The City That Care Forgot: Apartheid Health Care, Racial Health Disparity, and Black Health Activism in New Orleans, 1718-2018

Abstract

This work examines the apartheid health care system in New Orleans from the city's founding in 1718 through the present, addressing several research questions. What factors led to the development and perpetuation of the apartheid health care system in New Orleans? What are the connections between apartheid health care and the larger system of racist hierarchy? How has apartheid health care impacted the health of Black residents? How have Black New Orleanians fought against this system and for improved health?

This work main's arguments can be summarized as follows. First, apartheid health care emerged as a key component of the slave-based economy, became institutionalized with the end of Reconstruction and the rise of Jim Crow, and helped support the system of segregation in the Crescent City; sadly, an apartheid health care system still exists today. Second, the medical system served white interests in ways that financially benefitted members of the medical community and both accommodated and supported the prevailing economic system and racist hierarchy from slavery, to Jim Crow, to the post WW-II liberal order of de jure segregation, and into the post-Katrina world of ascendant liberalism. Third, government policies at the local, state, and federal level helped the apartheid health care system grow and sustain. Fourth, within these shifting institutional and power structures, Black New Orleanians fought for access to health care and improved health, including carving out their own health care system, but always had to confront the limits imposed by the racist hierarchy.

Ultimately, this work posits that the apartheid health care system's survival was not inevitable. Although many factors facilitated its rise and perpetuation, there were crucial turning points when the apartheid health care system could have ended. These moments occurred in the late 1860s and 70s, the late 1960s and70s, and post-Katrina, when opportunities existed to dismantle, not expand, the apartheid health care system in New Orleans. These opportunities evaporated, but only because individual actors chose to maintain the apartheid health care system.