Why Hospital Desegregation Did Little to Close the Black-White Infant Mortality Rate Gap

A new study by scholars at Yale University, the Univesity of Colorado at Denver, and Montana State University finds that the federal government’s extensive efforts to desegregate hospitals in the American South in the 1960s did not significantly contribute to improvements in the Black infant mortality rate.

Prior to the signing of the Civil Rights Act of 1964, most hospitals in the South remained segregated by race, and many hospitals that treated both Black and White Americans assigned inferior facilities to Blacks. While the act broadly outlawed discrimination based on race, many hospitals did not immediately comply. In 1966, the creation of Medicare promised significant new federal spending on healthcare, and the Johnson Administration decreed that hospitals that failed to desegregate in compliance with the Civil Rights Act would not be eligible to receive such funds. Hospitals would have to be certified by the Office of Equal Health Opportunity before they could receive Medicare payments. OEHO inspectors fanned out across the country, and most hospitals came into compliance.

Researchers examined county-level data that enabled them to calculate when patients in a given county gained access to a Medicare-eligible hospital and to look at corresponding changes in the Black infant mortality rate in that area. They found that it is unlikely that hospital desegregation reduced the Black infant mortality rate or helped close the racial gap in the infant mortality rate.

In explaining why hospital desegregation did not help close the racial gap, the authors explain that the OEHO investigators who initially certified hospitals as being compliant with the Civil Rights Act looked primarily at whether patients were assigned to hospital rooms, wards, and caregivers “without regard to race, color, or national origin.” The inspectors did not consider the structural barriers and cultural biases that prevented Black patients from receiving quality care.

The full study, “The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap,” is a working paper of the National Bureau of Economic Research. It may be accessed here.

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