The Covid-19 pandemic laid bare the problems with the South’s fragmented, patchwork health care system. Nine out of 10 people in the United States who fall into the “coverage gap” live in the South. The region leads the country in high rates of chronic disease and each year we see more and more hospitals shuttering across the rural South.

This week, on the Reckon Interview, we’re examining the roots of the South’s broken health care system and the work being done to improve it. Dr. Andrea Patterson is an expert on the history of health care in the South. She explains how academics in the 18th and 19th centuries created a biological justification for denying health care to Black Southerners that still haunts us today. And Olivia Paschal, a reporter with Facing South, describes what the fight to expand health coverage looks like today.

Here are a few excerpts from our conversation with Dr. Andrea Patterson to get you started. We’ll be back tomorrow with more from our discussion with Olivia Paschal, but you can listen to the whole episode here.

And go ahead and subscribe on Apple Podcasts, Spotify, Acast or wherever else you get your podcasts to stay informed about the South this election season.

Dr. Andrea Patterson on how the South’s broken health care system is rooted in racism

In January of this year, this was before the pandemic, we had 2.3 million Americans falling into the so-called “coverage gap.” They are not eligible for Medicare, but they still don’t have the funds to buy into health insurance. Now, 92% of these [people in the gap] are in the South. So nine out of 10 people who are not eligible reside in the South, and that affects in huge disproportionality, people of color.

Another fact is that in the South, we have the largest population of color today — 42% as compared to 35% in the rest of the nation — and 20% of the population is Black.

And I think it is impossible to argue about the reluctance to extend health care and the eagerness to opt out of the ACA and to refuse extending Medicare so prominent in the South, [and to not] see that there is not a connection to race. [There is] a long-standing thought process in place that is just looking at racial health disparities as something that should not be addressed to the fullest extent.

And in order to really understand why there is such an unwillingness or why there is such acceptance of this racial health disparity without any follow up action to address it, we have to go back in history. We have to kind of look at it in a historic context.

In the 18th and 19th centuries, biologists, academics, medical doctors, scholars, very renowned individuals, the elite of the intelligence and academia, created a conception of race that manifested itself biologically. In other words, all racial differences were explained as the cause of biological causes. The excessive morbidity and mortality among Black people, were because [people back then] would say they are “biologically inferior.” And in the context of the late 19th, early 20th century, we have the social Darwinist ideology, we have eugenics.

There was actually an argument made that it would be harmful to extend public health to Black people. Because that would, in the words of the leaders in health care and public health at that time, would “work against nature.” It would actually prolong what is inevitable, which is the extinction of the unfit races. Eugenicists, of course, went even further and thought “we can hasten this along and actually accelerate it” through involuntary sterilization. We have this really ugly history, particularly in the South where the majority of people of color resided at that time of consciously and very deliberately, not including Black people in health care for these reasons.

And it’s entrenched in this idea that biological differences can’t be addressed, right? There was no acknowledgement that morbidity and mortality was due to poverty, neglect, discrimination. And I mean, that goes back to slavery. We had racial health disparities in this country ever since the United States existed. Excessive morbidity and mortality during slavery, but again, it was not argued that it was due to sexual abuse, the separation, the overwork, horrendous living conditions. No, it was because of the biological differences in races.

In effect, the argument about genetic differences, it seems almost untenable, because you would have to argue that Black people have genes in every single category that make them more predisposed to disease. I mean, what would be the chance of that?

Health is a community issue. Everything is a community issue. Poverty in one area spills over into another area. The decision not to extend health care, for example, not to have preventative health care. 84% of our expenses go into chronic diseases. Particularly now, we have to realize we are in a new age of infectious diseases. This Covid will not be the last… In this new age of infectious diseases, it is instrumental to have a healthy community for everybody.

Because disease spills over and disease translates into economic loss, into job loss, and ultimately causes incredible financial burden. The irony is that we actually spend a lot of money on health care but we treat people for preventative diseases in the emergency room.

Andrea Patterson on why the biological constructs of race were invented

It was very difficult, after the American Revolution and our wonderful Declaration of Independence, to justify, you know, continued slavery, and also in terms of gender, right? I mean, women in the 18th century and slaves were very hopeful because, you know, of this idea of equality being articulated. And so, as a result, I think we had to come up with a different justification. And we did that for both for women and for people of color, right? “They’re biologically different.” “They don’t have the same intellect.” That’s why they can’t vote. That’s why they cannot receive full citizenship.  Because who can argue against “biological differences?” Someone is just not “smart enough” to be a citizen. If somebody’s “not healthy enough,” if somebody is “too weak.” These ideas about the weak female gender for example, that is also an invention of the 19th century. These biological differences between men and women. Of course, we had inequality before, right? But what prior was justified socially or through religion, but when that falls away because we’ve declared equality and we actually separated the state from church, how do you substitute the system of oppression, be it along gender lines, be it along racial lines? And so we really see the rise of biological justification of difference.

To learn more about the history of the South’s broken health care system, listen to the full episode here. 

Episode One: The fight for the vote and how to ensure your vote counts

Episode Two: How the South created modern politics and what’s at stake in 2020

Episode Three: How the South nearly blocked women’s suffrage

Episode Four: To live here, you have to fight: Coalition building in the South