Sixty years ago this month, a courageous initiative created by civil rights activists and physicians aimed to transform the social and medical landscape of the United States by challenging segregation in the South. Called Freedom Summer, the work it began is still going on today.
In 1964, Dr. Robert Smith, an architect of the U.S. community health center model, called activist Dr. Tom Levin for help. Smith wanted Levin — and physicians across the country — to travel to Mississippi and set up medical field stations to support the segregation-defying project that would become known as Freedom Summer. Volunteers from across the nation streamed into Mississippi to set up schools, register Black voters, and fight for meaningful social and political representation in the face of violent opposition from segregationist organizations and members of local and state law enforcement. Health care workers came to provide first aid and medical care in case they were needed by the volunteers. Sadly, they were needed.
The horrors these physicians and activists confronted were systemic, sanctioned, and codified in contemporary laws and customs that were considered “normal” until they were challenged by grassroots opposition. Separate and unequal facilities for everything from educational venues to health care clinics enforced the dehumanization of Black lives in society.
At the time, the American Medical Association took an official position that accommodated local policies prohibiting Black physicians from joining regional medical associations or obtaining hospital privileges. By 1960, only 50 Black physicians were practicing in the state of Mississippi. The state’s Department of Public Health made it clear that individuals who traveled to the state to deliver first aid to civil rights activists would be prosecuted rather than licensed to provide services.
Before June 1964, Smith and colleagues like Dr. James Anderson and Dr. Aaron Shirley were among the few physicians willing to treat the injuries and illnesses of Black Mississippians and civil rights workers. The Student Nonviolent Coordinating Committee’s Digital Gateway project estimates that at least 80 volunteers were beaten, 35 shot, four were critically wounded, and six were murdered.
The bravery of more than 100 medical volunteers helped sustain the Freedom movement that summer. From a health care perspective, the change that followed was unprecedented. Their advocacy helped create the political foundation to secure new and inclusive health policies, including establishing Medicare, the Head Start program, and other health-promoting care models that improved access for everyone.
As a physician and researcher, I have spent much of my career examining how social environments influence health. As I reflect on the history of Freedom Summer, I am mindful of the eloquent words of Medgar Evers, “Freedom has never been free.” These motivational words are still painfully true in the struggle for fair and quality health care. Clinicians still confront health crises stemming from delayed or forgone care that everyday people face. Because of actions before and during Freedom Summer, physical signs no longer hang at hospital entrances to turn people away from care. Instead, it’s contemporary pricing practices that turn many Americans away from receiving the health care they need.
Six decades after Freedom Summer, the fight is still on to increase access to affordable health care for millions of Americans. Twenty years after the National Academy of Medicine published “Unequal Treatment” to expose widespread disrespectful treatment and uneven quality in health care delivery, clinicians are still confronting ubiquitous disparities in deaths and disease. More than a decade after the passage of the Affordable Care Act, access to respectful, compassionate, and affordable care remains elusive for far too many people.
States that have not expanded Medicaid as part of the Affordable Care Act, including Mississippi, have unequivocally higher percentages of uninsured people than states that have expanded coverage. Mississippi has made progress toward extending coverage, though efforts to pass Medicaid expansion failed this past month. A work requirement provision added to the bill is cause for concern. Research shows that such requirements have the potential to lower insurance coverage rates without much impact on employment rates.
During the summer of 2024, there may not be field stations or grassroots groups amplifying the desperate health care crises many Americans face. As a society, Americans have often viewed the experiences of individuals suffering from shuttered hospitals and unmanageable health care costs as private indignities that are just a part of life that people must navigate alone. Today’s injustices in health care stem from society’s failure to view inequities in health care delivery as this era’s pressing civil rights issue.
As the country commemorates the 60th anniversary of Freedom Summer, Americans must continue challenging today’s “normal” practices that prohibit people from accessing affordable, trustworthy, and compassionate care. It is not acceptable for states to accommodate high rates of deaths and hospital closures when policy solutions, such as Medicaid expansion and investing in community health centers are feasible to implement. More people need to have the courage to advocate for models of care that foster equal opportunity to achieve optimal health.
Cheryl R. Clark, M.D., Sc.D., is a physician and researcher at Brigham and Women’s Hospital in Boston and executive director and senior vice president of the Institute for Health Equity Research Evaluation and Policy for the Massachusetts League of Community Health Centers. She is also a collaborator on the Our Health Stories project.