Downstream effects of segregation sustain poor health in the American South

A medical professor in Mississippi investigates a little-known Southern Governors’ plan that helps explain the shortage of black physicians

Health in the rural South is the worst in the nation, but there are often no doctors in the communities that need them most. And while patients are predominantly black, black doctors are few and far between.

Richard deShazo, MDThere is an acute shortage of African American physicians in the United States, especially in the southern states. And these physicians are highly sought after because they choose primary care and practice in rural areas more often than do white physicians.

While there are many reasons for this shortage, at the core is the racism that was so pervasive in the professions, including medicine, a half century ago.

Much of what occurred — especially with medical education — was concealed and appears to remain hidden in the footnotes of a few historical volumes.

But the memories linger, and they continue to haunt the South.

Black and white physicians still have separate medical associations in states like Mississippi.

And southern medical schools struggle to recruit minority students with limited knowledge of the residual hurt experienced by black physicians in an era of injustice that roared to a crescendo in the 1960s.

The Southern Governors' plan

One arrangement from that period continues to affect the South, and a medical professor there is is trying to set the record straight.

As Professor of Medicine and Pediatrics at the University of Mississippi Medical Center (UMMC), Dr. Richard deShazo leads a variety of initiatives to promote public health and racial conciliation in his state.

He grew up in Birmingham, Alabama, attending segregated public schools at a time when black people were required to drink from separate water fountains and sit at the back of the bus. As a college student in the mid-1960s, he was fired from his job as a church youth director because he suggested opening the group to "negroes," as African Americans were then called.

"I grew up in the civil rights era and was influenced by it in many ways," he said, in an interview for Elsevier Connect.

While he was well aware of the racism and the Jim Crow laws that pervaded life in the Deep South, there was one story he – and many in his generation – knew nothing about. Until recently.

In 1945, a wave of African Americans returned from service in World War II, some having attended black colleges before their military service. Now they could complete their education using the tuition support of the GI Bill.

Many southerners were horrified at the prospect of those negroes integrating all-white state colleges and universities, especially the professional schools. In the case of medical schools, the governors of 16 southern and border states came up with a carefully-crafted plan to shunt African American medical school applicants away from their segregated state schools to historically black medical colleges, thus protecting the status quo.

"Qualified black pre-medical students were mailed off," Dr. deShazo said. "They were given scholarships by southern states to attend one of the two traditionally black medical schools."

For efficiency's sake, the 16 governors who were members of the Southern Governor's Conference centralized the operation of scholarship programs for black medical school applicants. They forged agreements with Meharry Medical College in Nashville, Tennessee, and Howard University in Washington, DC, to reserve seats in their medical and health professions schools for black students sponsored by the Southern Governors' Conference. These scholarships were granted through the Southern Regional Education Board (SREB).

The Meharry Medical Campus, circa 1933. The building on the left is Hulda Lyttle Hall. The first entrance of the building on the right leads to the dispensary. The second entrance on the right opens into the old George W. Hubbard Hospital, named after Meharry's first President. These buildings still stand on Dr. DB Todd Jr. Blvd. in Nashville, Tennessee. (Source: Richard deSHazo, American Journal of Medicine)"Those schools were glad to accept these bright students because they needed the money," Dr. deShazo said. "They were underfinanced and, in the case of Meharry, about to close. This revenue stream kept them afloat."

Meharry's predominantly white leadership took the arrangement a step further. As the college was on the brink of financial ruin, they offered to transfer all property and endowment to the Southern Governor's Conference itself. News of that offer was leaked to The New York Times, which ran a story on January 19, 1948 with the headline, "Medical College Offered to the South."

This story is the subject of an article that was published last summer in the American Journal of Medicine, titled "Crooked Path Made Straight: The Rise and Fall of the Southern Governors' Plan for the Education of Black Physicians."

Two years of detective work

The article is based on two years of detective work and investigative reporting by Dr. deShazo, the lead author, and his co-authors: Dr. Keydron K. Guinn, acting Executive Director of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College; Dr. Wayne J. Riley, former President of Meharry Medical College, and William Winter, former Mississippi governor and SREB member and an attorney for Jones Walker Law Firm in Jackson, Mississippi.

Keydron K. Guinn, PhDWilliam Winter, JDWayne J. Riley, PhDDr. deShazo has written a set of companion pieces for the Journal of the Mississippi State Medical Association, of which he is an associate editor.

At Meharry, the proposal to turn over the college to the Southern Governors infuriated many alumni and faculty. As the authors of the AJM paper reported, the college administration received a telegram from alumni who had graduated as far back as 1922 stating that "the soul of one-half the Negro medical profession" had been sacrificed at the "altar of white supremacy." They suggested that the southern states "build their own Jim Crow institutions, but let Meharry be free of political entanglements."

The public criticism blocked the transfer of the real estate and endowment, but the tuition arrangement went through. And despite further laws banning "separate but equal" policies in education, the arrangement continued well into the 1970s when federal agencies forced admission of blacks into state medical schools, the authors reported in AJM.

'The story has not been told ...'

"The story really hasn't been told – most of the information has been lost in chapters of a few out-of-print and rarely read books," Dr. deShazo said. "It's just as startling and informative, I think, as some of the other segregation-era stories that have received national attention. It reflects the fact that discrimination reached into the professions during this period, and there were some people who stood up and tried to do the right thing."

Mississippi Black Physician Southern Regional Educational Board Scholarship recipients: (left to right) James Anderson, MD; Aaron Shirley, MD; Robert Smith, MD; and Helen Barnes, MD One of those people was Dr. Robert Smith, an African American physician Dr. deShazo met while helping to produce documentaries on southern health issues. Dr. Smith had attended Tougaloo College in Jackson, Mississippi, a Baptist college founded after the Civil War to educate black students, who were not allowed into state schools. He then graduated from Howard University medical school on a SREB scholarship.

He went on to play a key role in the Civil Rights movement. In 1964, he used his connections to rally his fellow physicians to volunteer during Freedom Summer, when thousands of civil rights activists converged on Mississippi to register black citizens to vote and to create schools and health clinics.

Dr. Smith and two of his Mississippi colleagues, Dr. James Anderson and Dr. Aaron Shirley, worked with the newly formed Medical Committee for Human Rights to recruit hundreds of medical professionals from New England and elsewhere to provide emergency aid for civil rights activists who were being threatened, jailed and in some cases, assaulted. Their services were crucial as many local physicians would not to treat the activists for fear of retribution from the Ku Klux Klan, White Citizens Councils and others.

He also joined in picketing the American Medical Association in efforts to obtain membership for African American physicians who were excluded.

Dr. deShazo refers to these doctors as "heroes." Their story is told in a book called The Good Doctors by John Dittmer, published in 2010 by Bloomsbury Press.

It was from Drs. Smith and Shirley, both SREB scholarship recipients, that Dr. deShazo first learned of scholarship programs for black medical school applicants.

But the story has yet to end. Even though the University of Mississippi Medical Center has been an advocate of civil rights — and was recently recognized by the Liaison Committee on Medical Education (LCME) for their use of holistic admission policies to increase numbers of minority students in its educational programs — the history they were a part of continues to challenge minority recruitment.

"We've had trouble getting the brightest African Americans to stay here for medical school because they are highly sought after by medical schools outside of the South and given considerable financial enticements to attend those institutions," he explained.

Meanwhile, those who do go to medical school in Mississippi are often recruited into post-graduate training and subsequently to faculty positions elsewhere.

"The memories of past injustices are still very much in the minds of our older physicians," he said. "And the younger black students and physicians hear their stories and are aware of the things that happened.

"But we've changed in Mississippi. It is a very different place. And we want these doctors and those we recruit from elsewhere to stay in Mississippi and help us care for the large number of minority and underserved patients with major health issues."

Seeking reconciliation

In Mississippi, 75 percent of people are overweight, the rate of heart disease is among the highest in the country, and 30 percent of the population will be diabetic by 2030, according to a 2012 report by the Trust for America's Health.

"We have an epidemic of bad health, and we need as much help as we can get – and we don't care what color people are – now. But that's not what they hear about and what burdens us," Dr. deShazo said. "So we're trying to follow the Mandela model — that is, to openly acknowledge the mistakes that occurred, apologize and move forward.

"That's what this (AJM) article is about — an effort to reach reconciliation among black and white physicians as a model for all Mississippians."

Walter Lear, MD, Robert Smith, MD, and JS "Mike" Holloman, MD, picket the AMA meeting in Atlantic City, New Jersey, in 1963. (Photo from the Journal of the Mississippi State Medical Association) Efforts by the University of Mississippi Medical Center are working. For example, five years ago, Netscape founder and Mississippi native Jim Barksdale donated 12 full scholarships worth $12 million for medical students who agree to reside and practice in Mississippi for five years — an attractive option for many of the state's African American medical school applicants.

"Thanks to our scholarship programs, we're now recruiting more than the national average of minority students into our freshman classes," Dr. deShazo said. "We would like to have even more."

The AMA has long since apologized for their role in condoning the exclusion of black physicians from regional medical societies during this period, an action that Dr. Smith and others protested after the murder of Mississippi NAACP director Medgar Evers in 1964. But distrust remains between black and white physicians.

Dr. deShazo pointed out that black and white physicians, for the most part, still remain members of their respective medical organizations – the state affiliates of the National Medical Association (NMA) and American Medical Association (AMA).

"One of the things we hope to do is to stimulate a dialogue between black and white physicians because we need the black physicians to help us recruit new black physicians to come and work in our state," Dr. deShazo said. "We're desperate for physicians, in particular African American and other minority physicians, because they are willing to practice in rural areas. We have counties in Mississippi that have no doctors. None – not one.

"To get physicians to come to Mississippi and make them feel welcome, we must reconcile among ourselves," he said.

To this end, Dr. deShazo recently co-authored an article in the July 2013 issue of the Journal of the Mississippi State Medical Association with journal editor and chair of the Mississippi State Board of Health, Lucius "Luke" Lampton, MD, titled, "The Educational Struggles of African-American Physicians in Mississippi: Finding a Path Toward Reconciliation." The article reviews details of past injustices toward black physicians at the state level and calls for the state medical association to establish a permanent working group on race relations among black and white physicians.

Like many who witnessed the injustices of the Civil Rights era in the South, Dr. deShazo has his own regrets.

'I saw the injustice and knew it was wrong …'

"I saw the injustice of racism as a teenager and a college student, and I knew it was wrong. But it was the social order and in many cases, the law. People who tried to stand up to it lived in fear.

"I've always felt sorry about not being more involved in civil rights when I was a college student. We were told that if we got involved in demonstrations and activities, we would be expelled. The college was afraid it would lose financial support from the community. … So many of us were intimidated."

Over the years, like many southerners in his generation, he found opportunities to speak out against discrimination. For example, after he returned from a 9-year stint at the Walter Reed Military Medical Center as part of service during the Vietnam War, he played a major role in establishing clinical and research programs for gay men in what came to be the Tulane–Louisiana State University AIDs Clinical Trial Center in New Orleans.

Now, Dr. deShazo is continuing his efforts to raise awareness of African American health issues historically and today. His articles for the state medical journal also include those on antebellum health care for slaves and post-war health care black tenant farmers in Mississippi ("It was better for slaves."); development of the Federally Qualified Health movement, which started in Mississippi in the 1960s; and the history of medical education for black physicians in the South.

At his university, he also hosts and is a producer of a documentary television series on Mississippi Public Broadcasting called Southern Remedy, which addresses statewide health issues such as teen pregnancy, obesity and drug abuse.

With his colleagues at UMMC, he has also developed a statewide Community Health Advocate Training Program, which trains health screeners through churches throughout the state. The program is supported by UMMC Dean/Vice Chancellor James Keeton, MD, and Bishop James E. Swanson Sr . of United Methodist Church in Jackson.

Mississippi is in the midst of commemorating the 50th anniversary of the assassination of Medgar Evers, who tried to address many of the issues still operative in the Deep South. Dr. deShazo said he likes to think Evers would be proud and supportive of the activities on racial reconciliation his medical center supports.


Read the article in the American Journal of Medicine

This article is freely available on the American Journal of Medicine website.


Elsevier Connect Author

Alison Bert, DMAAlison Bert (@AlisonBert) is Editor-in-Chief of Elsevier Connect. She joined Elsevier five years ago from the world of journalism, where she was a business reporter and blogger for The Journal News, a Gannett daily newspaper in New York. In the previous century, she was a classical guitarist on the music faculty of Syracuse University. She holds a doctorate in music from the University of Arizona, was a Fulbright scholar in Spain and performed in the 1986 international master class of Andrés Segovia.

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