Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Committee Chair

Hines-Martin, Vicki


African Americans--Medical care--History--19th century; African Americans--Medical care--History--20th century; Health services accessibility--United States--History--19th century; Health services accessibility--United States--History--20th century


It is well documented that inequality in the delivery of health care exists within the U.S. (Smedley, Stith & Nelson, 2003; Trivedi, Zaslavsky, Schneider, & Ayanian, 2006). Historically, our health care system was a segregated one in which white Americans enjoyed one system of health care—a more privileged one-- while black Americans experienced another, supported by law and custom. Laws changed after the Civil Rights Act of 1964 but disparate practices lingered. Although there have been studies about the historical picture of segregated health care available to black Americans (Byrd & Clayton, 2000; Savitt, 2007), there is a lack of research about the evolution of that health care system to its current state as a more fully integrated one. The purpose of this study was to examine the evolution of health care for the black community of Louisville, Kentucky, a mid-size city of approximately 800,000 citizens situated along the Ohio River which historically served as a gateway to the south. The study aims were to describe 1) health care delivery over time, 2) attitude assumptions, perceptions and experiences of health care providers, 3) activities that influenced health care integration and 4) the quality of health care for black Louisvillians pre- and post- integration. An historical research method guided by Critical Race Theory was used to describe the perspective of those who were marginalized within this society. Archival material and oral histories framed by secondary literature on this topic served as data. Study findings confirm the presence of overt stereotypes and bias that perpetuated the segregated health care system historically. Motivation for change stemmed more from the white health care providers’ gain than from an internal change perspective regarding the Black citizens’ right to comparable care within an integrated system. However, the overt stereotypes that had been easily identified in archival records prior to integration became less visible after integration of the health care system. Even as overt discrimination declined, study findings also indicate that disparate treatment and caregiver bias remained throughout the time period explored in this study.