Racial Disparities in Tuberculosis Control

A Campaign that failed

The Durham Public Health Department led the charge against tuberculosis with screening programs and behavioral interventions. Health officials conducted tuberculosis tests in industrial plants, schools, and outside the Durham County Courthouse. Schools employed nutritionists, and tuberculosis nurses who made neighborhood rounds to register and monitor patients.

This flyer shows how x-rays were used to screen for tuberculosis. The red icon in the top left is for Christmas seals, a charity Durhamites could support to fund tuberculosis prevention.

⁸ National Library of Medicine Digital Collections

⁹ National Library of Medicine Digital Collections

Durham’s health department employed a full-time tuberculosis nurse to screen and follow white Durham residents from the 1920s through the 1940s. But while its leaders recognized that infection afflicted far more African Americans, it provided a similar nurse for its Black population for only a five-year period in the mid-twenties—and even this nurse was supported by the Durham Women’s Club.

WHY DID THE DURHAM’S WOMEN’S CLUB INVEST IN THE BLACK POPULATION?

In 1923 the Durham Women’s Club raised $3400 for the health department to launch a major TB campaign (including a dedicated nurse) aimed at the city’s Black population. This was a remarkable gesture in the Jim Crow Era. Women’s clubs in this era often cooperated with health agencies in reform projects benefitting mothers and children. Racial fear likely played a role as well; many middle-class women feared that their Black housekeepers might introduce tuberculosis into their own households.

“Tuberculosis among Negroes is the most serious problem with which we have to deal… since Negro nurse maids, cooks, food handlers and personal servants in the homes of the white population, their tuberculosis problem also vitally concerns the people of the state.”

¹⁰ Biennial Report of the North Carolina State Sanatorium, 1934-1936

¹¹ Durham Morning Herald

RESOURCES WERE NOT UTILIZED

Durham’s African-American tuberculosis campaign opened with much fanfare—but few people came. Newspapers blamed “lack of interest” among the city’s Black residents, but the real reason was more likely distrust. Some Blacks may have suspected that the campaign’s real motivation was to protect the city’s white population. To many, screening offered little direct benefit, and posed substantial risks—such as losing one’s job. Screening campaigns focused on the individual did nothing to address the social conditions underlying tuberculosis.