Kevin McQueeney is Assistant Professor of History at Nicholls State University. This interview is based on his new book, A City without Care: 300 Years of Racism, Health Disparities, and Health Care Activism in New Orleans (University of North Carolina Press, 2023).
JF: What led you to write A City without Care?
KM: A City Without Care is based on my doctoral dissertation. I had lived and worked in New Orleans prior to pursuing my PhD in History at Georgetown University, and I knew that I wanted to research and write about the Crescent City. While living in New Orleans, I had been struck by the physical presence of the health care sector, which occupied large swaths of the landscape. However, despite the existence of multiple medical schools, many hospitals, and other health care institutions which employed thousands of residents, I knew that a wide health and health care disparity existed. Black New Orleanians had significantly higher disease and mortality rates, and were underrepresented as medical students, physicians, and health care administrators. I wanted to explore the historical reasons for these issues. What factors led to the development and perpetuation of a health care system that has been both deeply connected to the city’s economy and success, and contributed to racial discrimination and health inequity.
JF: In 2 sentences, what is the argument of A City without Care?
KM: This work argues that a racialized health care system, a system built on the historical exclusion and exploitation of non-whites, emerged as a key component of the slave-based economy, became institutionalized with the end of Reconstruction and the rise of Jim Crow, and helped support the system of segregation in New Orleans; sadly, a racialized healthcare system, with racism deeply embedded in its structure, still exists today. Black New Orleanians fought for access to health care and improved health, including carving out their own health care system, but always had to confront the limits imposed by the racist hierarchy and government policies that helped perpetuate racialized health care.
JF: Why do we need to read A City without Care?
KM: While this work concentrates on New Orleans, I believe the findings mirror the historical experiences of many African Americans nationwide who have faced the same struggles over access to health care and the perpetuation of racial health inequities. Compared to whites, African Americans and other historically marginalized communities have significantly lower life expectancies, and higher rates of disease, chronic health conditions, infant mortality, pregnancy-related mortality, and all-cause mortality. These health disparities reflect lack of access to health care, including lower rates of health insurance and preventative care.
Health disparity is a significant issue, one that has received greater attention in the past three years due to the notable racial mortality gap for victims of COVID19. Analysis of this disparity is vital, but it is important that we do not simply ascribe this issue to individual choices about health or reduce the problem to trying to promote healthier lifestyles. Health disparity reflects what are called the social determinants of health, which include access to health care, but also housing, education, employment, access to food, exposure to pollutants, and other factors. While my work concentrates on the health care system, it also addresses these other areas of social determinants of health.
Additionally, the health care sector is an important economic field not just in New Orleans, but in cities throughout the country. Currently, the health care industry is the largest employment sector in the United States, and is projected to be the fastest growing field in the next decade. Yet, the expansion of the health care sector is not without significant problems. Medical centers are one of the driving forces of gentrification. The health care field is rife with the racial sort of minoritized people into lower-paying jobs and under-representation in higher-paying positions, including physicians and surgeons. For example, African Americans are about 13% of the population nationwide, yet make up less than 6% of doctors; in Louisiana, African Americans make up over 31% of the state’s population but are less than 8% of doctors. Surveys of medical students have found that many white students hold false beliefs about racial physiological differences, including the prevalent idea that African Americans patients have thicker skin and do not feel pain as much as whites. These problems are the legacies of our historically white health care system and the promotion of scientific racism. Institutional racism pervades health care. While my work does not contain all the answers on how to dismantle this problem, I hope that it can contribute to a necessary conversation about what we need to not only address issues within the health care field, but what we can do to improve social determinants of health and overall health for historically marginalized communities.
JF: Why and when did you become an American historian?
KM: After college, I worked in the social justice, non-profit field through the AmeriCorps National Service Program and as a construction supervisor with Habitat for Humanity. I worked in New Orleans, and was fascinated by the city’s rich history. I read broadly about New Orleans’s history, and also whetted my appetite for history by listening to history audiobooks and Backstory, the American History Podcast, while building houses for work. I was especially interested in works that addressed historical roots of contemporary social justice issues. I decided to pursue my Master’s degree in history at the University of New Orleans, which allowed me to continue working as I earned my degree. There, I was fortunate to work with inspiring professors, including my advisers Michael Mizell-Nelson and Mary Niall Mitchell, who both encouraged me to earn my PhD and become an academic historian. At Georgetown University, my mentor Marcia Chatelain also modeled how to use historical scholarship to address social justice issues. I am currently an Assistant Professor of History at Nicholls State University in Louisiana, and I hope that I can be the same kind of scholar, teacher, and mentor that inspired me to become an historian.
JF: What is your next project?
KM: My next project focuses on a small period in New Orleans that I briefly address in my first book—the year 1994—which witnessed a peak in several public health epidemics: gun-related homicides; HIV/AIDs cases and deaths; and exposure to lead poisoning and other toxins. The work will utilize a historical epidemiological approach to analyze the factors that led to this syndemic and its impact, as well as explore how the African American community responded to these events in terms of both activism—including resident-initiated lawsuits—and cultural expression. I plan to add two other cities as case studies.
JF: Thanks, Kevin!