and was achieved by literally ironing it straight with a flatiron on an ironing board, assuming the hair was long enough to make this approach workable. (Where there's a will, there's a way.)
  2. Strong polypeptide bonds which can be broken permanently using chemicals found in permanent wave solution (active ingredient: ammonium thioglycolate) and in hair relaxers (active ingredient: most commonly sodium hydroxide or natrium hydroxide). Chemically breaking the polypeptide bonds inside the hair shaft makes the change impervious to reversion to its natural configuration by water or humidity; hence the descriptor "permanent," or "perm" for short, be it permanent wave or permanent relaxer. As an aside, in the development of permanent waves, the early versions required that the permanent wave solution applied to the hair had to be activated by heat from an electric permanent-wave machine. Later formulas needed no heat; chemical reaction alone worked. Which is why they were called "cold" waves for many years, to underscore their refinement compared to the more primitive machine-made "hot" curls. 

It may require more research to validate this version of history vs. the one in your online post, but on the face of it, it makes more practical sense than your version, as detailed above; but is offered subject to superior contrary evidence. It is unfortunate that so little documentation prevailed in those days, especially in the black community, to pinpoint what happened when. 

As an aside, I understand that recently a telemovie has been produced of the life of Madame C.J. Walker, reputed to have been America's first black female millionaire, back when a dollar was a dollar. The Walker family continued selling hair care products under the founder's name, from headquarters in Indianapolis.  
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