How Can You Rest if You're Poor?

The Structural Roots of a Health Disparity

BLACK DURHAM RESIDENTS (1940)

of the county's total population

0 %

of those who contracted tuberculosis

0 %

more likely than whites to die from tuberculosis

0 x

Black Durhamites lived and worked in conditions that increased their risk of contracting and dying from tuberculosis. Crowded homes and neighborhoods were environments where tuberculosis easily spread. In Durham’s tobacco factories, unsanitary conditions and poor air quality facilitated the spread of the disease.

¹² Billy E. Barnes Collection

¹³ Rubenstein Library, Duke University

African Americans also had less access to health care. North Carolina’s sanatoria, the institutions where tuberculosis patients with treated through the “rest cure,” were only beginning to open their doors to Blacks in the mid-1920s. Most of Durham’s Black TB patients were cared for by family members at home. While Lincoln Hospital was one of the best African-American hospitals in the country, it struggled with funding during the depression, and could not accommodate the long-term care required by tuberculosis patients.

¹⁴ Lincoln Hospital Annual Report 1938

It was not until 1943 that the Durham County Health Department rebuilt an old jail as a tuberculosis sanitorium that serviced both white and Black people. However, most Black Durhamites worked jobs with no security and no sick leave, so seeking long-term treatment in a hospital or sanatorium could mean losing vital family income.

Working demanding, low-wage jobs, Black Durhamites did not have the time or resources needed to access available tuberculosis treatment. But Durham County health officials doubled down on behavioral interventions, encouraging cleanliness, rest, and isolation. Left without a viable solution to the tuberculosis epidemic in their communities, Black Durhamites continued to suffer from tuberculosis at disproportionate rates through the 1940s.

¹⁵ Durham County Sanitorium, 1956, Swindwell Collection