Introduction to Healthcare Disparities in the Deep South
MONTGOMERY, Ala. — Tara Campbell unlocked the front door of the Bricklayers Hall, a no-frills brick building on South Union Street in downtown Montgomery, half a mile from the white-domed Alabama Capitol.
She was dressed in leggings, a T-shirt and bright blue running shoes. It was 8 a.m. on a Saturday, and she exuded the bouncy enthusiasm of a Zumba instructor as she welcomed the handful of Black women who’d just arrived.
Like Campbell, they were dressed for a workout. Three of them wore Wonder Woman socks that boasted tiny capes, which earned some laughs.
The women were ready for a two-mile group walk around Montgomery’s historically Black Centennial Hill neighborhood. But Campbell wanted to give them a quick tour of the building first.
For most, it was their first time inside the new Montgomery outpost of GirlTrek, a national organization dedicated to improving the health of Black women. A veteran of the nonprofit group’s Chicago chapter, Campbell moved south three months ago to open the new office in Montgomery.
GirlTrek chose its location deliberately. The Bricklayers Hall was the nerve center of the 1955-1956 Montgomery bus boycott, which successfully desegregated the city’s public buses and became a model of nonviolent protest. The Rev. Martin Luther King Jr. and other boycott leaders strategized inside the hall, where King also kept an office.
That office is now Campbell’s office. GirlTrek’s walking teams are designed to empower Black women to improve their health, but also to encourage civil rights-inspired activism to tackle broader health disparities.
The Bricklayers Hall, located in the historically Black neighborhood of Centennial Park in Montgomery, Ala., was the nerve center for the 1955-1956 Montgomery bus boycott touched off by Rosa Parks. (Anna Claire Vollers/Stateline/TNS)
Civil Rights and Healthcare
This year marks the milestone anniversaries of several civil rights victories: the 70th anniversary of the bus boycott, the 60th anniversary of the Selma-to-Montgomery marches, the landmark Voting Rights Act of 1965.
But 2025 also marks the 60th anniversary of Medicaid, the public health insurance program for people with low incomes.
The creation of Medicaid isn’t typically considered a civil rights victory. But the idea of health care as a human right was very much a part of the Civil Rights Movement, as was the belief that universal coverage could help dismantle racial inequities in health care.
“The connection between Medicare, Medicaid and the Civil Rights Movement was there from the beginning,” said Zachary Schulz, a history lecturer at Auburn University who specializes in public health history and policy. “Desegregation is often discussed in education, but there could be an argument made that it began in health care.”
Many of the Alabama communities that were home to the fiercest civil rights battles of the 20th century still grapple with systemic neglect that’s resulted in poor health outcomes, high uninsured rates and a shortage of medical providers.
Healthcare Disparities in Alabama
In the neighborhoods around the Alabama Capitol, where nearly 50,000 people gathered in March of 1965 to meet the Selma-to-Montgomery marchers and push for voting rights, nearly a quarter of residents don’t have health insurance, according to the latest U.S. census data, for 2023. Around the Bricklayers Hall, the median household income is about$23,615, less than half of what it is statewide.
The neighborhood’s closest hospital filed for bankruptcy in February.
Statewide, 12% of Black residents under age 65 are uninsured, compared with 8.2% of white people and 10.3% for all races, according to the census.
Just as civil rights activists marched for voting rights and an end to segregation, the next generation of organizers is demanding something they see as no less essential: the right to accessible, affordable health care in a system that continues to deny it.
The Fight for Medicaid Expansion
The women in the Saturday morning walking group come from different neighborhoods across the city. Most said they have health insurance. But everybody knows somebody who’s struggled to get the health care they need.
Campbell believes unjust policies harm the health of Black women everywhere — and wants to encourage them to continue pushing for change.
One policy change that has long been the focus of rallies, committee hearings and advocacy across the state: Alabama’s refusal to expand Medicaid to more adults under the Affordable Care Act, despite evidence that the state’s health care system is failing huge swaths of Alabamians. Alabama consistently ranks at or near the bottom in health measures, including high rates of heart disease, obesity and maternal deaths.
“We’re trying to save our own lives,” Campbell said. “We’re here in the footsteps of the Civil Rights Movement where, when they walked, things changed.”
The Most Shocking and Inhuman
Black medical leaders of the Civil Rights Movement, such as Dr. W. Montague Cobb, advocated for the passage of Medicaid and Medicare. Others, including King, spoke of health care as a moral imperative. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman,” he reportedly said in a 1966 speech to health care workers.
When Medicaid and Medicare launched that year, many Southern hospitals were still segregated. The feds sent teams to thousands of hospitals over the next few years to make sure they were following federal law before they could receive federal Medicare and Medicaid funding.
“Southern states were especially resistant back then to participation because it required compliance with federal regulations, including civil rights laws,” said Schulz, of Auburn University. Alabama didn’t launch its Medicaid program until 1970.
Some see echoes in today’s debate over Medicaid expansion.
Connect and Keep Moving
Less than three miles from the Bricklayers Hall, Valtoria Jackson pastors the St. Peter African Methodist Episcopal Church. Her flock is a small but active Black congregation whose mission work often centers on health issues. Situated in a lower-income Montgomery neighborhood that’s recently seen signs of gentrifying, the church has sponsored a community garden, fitness classes and a fund to help neighbors pay their medical bills.
Jackson has also been a nurse for 41 years, most of them in Montgomery, and reckons she’s worked at every hospital in the city.
“I see myself as a connector,” she said. “I don’t like being in front. I just connect and keep moving.”
On a recent weekday morning she was in her car, delivering boxes of food to older people as part of a nutrition program funded by the U.S. Department of Agriculture. She’s also a familiar face in Montgomery’s advocacy circles. She’s spoken at rallies on the steps of the state Capitol, protesting with organizations such as the Poor People’s Campaign against poverty and for universal health care and Medicaid expansion.
“There’s no reason we shouldn’t have Medicaid expansion here in the South,” Jackson said.
Good Sam
In 1965, Lula Edwards was a 35-year-old nurse at Good Samaritan Hospital in Selma, Alabama. The hospital, known in the community as “Good Sam,” was the only medical center in six counties that was open to Black people.
On March 7, 1965, its hallways filled with the bleeding and injured after Alabama state troopers attacked civil rights marchers on the Edmund Pettus Bridge in what would become known as Bloody Sunday. Edwards was supposed to be off work that day, but was called in to care for the wounded.
Outside of her hospital work, she kept her Montgomery home open to people who needed treatment. For Edwards, community-based care was a human right.
“She treated people in her own home when she wasn’t at the hospital, giving people their shots, giving stitches, giving medicine,” said her grandson, Robert Stewart. “She was right there in the neighborhood and treated them for free.”
Stewart was determined to continue her legacy and that of his other grandparents, who marched in Selma during the Civil Rights Movement and helped register people to vote.
Conclusion
The fight for healthcare is a fight for human rights, and the women of GirlTrek are at the forefront of this battle. By walking and advocating for change, they are demanding that their voices be heard and that their health be prioritized. The legacy of the Civil Rights Movement lives on through their efforts, and it is a reminder that the struggle for justice and equality is far from over.
FAQs
Q: What is GirlTrek and what is its mission?
A: GirlTrek is a national organization dedicated to improving the health of Black women through walking and advocacy.
Q: What is the significance of the Bricklayers Hall in Montgomery, Alabama?
A: The Bricklayers Hall was the nerve center of the 1955-1956 Montgomery bus boycott and is now the location of the Montgomery outpost of GirlTrek.
Q: What is the current state of Medicaid expansion in Alabama?
A: Alabama has not expanded Medicaid to more adults under the Affordable Care Act, despite evidence that the state’s health care system is failing huge swaths of Alabamians.
Q: What are the health disparities faced by Black communities in Alabama?
A: Black communities in Alabama face high rates of uninsured residents, poor health outcomes, and a shortage of medical providers.
Q: How can individuals get involved in the fight for healthcare justice?
A: Individuals can get involved by advocating for Medicaid expansion, supporting organizations like GirlTrek, and demanding that their voices be heard in the fight for healthcare justice.
