Mapping Care Project: The History of Black Nurses in Chicago

Access to Quality Healthcare: The Jim Crow Years (1870’s-1960’s)

In the early twentieth century, disease and death was increasing among Black Americans at an alarming rate compared to their white counterparts. The federal government had created hospitals to treat Black Americans after the Civil War, but many of those had disappeared by 1877 due to lack of funding and government support and an end to the Reconstruction Era of U.S. history. Black people living in the rural South lived far from most medical care. Black Americans seeking new opportunities in northern cities like Chicago found themselves living in crowded, segregated communities where disease spread quickly.  Black patients often could not be admitted to public hospitals or were sent to segregated wards. Most hospitals refused to train Black nurses or doctors, yet many white healthcare workers refused to care for Black patients. When they could get hospital treatment, Black people were often treated by racist white medical staff, creating deep distrust in the Black community regarding the healthcare system.

Black physicians, nurses, their communities, and their white allies responded by creating a network of Black hospitals and nurse training schools, including Provident Hospital on the southside of Chicago. Black nurses often did most of the day-to-day labor of caring for patients at these hospitals. Provident accepted all patients, regardless of their race or their ability to pay for services, meaning that it was the only option for many Black Chicagoans. Even middle class Black Chicagoans went to Provident, because they appreciated receiving treatment from healthcare staff who treated them with respect and understood their racial and cultural background. Black nurses also provided healthcare access within Black communities as part of public health agencies. Public health nurses visited people who could not get to hospitals and provided health education that was sensitive to the specific needs of members of the Black community. Learn more about the history of Black nurses’ public health work here.

The passage of Medicare and Medicaid in 1965, in the midst of the Civil Rights movement, dramatically changed access to healthcare for Black Americans. Civil Rights activists, including members of the National Association for Colored Graduate Nurses, had pushed for years to eliminate Jim Crow laws. In 1964, President Johnson and Congress passed the Civil Rights Act, which prohibited discrimination in employment, public places, and federally funded programs. This meant that when the federal government created the Medicare and Medicaid programs the following year, any hospital that discriminated based on race would not receive reimbursement for treating patients with Medicare or Medicaid. The Office of Equal Health Opportunity recruited thousands of volunteers, including government employees and Civil Rights organizers, who traveled to hospitals all over the country to ensure they followed anti-discrimination laws and eligible for federal funds. Due to their efforts, a thousand hospitals integrated in less than four months.1

While a huge victory for Americans, integration of hospitals led to a sharp decline in funding and patient visits at historically Black-run hospitals like Provident. Middle-class Black patients and staff moved to better-funded white hospitals, but white patients and doctors did not choose Black hospitals. Thus as many traditional Black healthcare institutions lost resources and even began to close their doors, the fight for access to healthcare would take a different form.

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