A City without Care: 300 Years of Racism, Health Disparities, and Health Care Activism in New Orleans by Kevin McQueeney (review)

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• A City without Care: 300 Years of Racism, Health Disparities, and Health Care Activism in New Orleans by Kevin McQueeney
• Ezelle Sanford III

A City without Care: 300 Years of Racism, Health Disparities, and Health Care Activism in New Orleans. By Kevin McQueeney. Studies in Social Medicine. (Chapel Hill: University of North Carolina Press, 2023. Pp. xiv, 271. Paper, $29.95, ISBN 978-1-4696-7392-9; cloth, $99.00, ISBN 978-1-4696-7391-2.)

Kevin McQueeney joins the likes of Keith Wailoo, Samuel Kelton Roberts Jr., and Andrew T. Simpson among a growing cohort of scholars who critically examine racial inequities and the history of American medicine and health care at the local level. With his new book, A City without Care: 300 Years of Racism, Health Disparities, and Health Care Activism in New Orleans, McQueeney brings a deep knowledge of the complex development of health care in New Orleans to join others’ studies of Memphis, Baltimore, Pittsburgh, and Houston.

McQueeney traces the development of a “racialized health care system,” which he defines as “one built on [d]ifferent levels of access to, and treatment for, whites versus nonwhites, based on the placement of individuals into racial categories, and often on ideas of scientific racism that define African Americans as biologically different from and inferior to whites” and on “[t]he embedding of racism into the structure of health care, seen most visibly in historically white health care institutions (hospitals, clinics, medical schools, etc.) that have carried out efforts of exclusion of African Americans as patients and practitioners and the exploitation of African Americans by white medical practitioners for profit and professional advancement” (p. 5). Central to McQueeney’s exploration of racialization in urban American health care is the notion that racial health disparities are historically produced.

His sweeping study traverses more than three hundred years, beginning with the French colonial foundations of New Orleans in 1718. He explores the [End Page 408] development of its white medical establishment and its connections to the economies of enslavement. By 1861, New Orleans had become “the ‘medical metropolis of the South,’” a title supported by two of the city’s first hospitals: the French Company of the Indies’s Royal Hospital and the private Charity Hospital (p. 33). Both institutions owned enslaved people. After an examination of the short-lived Freedmen’s Bureau hospital system, McQueeney recounts the development of an “alternate Black medical district,” which included the city’s Black-owned and Black-operated Flint Goodridge Hospital, a facility with more than one hundred beds (p. 14). The district also included Black doctors’ private practices. Importantly, McQueeney details the structural forces behind Flint Goodridge’s struggle for resources and Charity Hospital’s transition from a segregated white institution to one dominated by Black indigent patients. He clearly explains the impact of funding and policy shifts, at the federal and local levels, which fueled the growth of private, historically white institutions. He ends with the racialized disparities made visible by the impact of Hurricane Katrina and the recent COVID-19 pandemic.

Throughout his chronological survey, McQueeney offers a careful historical analysis of the structures that have produced and reproduced racialized health outcomes in New Orleans. He argues that at three critical turning points—1868 to 1877, the 1910s to the 1930s, and the late 1960s—the process of racialization could have been stalled or even reversed. However, McQueeney’s findings align with those of other scholars who identify the social, political, and economic processes that further entrenched racial health inequities.

McQueeney demonstrates that New Orleans was anything but “a city without care.” More than a study in the history of medicine and public health, as the author makes clear, A City without Care is an urban history. He is critical of the so-called meds-and-eds economy as urban renaissance, as he carefully follows the relationship between the city’s anchor medical institutions, namely, Flint Goodridge Hospital, Charity Hospital, and the city’s two medical schools (Tulane University’s and Louisiana State University’s). Aided by federal funding (excluding Flint Goodridge), these institutions have shaped New Orleans’s geography and spatial relationships. Consequently, these efforts of hospital...