Academic journal article The Journal of Southern History

The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960

Academic journal article The Journal of Southern History

The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960

Article excerpt

THE HOSPITAL SURVEY AND CONSTRUCTION ACT--COMMONLY KNOWN as the Hill-Burton Act or simply Hill-Burton in recognition of its Senate sponsors, Lister Hill (D-Ala.) and Harold H. Burton (R-Ohio)--was debated in Congress and passed into law in 1946 at the height of the South's paradoxical status as the nation's neediest yet most politically powerful region. From 1947 to 1971 Hill-Burton underwrote the creation of a modern health care infrastructure with $3.7 billion in federal funding and $9.1 billion in matches from state and local governments. Space for nearly a half million beds was constructed in 10,748 projects, including nursing homes, mental health and other specialized facilities, and public health centers as well as hospitals. Edward H. Beardsley's seminal 1987 study of southern health care, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South, contains the most nuanced and detailed historical analysis to date of Hill-Burton's impact on the South, where half the facilities were built. While recognizing that most participating southern hospitals remained closed to black physicians, Beardsley asserts that with the help of Hill-Burton projects "Southerners of both races, but blacks particularly, began to enjoy an access to modern hospital care that they had never known before." (1)

Most scholars since Beardsley have focused on Hill-Button's separate-but-equal clause and the program's failure to completely end racial discrimination in southern hospitals. This body of work at times views Hill-Burton in a deterministic light, with some scholars essentially sharing the view of integrationist medical activists that eliminating segregation in health care was a "magic bullet" that would end racial health disparities. This article posits a "long civil rights movement" in health care by surveying and elaborating on the historiography of Hill-Burton in the South and considering multiple factors that contributed to the expansion of hospital care for blacks and whites, particularly in underserved rural areas. The essay focuses mainly on the fifteen-year period from 1939, when hospital construction was first debated in Congress as part of proposals to establish a national health plan, to 1954, when the Supreme Court in Brown v. Board of Education of Topeka declared segregation unconstitutional and inherently unequal in public elementary and secondary education. Finally, this article uses North Carolina as a case study to evaluate Hill-Burton's record in improving blacks' access to hospital care during the two decades before full compliance with integration was made a condition of federal aid in all health care programs as a result of the Supreme Court's 1963 Simkins v. Cone decision, the Civil Rights Act of 1964, and the Medicare and Medicaid legislation of 1965. (2)

Hill-Burton contributed to a series of major transitions in the life of the South and the nation. Scholars commonly cite the Fair Labor Standards Act of 1938 as the New Deal's end point, but Hill-Burton was the last and perhaps the most progressive expression of redistributive New Deal liberalism. Lawrence J. Clark, a health administrator and policy analyst, and his coauthors judged the act to be "one of the most ambitious efforts for the development of social capital to that time." Hill-Burton was the first federal program to incorporate a graduated, need-based allocation formula that favored the South, paving the way for federal sponsorship of health, education, and welfare as well as costly new infrastructure that made Sun Belt prosperity possible while allowing southern states to maintain low taxes. As an outgrowth of Florida Democratic senator Claude D. Pepper's Subcommittee on Wartime Health and Education, Hill-Burton was among the first and most successful examples of a new postwar brand of federal reform that garnered bipartisan support by blending centralized planning, economic development, and a rationale for domestic spending based on national defense. …

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