Michael Byrd and Linda A. Clayton

New York,
NY, Routledge 2000; 588 pp.

Review by
John Price

Why are Black folks
in such poor health? An American Health Dilemma examines this oft-ignored
question by probing deeply 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 in plain language 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. Instead, Black health
disparity resides deeply in the roots of age-old Western conceptions of race,
and in the structural core of American racism.

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

This 588
meticulously documented volume traces race and the historical development of
medicine from antiquity to the modern era. An American Health Dilemma
paints a detailed picture of Western medicine’s “morbid preoccupation with human

Volume 1 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 of the volume 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historical references to the cherished works of Ivan Van Sertima, Cheik Anta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.

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.

Indeed, 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