Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
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Ballooning over Berlin
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Ballooning over Berlin
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Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
Individuals often find themselves in circumstances that…well, they’d rather not be in. Here are six ingenious escapes throughout history.
Tower of London liberation
For much of England’s history, the Tower of London was a notorious prison. Among those incarcerated there was a troublemaking Jesuit priest named John Gerard who in 1597 made an audacious escape. After chipping away at the stones around his cell door, Gerard quietly sneaked past the corridor guards to a wall overlooking the moat. Waiting below was a boat arranged by a sympathetic prison guard. The boatmen tossed Gerard a rope, which he tied to a cannon, then Gerard slid down the rope and across the moat to freedom.
Shipping out, literally
Henry (“Box”) Brown was an enslaved American who literally mailed himself out of bondage. After his wife and children were sold to a slaveholder in another state, Brown decided to effect his own escape. He asked a sympathetic carpenter to construct a wood box three feet long and two feet wide with an airhole, and then Brown had two friends ship him by rail from Virginia to the Pennsylvania Anti-Slavery Society in Philadelphia. Brown spent part of the grueling 27-hour journey upside down but arrived in Philadelphia a free man.
Dalai Lama: master of disguise
In 1959 China attempted to remove the 14th Dalai Lama, then Tibet’s ruler and spiritual leader, as part of its effort to gain greater control of the region, which it considered a territory. Fearing for his life, the 23-year-old holy man disguised himself as a soldier and disappeared into the crowds that had gathered to protect him. Traveling only at night, the Dalai Lama and his small entourage eventually made their way from Tibet to safety in India.
The infamous Alcatraz prison break
Over its decades of service as a federal prison, Alcatraz Island was considered escape-proof. If a prisoner was somehow able to get past the heavily armed guard towers and barbed wire fences, he faced the cold, rough San Francisco Bay, which was almost impossible to cross without a boat. Nonetheless, many prisoners decided to try their luck over the years, and most either died or were recaptured for their efforts. However, in 1962, prisoners Frank Morris, Clarence Anglin, and John Anglin managed to escape during one of Alcatraz’s most infamous moments. The trio spent months quietly chipping at the concrete around the air shafts in their cells to gain access to an unguarded utility corridor, hiding their work by filling in the holes with a paste made from wet paper. On June 11, after considerable planning, the men made their move. Using painted plaster busts to fool the night guards into thinking they were asleep in their bunks, Morris and the Anglin brothers made their way through the ventilation system to the roof, where they climbed down the bakery smokestack and jumped a fence. Outside the prison walls, they attempted to cross the San Francisco Bay on a raft made from rubber raincoats and other materials. However, it appears they were unsuccessful in reaching shore. Their bodies were never recovered, but authorities now believe that the men drowned.
Ballooning over Berlin
The Berlin Wall separated East and West Berlin for almost three decades. Border guards in East Berlin had orders to shoot anyone who attempted to escape to the West, forcing desperate families to develop innovative ways to gain their freedom. Tunneling was a common method, with one famous tunnel beginning in an East Berlin graveyard. But perhaps the most daring escape involved a hot air balloon made from raincoats, sheets, and other material, powered by a gas burner. On the morning of September 16, 1979, two families used the huge balloon to fly high over the Berlin Wall into West Germany. Their story has since been turned into more than one motion picture.
El Chapo’s escape
Joaquín (“El Chapo”) Guzmán was one of Mexico’s most notorious drug kingpins, wanted by law enforcement on both sides of the Mexico-U.S. border. After 13 years eluding authorities, Guzmán was finally captured and sentenced to prison in Mexico. On July 11, 2015, Guzmán stunned the world when he escaped from his cell via an intricate mile-long tunnel that led to a building outside the prison. Despite an extensive manhunt, Guzmán remained on the run for six months before being captured again. He was eventually extradited to the United States, where he was sentenced to life in prison.
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+ What are records?
+ Since 2014, The Marshall Project has been curating some of the best criminal justice reporting from around the web. In these records you will find the most recent and the most authoritative articles on the topics, people and events that are shaping the criminal justice conversation. The Marshall Project does not endorse the viewpoints or vouch for the accuracy of reports other than its own.
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+ The Black Mortality Gap, and a Century-Old Document
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+ 1 in 5 African American deaths happens earlier than if they were White. Black doctors say the Flexner Report holds clues to the health system’s role in racial health disparities.
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The Marshall Project is a nonprofit newsroom covering the U.S. criminal justice system. Sign up for our newsletters to receive all of our stories and analysis.
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+ If Black Americans died at the same rates as White Americans, in 2019 about 294,000 Black Americans would have died.
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+ Each dot is 1 person's death
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+ Here's what those deaths would look like arranged by age.
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But, due to racial disparities in mortality, Black Americans die younger at almost every age. Here are actual deaths in 2019: over 72,000 more Black Americans died at younger ages.
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+ Once Americans reached their mid-80s, Black people began to have lower death rates than Whites, with about 11,000 fewer Black deaths in 2019.
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+ In total, that adds up to over 355,000 Black deaths in 2019
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+ — 1 in 5 of which happened earlier than expected for White Americans.
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+ The biggest inequality affected Black infants, who had more than twice the White infant mortality rate. In 2019, almost 3,600 more Black babies died before their first birthday.
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Black Americans die at higher rates than White Americans at nearly every age.
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In 2019, the most recent year with available mortality data, there were over 62,000 such earlier deaths — or one out of every five African American deaths.
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The age group most affected by the inequality was infants. Black babies were more than twice as likely as White babies to die before their first birthday.
Some clues to why health care is failing African Americans can be found in a document written over 100 years ago: the Flexner Report.
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In the early 1900s, the U.S. medical field was in disarray. Churning students through short academic terms with inadequate clinical facilities, medical schools were flooding the field with unqualified doctors — and pocketing the tuition fees. Dangerous quacks and con artists flourished.
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Physicians led by the American Medical Association (A.M.A.) were pushing for reform. Abraham Flexner, an educator, was chosen to perform a nationwide survey of the state of medical schools.
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He did not like what he saw.
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Published in 1910, the Flexner Report blasted the unregulated state of medical education, urging professional standards to produce a force of “fewer and better doctors.”
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Flexner recommended raising students’ pre-medical entry requirements and academic terms. Medical schools should partner with hospitals, invest more in faculty and facilities, and adopt Northern city training models. States should bolster regulation. Specialties should expand. Medicine should be based on science.
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The effects were remarkable. As state boards enforced the standards, more than half the medical schools in the U.S. and Canada closed, and the numbers of practices and physicians plummeted.
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The new rules brought advances to doctors across the country, giving the field a new level of scientific rigor and protections for patients.
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But there was also a lesser-known side of the Flexner Report.
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Black Americans already had an inferior experience with the health system. Black patients received segregated care; Black medical students were excluded from training programs; Black physicians lacked resources for their practices.
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Dr. Alvin Poussaint, a leader in the health care civil rights movement, with an “ambulance” during the 1965 march from Selma to Montgomery, Ala. Since White hospitals frequently refused to send ambulances for Black patients, Black medical workers repurposed hearses for medical transport. Patients sometimes died in the hearse as the driver searched for a hospital willing to accept a Black person.
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+ Photo courtesy Dr. Poussaint.
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Handing down exacting new standards without the means to put them into effect, the Flexner report was devastating for Black medicine.
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Of the seven Black medical schools that existed at the time, only two — Howard and Meharry — remained for Black applicants, who were barred from historically White institutions.
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The new requirements for students, in particular the higher tuition fees prompted by the upgraded medical school standards, also meant those with wealth and resources were overwhelmingly more likely to get in than those without.
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The report recommended that Black doctors see only Black patients, and that they should focus on areas like hygiene, calling it “dangerous” for them to specialize in other parts of the profession. Flexner said the White medical field should offer Black patients care as a moral imperative, but also because it was necessary to prevent them from transmitting diseases to White people. Integration, seen as medically dangerous, was out of the question.
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The effect was to narrow the medical field both in total numbers of doctors, and the racial and class diversity within their ranks.
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When the report was published, physicians led by the A.M.A. had already been organizing to make the field more exclusive. The report’s new professional requirements, developed with guidance from the A.M.A.’s education council, strengthened those efforts under the banner of improvement.
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Elite White physicians now faced less competition from doctors offering lower prices or free care. They could exclude those they felt lowered the profession’s social status, including working-class or poor people, women, rural Southerners, immigrants and Black people.
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This illustration from an early 19th-century book, “Histoire naturelle de genre humain” by Julien-Joseph Virey, gives a glimpse at how science of the era was used to justify theories of racial inferiority.
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+ Plate from Wellcome Library, London.
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And so emerged a vision of an ideal doctor: a wealthy White man from a Northern city. Control of the medical field was in the hands of these doctors, with professional and cultural mechanisms to limit others.
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To a large degree, the Flexner standards continue to influence American medicine today.
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The medical establishment didn’t follow all of the report’s recommendations, however.
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The Flexner Report noted that preventing health problems in the broader community better served the public than the more profitable business of treating an individual patient.
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“The overwhelming importance of preventive medicine, sanitation, and public health indicates that in modern life the medical profession” is not a business “to be exploited by individuals,” it said.
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But in the century since, the A.M.A. and allied groups have mostly defended their member physicians’ interests, often opposing publicly funded programs that could harm their earnings.
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A 1949 letter to a friend by President Harry Truman reflects the opposition he faced in efforts to create a national health care plan, in particular the A.M.A. misrepresenting his proposal as “socialized medicine”. A national program providing support for some lower-income and older people was not accomplished until more than a decade and a half later.
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+ Image from the National Archives and Records Administration.
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Across the health system, the typically lower priority given to public health disproportionately affects Black Americans.
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Lower reimbursement rates discouragedoctors from accepting Medicaid patients. Twelve states, largely in the South, have not expanded Medicaid as part of the Affordable Care Act.
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Specialists like plastic surgeons or orthopedists far out-earn pediatricians and family, public health and preventive doctors — those who deal with heart disease, diabetes, hypertension and other conditions that disproportionately kill Black people.
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With Americans able to access varying levels of care based on what resources they have, Blackdoctorssay many patients are still, in effect, segregated.
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The trans-Atlantic slave trade began a tormented relationship with Western medicine and a health disadvantage for Black Americans that has never been corrected, first termed the “slave health deficit” by the doctor and medical historian Dr. W. Michael Byrd.
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Dr. Byrd, born in 1943 in Galveston, Texas, grew up hearing about the pain of slavery from his great-grandmother, who was emancipated as a young girl. Slavery’s disastrous effects on Black health were clear. But by the time he became a medical student, those days were long past — why was he still seeing so many African Americans dying?
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Dr. Linda A. Clayton had the same question.
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Her grandfather had also been emancipated from slavery as a child. And growing up, she often saw Black people struggle with the health system — even those in her own family, who were well able to pay for care. Her aunt died in childbirth. Two siblings with polio couldn’t get equitable treatment. Her mother died young of cancer after being misdiagnosed.
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Dr. Linda A. Clayton and Dr. W. Michael Byrd in at a book signing in Boston for their second book on the history of racial health disparities in the United States.
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+ Photo courtesy Dr. Clayton.
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By 1988, when Dr. Byrd and Dr. Clayton met as faculty members of Meharry Medical College in Nashville, he had been collecting data, publishing and teaching physicians about Black health disparities for 20 years, calling attention to them in the news media and before Congress.
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In their decades-long partnership and marriage that followed, the two built on that work, constructing a story of race and medicine in the U.S. that had never been comprehensively told, publishing their findings in a two-volume work An American Health Dilemma.
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Dr. W. Michael Byrd and Dr. Linda A. Clayton’s two-volume work, An American Health Dilemma (2000 and 2001, Routledge).
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Much has changed since the publication of the Flexner Report.
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Racial discrimination is prohibited by law. Medical schools, practices and hospitals are desegregated.
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In 2008, a past A.M.A. president, Dr. Ronald M. Davis, formally apologized to Black doctors and patients. The association has established a minority affairs forum and a national Center for Health Equity; collaborated with the National Medical Association, historically Black medical schools and others in Black health; and created outreach and scholarships.
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But Dr. Clayton and Dr. Byrd have questioned whether the field is working hard enough to change the persistent inequalities. And they aren’t the only experts wondering.
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To Adam Biggs, an instructor of African American studies and U.S. history at the University of South Carolina Lancaster, Flexner’s figure of the elite physician still reigns. That person is most likely to have resources to shoulder the tuition and debt; to get time and coaching for testing and pre-medical preparation; and to ride out years of lower-paid training an M.D. requires.
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Evan Hart, an assistant professor of history at Missouri Western State University, has taught courses on race and health. She said medical school tuition is prohibitively expensive for many Black students.
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Earlier this year, an A.M.A. article estimated there are 30,000-35,000 fewer Black doctors because of the Flexner Report.
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Today, Black people make up 13% of Americans, but 5% of physicians — up just two percentage points from half a century ago. In the higher-payingspecialties, the gap grows. Doctors from less wealthy backgrounds and other disadvantaged groups are underrepresented, too.
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This disparity appears to have real-world effects on patients. A study showed Black infant mortality reduced by half when a Black doctor provided treatment. Another showed that Black men, when seen by Black doctors, more often agreed to certain preventive measures. Data showed over 60% of Black medical school enrollees planned to practice in underserved communities, compared with less than 30% of Whites.
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The limits of progress are perhaps clearest in the continuing numbers of Black Americans suffering poor health and early death. Millions remain chronically uninsured or underinsured.
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According to Dr. Clayton, a key problem is that the health system continues to separate those with private insurance and those with public insurance, those with resources versus those without, the care of individuals versus the whole.
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During the Civil Rights movement, Medicare and Medicaid passed in part because of the advocacy of Black doctors, extending care to millions of lower-income and older Americans. The A.M.A. opposed federal health insurance until the 1960s.
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But the A.M.A.’s long battle against public programs has contributed to the U.S.’s position as the only advanced nation without universal coverage. When a social safety net is left frayed, research shows, it may hurt Black Americans more, and it also leaves less privileged members of all races exposed.
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“It is basically a segregated system within a legally desegregated system,” Dr. Clayton said.
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In February, Dr. Byrd passed away from heart failure in a hospital in Nashville at 77. Dr. Clayton was holding his hand.
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Before his death, the two doctors had given hours of interviews to The New York Times/The Marshall Project over the course of six months.
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Dr. Byrd said he wanted to spread awareness to more American doctors — and Americans generally — about the Black health crisis that slavery began, and that continues in a health system that hasn’t fully desegregated.
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The doctors’ work showed that never in the country’s history has Black health come close to equality with that of Whites.
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“We’re still waiting,” Dr. Byrd said.
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An earlier version of this article imprecisely described the American Medical Association's stance over time toward federal health insurance in the Civil Rights movement. The A.M.A. opposed federal health insurance for much of the movement, into the 1960s. It did not oppose it for the entire era, supporting the final version of Medicaid that passed in 1965.
+ “Stranger Fruit”: Black Mothers and the Fear of Police Brutality
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+ Jon Henry's photography project seeks to convey the impact of police violence on Black families.
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+ “Untitled #53,” North Little Rock, AR
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The Marshall Project is a nonprofit newsroom covering the U.S. criminal justice system. Sign up for our newsletters to receive all of our stories and analysis.
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Police brutality cases that capture public attention follow a familiar pattern: first relentless media coverage, then local or national outrage, and then — if charges are ever brought against the officers involved — the drawn-out legal process. But what happens when this public cycle ends? In his ongoing series "Stranger Fruit," photographer Jon Henry focuses on the private relationship between Black mothers and their sons, looking at how fear of violence permeates the daily lives of Black families across the United States.
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"Stranger Fruit," a project seven years in the making, features intimate portraits of Black mothers with their sons across the United States. Inspired by Renaissance paintings such as those by Titian, Henry poses the mothers cradling their sons in a manner that evokes Michelangelo’s Pietà, as if in mourning. Though these families have not experienced fatal police violence, Henry said they live with the possibility of such loss daily.
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+ “Untitled #57,” Houston, TX
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+ “Untitled #6,” Parkchester, NY
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+ “Untitled #4,” Harlem, NY
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The boys range from children to adult men, against such backdrops as parking lots, backyards, basketball courts, a Target and a state Capitol. The images are made in towns and cities across the country, from Minneapolis to rural Alabama. The breadth of the project is intentional: Henry said it was important for viewers of the work to know that the violence and fear that Black communities experience is not limited to any region. The work has been exhibited in solo and group shows in 12 states, France and Korea.
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“It’s a nationwide issue, if not global,” Henry said. “The photos can be made anywhere, just as this could happen anywhere.”
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In some images, Henry photographs the mothers alone, as if lamenting. In these images especially, he chooses to center the experiences of Black women, a group often overlooked in conversations about police brutality. Henry’s work is also unique for its quiet simplicity, centered around the private relationship between mother and son.
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+ “Untitled #33,” Jersey City, NJ
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+ “Untitled #25,” Montgomery, AL
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+ “Untitled #13,” Groveland Park, IL
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+ “Untitled #11,” Buffalo, NY
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+ “Untitled #17,” South Side Chicago, IL
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+ “Untitled #1,” Co-Op City, NY
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+ “Untitled #44,” Crenshaw Blvd, CA
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Henry, a Queens, New York native, said the project was partly a response to the police killing of Sean Bell in 2006. The night before Bell’s wedding, five New York City officers fired about 50 bullets into his car while he was parked outside a strip club with two friends. Bell was unarmed.
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Bell, 23, was around the same age as Henry at the time, and also from Queens.
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“After the [not guilty] verdict, I was at a friend’s wedding thinking, ‘What if this was happening to us?’” Henry said.
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For years following Bell’s killing, as other police violence cases followed, Henry’s thoughts returned to the mothers and families who were left behind. Along with the weight of grief, Henry considered how the grueling process of a trial and its subsequent media coverage affects Black families and communities.
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“A mother losing their child is something no one should have to endure, much less at the hands of the police who are supposed to serve and protect,” Henry said.
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By placing the bond between mother and child at the forefront of "Stranger Fruit", Henry hopes to spark dialogue among viewers and inform the ongoing work of communities across the country fighting to end police brutality.
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“The work has to continue. Even after the past year, when there’s been an awakening, there is still a lot that needs to change,” he said.
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"Stranger Fruit," along with Henry’s other work, can be seen on his website, https://www.jonhenryphotography.com, or on his Instagram account, @whoisdamaster.
+ What are records?
+ Since 2014, The Marshall Project has been curating some of the best criminal justice reporting from around the web. In these records you will find the most recent and the most authoritative articles on the topics, people and events that are shaping the criminal justice conversation. The Marshall Project does not endorse the viewpoints or vouch for the accuracy of reports other than its own.
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+ “From time to time you hear someone shout something like, ‘Trump cannot be stopped!’ or, ‘Let’s get this White Nazi out of power!’ There is no gray area.”
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The Marshall Project is a nonprofit newsroom covering the U.S. criminal justice system. Sign up for our newsletters to receive all of our stories and analysis.
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Election Night: Eyes Glued to Cable News
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Standing at their steel bars—rattling them—a group of White prisoners chant, "Four more years, four more years!" Convinced that Donald J. Trump will retain the presidency, they make jokes about how “Creepy Joe” actually thought he could win. The polls were wrong once again, they say.
We prisoners at Washington State Reformatory are getting our election night news in various ways. Some listen to reports on headphones in hopes of drowning out the madness taking place in person. But many have their TVs turned up for all to hear as they cheer for Trump or Biden. The three major cable news stations are in play: Fox News for all the Trump supporters, CNN and MSNBC for others. All of the stations seem to be polarized in one direction or another.
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From time to time you hear someone shout something like, “Trump cannot be stopped!” or, “Let’s get this White Nazi out of power!” There is no gray area.
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Most of the prisoners who loudly support Trump express White supremacist views. They claim that they support him because they care about the economy and rebuilding America, but when you get them talking about why we need immigrants removed from American soil or why a Southern border wall is so important, it’s clear why he’s their desired leader.
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Many of us on the other side have spent the last four years listening to these individuals claim how amazing Trump is. We had hoped that tonight would be the night we sent Trump and his ideologies packing. But the final results aren’t in. We go to sleep on pins and needles. Like the rest of society, we have to be patient.
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Day 2: Fraud Accusations and Dire Predictions
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As the Trumpers learn that Joe Biden has a chance of becoming the next president, accusations spill out like vomit. They complain about how “all the extra ballots” are being wrongly used to propel Biden to victory. One pro-Trump prisoner yells, “Look, even the news is saying there were more ballots turned in than there are residents in Nevada! You see, there is proof the Democrats are cheating!” He encourages me to check Fox News if I don’t believe him.
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Throughout the day words more heated than this fly around the prison. One prisoner who lives just above me screams, “Be warned now! Halfway through Biden’s term Americans will be begging for a leader like Mr. Trump to be back in office! Begging!”
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I have often found myself arguing with these individuals. I have tried to get them to see that in Trump’s law-and-order-loving mind, they belong right where they are—behind countless feet of razor wire and mounds of brick and concrete.
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It’s not just prisoners who support Trump. A group of guards have been known to wear MAGA masks in the prison. During a shift change, around five gather on the third-floor landing. A small White female guard remains optimistic that Trump will win. She tells her coworkers about a party she is planning to acknowledge his big victory. “We are in for some great years,” she says, eyes bright with excitement.
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Day 3: Trolling the Trump Fans
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As the tallies continue to roll in, we anti-Trump prisoners can’t resist taking shots at the rattled contingent of Trump followers. While walking out of the prison dining hall, I ask a guard where all the MAGA masks have gone. “We were told by the higher ups that they are not to be worn as they are racist,” he replies, as if he thinks his superiors are being ridiculous. He looks to me for validation. I just walk off feeling good about getting a shot in at one of my oppressors.
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Later, as the night settles, many of us wonder if we will actually even see the end of this election.
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Day 4: The Slow-Count Torture Continues
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I turn on my TV as soon as I wake up. It’s clear that states are still counting ballots, but what catches my eye is the lead Biden has gained—four out of the six remaining states have him as their frontrunner.
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As the day goes on, I strike up conversations about a Biden presidency. One prisoner known to be a social justice warrior says something that really sticks out: "I want Trump to win.”
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Reading the disagreement on my face, he explains, “I hate Trump. But if he wins, people will continue to protest. If Biden wins, people will have a false hope that things are going to magically change, and they won’t. We have to keep the pressure on, or else people will continue to be abused by the system and those entrusted to positions of authority. Police will keep shooting unarmed Black people!"
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I have to admit he has a point. It is quite possible that with a Biden win people could become complacent. However, I remind him that there are other areas that would suffer, like heath care for the elderly, abortion rights, immigration and those protected under DACA. I remind my friend that it’s on us to keep the conversation going.
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Later I spend some time out in the prison yard walking around a track surrounded by razor wire and towering walls. A friend of Vietnamese descent tells me that he knows he will be deported upon his release from prison, as this has just recently happened to a friend of his.
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He hasn’t been to Vietnam since he was 10, and he is now over 40. “I have no one over there; my family and two kids live here,” he says. “I pray every night Trump doesn’t win, because he will send me back, and I will be alone.” Even though there were plenty of felony deportations during the Obama administration, I do my best to reassure him that Biden will win.
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Day 5: My Victory Song
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On Saturday, a little before 8:30 a.m. Pacific Time, Pennsylvania’s 20 electoral votes seal the deal for Biden, and this exhausting week comes to an end.
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In my loudest voice, I break out with, “Nah nah nah, nah/ Nah nah, nah, nah/ Hey, hey, hey, goodbye!” The sound vibrates off every wall and, to my surprise, others join in. We repeat this at least a dozen times, acquiring more voices with each chorus. It feels good to know that this is like nails on a chalkboard to the bigots who sought refuge in Trump. We’re excited to have a racist tyrant out of the White House. Most important is that we stood up to a bully, and those who choose to live through him are forced to hear us roar.
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Postscript: One Small Step
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Since the final results came in, I haven’t heard guards saying anything about the election. The young White female guard has failed to mention how her victory party went.
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Jokes aside, I know that Joe Biden isn’t going to solve all of our problems. But sometimes all you can do is focus on the next step. And the next step for our country is to extract the racist who played a major role in dividing our country from the White House.
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The number of Americans who voted for a fool like Trump after all that he has done is a clear reminder of just how far we need to go. But for now, I can rest assured that we have taken a small step toward rebuilding our country.
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The Washington Department of Corrections did not respond to requests for comment by publication.
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Christopher Blackwell, 39, is incarcerated at the Washington State Reformatory in Monroe, Washington, and is working toward publishing a book on solitary confinement. His writing has been published by Jewish Currents, BuzzFeed, The Crime Report and several other outlets. He is serving a 45-year sentence for murder and robbery.
+ The Black Mortality Gap, and a Century-Old Document
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+ 1 in 5 African American deaths happens earlier than if they were White. Black doctors say the Flexner Report holds clues to the health system’s role in racial health disparities.
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The Marshall Project is a nonprofit newsroom covering the U.S. criminal justice system. Sign up for our newsletters to receive all of our stories and analysis.
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+ If Black Americans died at the same rates as White Americans, in 2019 about 294,000 Black Americans would have died.
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+ Each dot is 1 person's death
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+ Here's what those deaths would look like arranged by age.
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But, due to racial disparities in mortality, Black Americans die younger at almost every age. Here are actual deaths in 2019: over 72,000 more Black Americans died at younger ages.
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+ Once Americans reached their mid-80s, Black people began to have lower death rates than Whites, with about 11,000 fewer Black deaths in 2019.
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+ In total, that adds up to over 355,000 Black deaths in 2019
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+ — 1 in 5 of which happened earlier than expected for White Americans.
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+ The biggest inequality affected Black infants, who had more than twice the White infant mortality rate. In 2019, almost 3,600 more Black babies died before their first birthday.
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Black Americans die at higher rates than White Americans at nearly every age.
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In 2019, the most recent year with available mortality data, there were over 62,000 such earlier deaths — or one out of every five African American deaths.
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The age group most affected by the inequality was infants. Black babies were more than twice as likely as White babies to die before their first birthday.
Some clues to why health care is failing African Americans can be found in a document written over 100 years ago: the Flexner Report.
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In the early 1900s, the U.S. medical field was in disarray. Churning students through short academic terms with inadequate clinical facilities, medical schools were flooding the field with unqualified doctors — and pocketing the tuition fees. Dangerous quacks and con artists flourished.
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Physicians led by the American Medical Association (A.M.A.) were pushing for reform. Abraham Flexner, an educator, was chosen to perform a nationwide survey of the state of medical schools.
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He did not like what he saw.
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Published in 1910, the Flexner Report blasted the unregulated state of medical education, urging professional standards to produce a force of “fewer and better doctors.”
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Flexner recommended raising students’ pre-medical entry requirements and academic terms. Medical schools should partner with hospitals, invest more in faculty and facilities, and adopt Northern city training models. States should bolster regulation. Specialties should expand. Medicine should be based on science.
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The effects were remarkable. As state boards enforced the standards, more than half the medical schools in the U.S. and Canada closed, and the numbers of practices and physicians plummeted.
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The new rules brought advances to doctors across the country, giving the field a new level of scientific rigor and protections for patients.
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But there was also a lesser-known side of the Flexner Report.
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Black Americans already had an inferior experience with the health system. Black patients received segregated care; Black medical students were excluded from training programs; Black physicians lacked resources for their practices.
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Dr. Alvin Poussaint, a leader in the health care civil rights movement, with an “ambulance” during the 1965 march from Selma to Montgomery, Ala. Since White hospitals frequently refused to send ambulances for Black patients, Black medical workers repurposed hearses for medical transport. Patients sometimes died in the hearse as the driver searched for a hospital willing to accept a Black person.
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+ Photo courtesy Dr. Poussaint.
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Handing down exacting new standards without the means to put them into effect, the Flexner report was devastating for Black medicine.
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Of the seven Black medical schools that existed at the time, only two — Howard and Meharry — remained for Black applicants, who were barred from historically White institutions.
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The new requirements for students, in particular the higher tuition fees prompted by the upgraded medical school standards, also meant those with wealth and resources were overwhelmingly more likely to get in than those without.
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The report recommended that Black doctors see only Black patients, and that they should focus on areas like hygiene, calling it “dangerous” for them to specialize in other parts of the profession. Flexner said the White medical field should offer Black patients care as a moral imperative, but also because it was necessary to prevent them from transmitting diseases to White people. Integration, seen as medically dangerous, was out of the question.
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The effect was to narrow the medical field both in total numbers of doctors, and the racial and class diversity within their ranks.
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When the report was published, physicians led by the A.M.A. had already been organizing to make the field more exclusive. The report’s new professional requirements, developed with guidance from the A.M.A.’s education council, strengthened those efforts under the banner of improvement.
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Elite White physicians now faced less competition from doctors offering lower prices or free care. They could exclude those they felt lowered the profession’s social status, including working-class or poor people, women, rural Southerners, immigrants and Black people.
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This illustration from an early 19th-century book, “Histoire naturelle de genre humain” by Julien-Joseph Virey, gives a glimpse at how science of the era was used to justify theories of racial inferiority.
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+ Plate from Wellcome Library, London.
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And so emerged a vision of an ideal doctor: a wealthy White man from a Northern city. Control of the medical field was in the hands of these doctors, with professional and cultural mechanisms to limit others.
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To a large degree, the Flexner standards continue to influence American medicine today.
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The medical establishment didn’t follow all of the report’s recommendations, however.
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The Flexner Report noted that preventing health problems in the broader community better served the public than the more profitable business of treating an individual patient.
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“The overwhelming importance of preventive medicine, sanitation, and public health indicates that in modern life the medical profession” is not a business “to be exploited by individuals,” it said.
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But in the century since, the A.M.A. and allied groups have mostly defended their member physicians’ interests, often opposing publicly funded programs that could harm their earnings.
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A 1949 letter to a friend by President Harry Truman reflects the opposition he faced in efforts to create a national health care plan, in particular the A.M.A. misrepresenting his proposal as “socialized medicine”. A national program providing support for some lower-income and older people was not accomplished until more than a decade and a half later.
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+ Image from the National Archives and Records Administration.
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Across the health system, the typically lower priority given to public health disproportionately affects Black Americans.
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Lower reimbursement rates discouragedoctors from accepting Medicaid patients. Twelve states, largely in the South, have not expanded Medicaid as part of the Affordable Care Act.
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Specialists like plastic surgeons or orthopedists far out-earn pediatricians and family, public health and preventive doctors — those who deal with heart disease, diabetes, hypertension and other conditions that disproportionately kill Black people.
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With Americans able to access varying levels of care based on what resources they have, Blackdoctorssay many patients are still, in effect, segregated.
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The trans-Atlantic slave trade began a tormented relationship with Western medicine and a health disadvantage for Black Americans that has never been corrected, first termed the “slave health deficit” by the doctor and medical historian Dr. W. Michael Byrd.
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Dr. Byrd, born in 1943 in Galveston, Texas, grew up hearing about the pain of slavery from his great-grandmother, who was emancipated as a young girl. Slavery’s disastrous effects on Black health were clear. But by the time he became a medical student, those days were long past — why was he still seeing so many African Americans dying?
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Dr. Linda A. Clayton had the same question.
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Her grandfather had also been emancipated from slavery as a child. And growing up, she often saw Black people struggle with the health system — even those in her own family, who were well able to pay for care. Her aunt died in childbirth. Two siblings with polio couldn’t get equitable treatment. Her mother died young of cancer after being misdiagnosed.
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Dr. Linda A. Clayton and Dr. W. Michael Byrd in at a book signing in Boston for their second book on the history of racial health disparities in the United States.
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+ Photo courtesy Dr. Clayton.
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By 1988, when Dr. Byrd and Dr. Clayton met as faculty members of Meharry Medical College in Nashville, he had been collecting data, publishing and teaching physicians about Black health disparities for 20 years, calling attention to them in the news media and before Congress.
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In their decades-long partnership and marriage that followed, the two built on that work, constructing a story of race and medicine in the U.S. that had never been comprehensively told, publishing their findings in a two-volume work An American Health Dilemma.
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Dr. W. Michael Byrd and Dr. Linda A. Clayton’s two-volume work, An American Health Dilemma (2000 and 2001, Routledge).
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Much has changed since the publication of the Flexner Report.
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Racial discrimination is prohibited by law. Medical schools, practices and hospitals are desegregated.
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In 2008, a past A.M.A. president, Dr. Ronald M. Davis, formally apologized to Black doctors and patients. The association has established a minority affairs forum and a national Center for Health Equity; collaborated with the National Medical Association, historically Black medical schools and others in Black health; and created outreach and scholarships.
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But Dr. Clayton and Dr. Byrd have questioned whether the field is working hard enough to change the persistent inequalities. And they aren’t the only experts wondering.
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To Adam Biggs, an instructor of African American studies and U.S. history at the University of South Carolina Lancaster, Flexner’s figure of the elite physician still reigns. That person is most likely to have resources to shoulder the tuition and debt; to get time and coaching for testing and pre-medical preparation; and to ride out years of lower-paid training an M.D. requires.
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Evan Hart, an assistant professor of history at Missouri Western State University, has taught courses on race and health. She said medical school tuition is prohibitively expensive for many Black students.
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Earlier this year, an A.M.A. article estimated there are 30,000-35,000 fewer Black doctors because of the Flexner Report.
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Today, Black people make up 13% of Americans, but 5% of physicians — up just two percentage points from half a century ago. In the higher-payingspecialties, the gap grows. Doctors from less wealthy backgrounds and other disadvantaged groups are underrepresented, too.
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This disparity appears to have real-world effects on patients. A study showed Black infant mortality reduced by half when a Black doctor provided treatment. Another showed that Black men, when seen by Black doctors, more often agreed to certain preventive measures. Data showed over 60% of Black medical school enrollees planned to practice in underserved communities, compared with less than 30% of Whites.
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The limits of progress are perhaps clearest in the continuing numbers of Black Americans suffering poor health and early death. Millions remain chronically uninsured or underinsured.
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According to Dr. Clayton, a key problem is that the health system continues to separate those with private insurance and those with public insurance, those with resources versus those without, the care of individuals versus the whole.
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During the Civil Rights movement, Medicare and Medicaid passed in part because of the advocacy of Black doctors, extending care to millions of lower-income and older Americans. The A.M.A. opposed federal health insurance until the 1960s.
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But the A.M.A.’s long battle against public programs has contributed to the U.S.’s position as the only advanced nation without universal coverage. When a social safety net is left frayed, research shows, it may hurt Black Americans more, and it also leaves less privileged members of all races exposed.
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“It is basically a segregated system within a legally desegregated system,” Dr. Clayton said.
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In February, Dr. Byrd passed away from heart failure in a hospital in Nashville at 77. Dr. Clayton was holding his hand.
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Before his death, the two doctors had given hours of interviews to The New York Times/The Marshall Project over the course of six months.
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Dr. Byrd said he wanted to spread awareness to more American doctors — and Americans generally — about the Black health crisis that slavery began, and that continues in a health system that hasn’t fully desegregated.
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The doctors’ work showed that never in the country’s history has Black health come close to equality with that of Whites.
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“We’re still waiting,” Dr. Byrd said.
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An earlier version of this article imprecisely described the American Medical Association's stance over time toward federal health insurance in the Civil Rights movement. The A.M.A. opposed federal health insurance for much of the movement, into the 1960s. It did not oppose it for the entire era, supporting the final version of Medicaid that passed in 1965.
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+ChatGPT
Chat history
Free Research Preview. ChatGPT may produce inaccurate information about people, places, or facts. ChatGPT May 24 Version
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+ChatGPT
Chat history
ChatGPT
Examples
Capabilities
Remembers what user said earlier in the conversation
Allows user to provide follow-up corrections
Trained to decline inappropriate requests
Limitations
May occasionally generate incorrect information
May occasionally produce harmful instructions or biased content
Limited knowledge of world and events after 2021
Free Research Preview. ChatGPT may produce inaccurate information about people, places, or facts. ChatGPT May 24 Version
Spelling age.In
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--- /dev/null
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@@ -0,0 +1,215 @@
+ChatGPT
Chat history
ChatGPT
Examples
Capabilities
Remembers what user said earlier in the conversation
Allows user to provide follow-up corrections
Trained to decline inappropriate requests
Limitations
May occasionally generate incorrect information
May occasionally produce harmful instructions or biased content
Limited knowledge of world and events after 2021
Free Research Preview. ChatGPT may produce inaccurate information about people, places, or facts. ChatGPT May 24 Version
Spelling age.In
\ No newline at end of file
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+ChatGPT
Chat history
1 / 1
Summarize the below passage
+Black Americans die at higher rates than White Americans at nearly every age.In 2019, the most recent year with available mortality data, there were over 62,000 such earlier deaths — or one out of every five African American deaths.
1 / 1
The passage states that Black Americans have higher mortality rates compared to White Americans across most age groups. In 2019, there were more than 62,000 deaths among Black Americans that occurred earlier than expected, which accounted for one-fifth of all African American deaths.
Free Research Preview. ChatGPT may produce inaccurate information about people, places, or facts. ChatGPT May 24 Version
![\"General](\"https://cdn.britannica.com/25/189025-131-5DA7C33D/Alcatraz-Island-San-Francisco-Bay-California.jpg\")
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