We'll fight it out here: A history of the ongoing struggle for health equityBy DavidChanoff and Louis W.Sullivan, Baltimore, MD: Johns Hopkins University Press. 2022. pp. 272. $30 (Hardcover). ISBN: 978‐14214‐4464‐2

Amid the recent COVID-19 pandemic, grassroots activists, health professionals, and scholars have increasingly drawn attention to ongoing racial health disparities in the United States. Authors David Chanoff and former Secretary of Health and Human Services (HHS) Louis Sullivan's book, We'll Fight It Out Here: A History of the Ongoing Struggle for Health Equity, brings to light the untold story of the Association of Minority Health Professions Schools (AMHPS) and its continuous efforts to enhance minority health care in the United States during the post-civil rights era. In a time of conservative political backlash against 1960s liberalism, AMHPS adeptly navigated the challenges posed by an era of austerity to quietly pass legislation that secured funding for the nation's historically Black (later expanded to minority) health professions schools, dedicated to the “social mission” of training underrepresented minorities in the health professions. Established in 1983, the organization eventually encompassed institutions such as Howard University College of Medicine, Morehouse College School of Medicine, and the Charles R. Drew University of Medicine and Sciences. We'll Fight It Out Here extends beyond narrating AMPHS's triumph during challenging times; it strives to place the organization's political endeavors within the broader context of marginalized Black healthcare history in the United States. Chanoff and Sullivan laid the foundation for AMPHS's story by examining this history. Combining elements of memoir and political history, the book traces AMPHS's ascent as it effectively lobbied for a renewed federal commitment to Black health. In its concluding chapters, the authors reflect on both the accomplishments and shortcomings of AMPHS and the prolonged journey toward achieving racial health equity. The title of the book is drawn from a speech delivered by the 19th-century Black physician, James McCune Smith (1813–1865). Chapter 1 delves into a crucial debate between Smith and Martin R. Delaney (1812–1885), both prominent medical figures. Smith, an alumnus of the University of Glasgow at Edinburgh, is widely acknowledged as the first credentialed Black American physician. Delaney, the highest-ranking Black military officer in the American Civil War and an abolitionist from Pittsburgh, Pennsylvania, practiced medicine informally and was briefly enrolled in Harvard Medical School. In 1850, as the Federal Fugitive Slave Law was enacted, these two medical and political leaders debated strategies for achieving Black freedom. Through the introduction of these historical figures, the authors not only explore the enduring tradition of political activism among Black medical leaders but also shed light on the structural barriers that marginalized and excluded these individuals from the medical field. The first chapter of the book employs historian Rayford Logan's concept of the “nadir” to describe the exclusion of Black Americans from American health institutions and the exclusion of Black physicians from organized medicine. Chapter 2 outlines how Black Americans, religious organizations, and philanthropic groups contributed to the establishment of historically Black medical schools like Howard University and Meharry Medical College. While collaborative efforts led to the creation of 14 Black medical schools (out of 148 across the United States), the consequences of the Carnegie Foundation-funded 1910 Flexner report, titled Report on Medical Education in the United States and Canada,4 along with the adoption of the biomedical model of medical education, resulted in school closures, especially affecting the small institutional network of Black medical education. Howard and Meharry, the last of the Black medical schools in the mid-20th century, largely trained the bulk of Black health professionals. The authors conclude this section with the formation of the National Medical Association (NMA), a professional organization created in response to the racially exclusive American Medical Association (AMA). These initial chapters of We'll Fight It Out Here present a concise and even-handed historical account of Black Americans' engagement with the medical profession during the 19th and early 20th centuries. Transitioning from the complexities of the medical color line, the book then jumps to the 1970s post-civil rights era. The narrative truly comes to life in Chapter 4, where Chanoff and Sullivan vividly describe the founding of AMPHS and its emerging legislative strategy. This chapter marks a notable shift from a conventional study in the history of medicine to contemporary political history. The authors highlight how the 1963 Health Professions Educational Assistance Act paved the way for federal and state funding that fueled a surge in institutional expansion in medical education during the 1970s. Morehouse College, a historically Black college, benefited from this program by establishing the Morehouse College of Medicine in 1975. Louis Sullivan, as the school's founding dean, brought together leaders from the network of Black health professions schools, ultimately forming AMPHS to secure additional funding and federal support. Sullivan believed that since the fleeting Freedmen's Bureau hospitals in the aftermath of the Civil War, the federal government had not sufficiently prioritized Black health. AMPHS aimed to address this oversight more than a century later through collaboration with supportive members of Congress. One of AMPHS's crucial allies was the Congressional Black Caucus (CBC), whose ascent coincided with AMPHS's efforts. The increased representation of Black individuals in Congress was a direct outcome of the 1965 Voting Rights Act and amplified political involvement in the southern United States. Among the organization's most steadfast advocates was Congressman Louis Stokes (1925–2015), the first Black elected congressional representative from Ohio. Stokes played a pivotal role in AMPHS's achievements, to the extent that the book is dedicated to his memory. AMPHS also skillfully capitalized on shifting national politics. By highlighting the geographical distribution of the schools, primarily concentrated in southern states, AMPHS created opportunities for former segregationists to rehabilitate their legislative careers. Operating within the realm of conservative politics and economic austerity, this coalition harnessed collective power to scrutinize Black health disparities during the 1980s. This endeavor culminated in the creation of the 1983 Hanft report, titled Blacks and the Health Professions in the ‘80s: A National Crisis and a Time for Action.5 This report, as seen from Sullivan's perspective, was a groundbreaking and profoundly impactful document that was “the first time anyone had ever brought together the facts about the extreme nationwide shortage of Black health professionals as it related to the dire health of the Black population. The report opened a new avenue of thinking about disparities in health care, research on Black health, and potential legislative cures for the injustices and inequities that had plagued Blacks” (p. 68). The AMPHS-sponsored report formed the basis for then-Reagan administration HSS Secretary Margaret Heckeler to issue a Report of the Secretary's Task Force on Black and Minority Health in 1985.6 Together, these documents were a “transformative force” in reshaping the relationship between the federal government and minority health. With strong support from their respective state delegations and the CBC, AMPHS rallied support for legislative measures that established a new pipeline to train Black health professionals and biomedical researchers. Key legislation included the Blakeley Act (1978) and the Excellence in Minority Health Education and Care Act (1987), both of which provided federal funding to a growing number of minority health professions schools. Additional legislative efforts focused on enhancing faculty quality, increasing scientific research capabilities, and fostering the recruitment of underrepresented students into the health professions. Sullivan and Chanoff's work in We'll Fight It Out Here also makes a significant contribution to the historical understanding of the institutionalization of “minority health” as a field of study and practice over the 19th and 20th centuries. The book demonstrates that AMPHS's impact extended beyond the realm of federal funding. The organization boldly challenged the institutional culture of the National Institutes of Health (NIH), which initially resisted AMPHS's initiatives to improve funding and research opportunities for minorities. Sullivan's trajectory from an external advocate to his role as George H. W. Bush's HHS Secretary allowed him to embed minority health within the federal government. This eventually led to the establishment of an Office of Minority Health and Health Disparities, evolving in 2010 into the National Institute on Minority Health and Health Disparities. The legislative successes of AMPHS in the 1980s marked a historic turning point. For the first time since the Reconstruction era, the US government acknowledged, to some extent, its responsibility for the health of minority citizens. Thanks to the efforts of AMPHS, the minority health bills allocated funding to health professions schools, facilitated the training of a new generation of practitioners, and paved the way for federally funded scientific research on minority communities by minority practitioners. These initial endeavors spearheaded by historically Black health professions schools also paved the way for funding and training opportunities for other underrepresented populations in the United States, including Hispanic, Indigenous, and rural white students. While the book contemplates the future of minority health care and the challenges that persist, it underscores that the struggle for health equity is far from over. Despite the considerable achievements of Sullivan and AMPHS, the new Institute of Minority Health (established in 2010) remains inadequately prioritized within the NIH budget. It comprises merely 1% of NIH's total funding and ranks second to last of all institutes. This issue is further exacerbated by the evolution of the minority health field in the COVID era. Increased funding for minority health in the aftermath of COVID-19 has drawn what a recent article termed “health equity tourists” to the field.7 Increased competition for research dollars, even in the minority health fields, threatens to replicate patterns of marginalization and exclusion. Recent developments, such as the stagnation in the number of Black medical graduates and alarming statistics on Black maternal health, underscore the ongoing urgency for progress. We'll Fight It Out Here resonates with the current political landscape, serving as a rallying cry to continue the fight for health equity within an ever-evolving world. The book's account of AMPHS provides a valuable example of how political pragmatism and strategic legislating that can help inspire contemporary health reformers and activists. While We'll Fight It Out Here makes several substantial contributions to the study of racial health inequities, some aspects of the history presented could be further developed and explored. The book's focus on the training of health professionals, while undeniably successful, might benefit from a broader context that encompasses other dimensions of health equity, especially the social, structural, and political determinants of health. Furthermore, the authors did not explore AMPHS's connections with the medical civil rights movement of the 1950s and 1960s, particularly the political activism of earlier generations of Black physicians like W. Montague Cobb, who spearheaded the “Integration Battlefront” in hospitals. Additionally, the book could have engaged with the influence of a grassroots-led health rights movement during the 1970s. The narrative surrounding AMPHS may take on a different hue when contextualized within the intricate tapestry of various concurrent efforts to attain health parity. Lastly, it is noteworthy that the historical account tends to be male-centric; a more comprehensive perspective could have been achieved through greater attention to the contributions of female figures such as 19th-century physician Rebecca Crumpler and registered nurses. Despite these points of critique, We'll Fight It Out Here is a pertinent and valuable exploration of the often-overlooked endeavors to address racial health disparities in the United States. The collaboration between Sullivan and Chanoff enriches the narrative by infusing it with Sullivan's firsthand accounts and insights as a historical participant. The book captivates readers by weaving together political history and memoir, interspersed with interviews and reflections from those closely associated with AMPHS to paint a vivid picture of a critical historical period. The narrative effectively conveys tension and excitement, employing clear and accessible language. By presenting an alternative perspective to the prevailing narrative of the 1970s and 1980s, Chanoff and Sullivan provide an illustrative example of how determination, political acumen, and strategic action can drive meaningful change even in the most challenging political climate, a valuable lesson that holds relevance for present-day healthcare reformers. Ultimately, We'll Fight It Out Here is a compelling and enlightening read that unearths a pivotal piece of history—AMPHS's struggle for health equity in the United States.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.