Hospitals and the History of Structural Racism in the United States

W. Michael Byrd and Linda A. Clayton's two-volume work An American Health Dilemma powerfully describes how racism has permeated every aspect of the US health delivery system. As part of commemorating An American Health Dilemma 25 years after its publication, this article discusses the place of hospitals in Byrd and Clayton's analysis. They argued that US hospitals have perpetuated health inequities through formal segregation, structural factors such as White flight and government disinvestment, and racist practices and ideologies that stigmatize African American patients as inferior or other. This article also seeks to integrate Byrd and Clayton's foundational work with recent scholarship on the history of community struggles against health disparities, including a new dissertation examining Chicago's Provident Hospital, the nation's first Black-run hospital. We demonstrate the enduring relevance of An American Health Dilemma and emphasize the need to recognize the role of hospitals in both maintaining and dismantling racial injustice. (Am J Public Health. 2026;116(5):643-648. https://doi.org/10.2105/AJPH.2026.308421).