“Sick and Tired of Being Sick and Tired”: Inequality, Disease, and Death in American History

The following is an excerpt from our new book, Building the Worlds that Kills Us: Disease, Death and Inequality in American History (Columbia University Press) publishing on October 8, 2024. In it we trace the history of the social and structural inequalities in the United States and their impacts on disease and death.

“I’m sick and tired of being sick and tired.” So declared Fannie Lou Hamer, the iconic organizer of the Mississippi Freedom Democratic Party, in her famous December 1964 speech at a Harlem rally with Malcolm X. The speech, which captured the frustration and anger that she and millions of others felt about white southern resistance to racial integration in general and more specifically to the Mississippi Democratic Party’s segregationist policies, detailed the exploitation of Blacks as they worked ten- or eleven-hour days picking cotton for a mere 3 dollars per day. And it detailed how the consequences of such treatment in disease, suffering, and death were woven into the fabric of the state’s history.

As Jack Geiger, the physician-activist who went to Mississippi with the Medical Committee on Human Rights during the “Freedom Summer” of 1964, later summed up the conditions he found, African Americans “lacked medical care . . . lived in poverty . . . had huge burdens of illness and premature mortality and [had] limited or no access to medical care.” It was a history that, in Hamer’s words, was more than “a little sickening.”

Attentive observers writing about the experiences of peoples in the United States of whatever race, ethnicity, gender, or geographic region have, with good reason, similarly remarked on the often-enormous disparities in health and well-being found among different classes, races, and other social groups. Studs Terkel, in Working, his now-classic 1972 book of interviews of American workers and their families, begins by saying that the “book, being about work, is, by its very nature, about violence—to the spirit as well as to the body. It is about ulcers as well as accidents . . . fistfights, about nervous breakdowns . . . about daily humiliations. To survive the day is triumph enough for the walking wounded among the great many of us.”¹ That so much of Terkel’s book uses the language of bodily harm, physical and psychic wounds, and even disease to describe the experience of working-class peoples is itself “no accident” or even a metaphor.

The argument that Terkel uses to describe exploitation in working-class life can be used to help us reconceptualize health. After all, at their core, disease, disability, death, and psychic distress of all sorts that may have physical manifestations entail violence done to the human body. The story of ill-health is the story of damage done, by bacteria and viruses like Covid-19, by another disease attacking the body, by exposure to toxic chemicals in the workplace or in the wider environment, or by the physical harm done to people by machinery, automobiles, guns, or the whip.

There are, of course, aspects of death, disease, and suffering that lie outside human control and that have varied across time. We all die; certain genetic mutations that lead to debilitating effects are, at least so far, beyond human control; we can end up in the wrong place at the wrong time (such as by getting caught in an earthquake, volcanic eruption, or a lightning strike); or we can unwittingly be exposed to dreadful diseases for which effective treatment anywhere is not available. To a surprising extent, however, disease, suffering, and premature death are a function of the worlds that we as a society have constructed for ourselves and for others over time. They are, more particularly, often a function of specific people and groups of people making decisions that create or maintain conditions in which ill-health and suffering can flourish.

Some instances of unnecessary suffering are glaringly obvious: for example, the exploitation and often premature death of Africans who were enslaved and transported to the New World under conditions so inhumane that approximately 10 to 20 percent perished during the Middle Passage; or the suffering and early death of those who survived and were consigned by whites to forced labor in the houses and fields of the American South, where the average life expectancy of a newborn slave child was less than twenty-two years, about half that of a white infant of the same era.

To take another example, Crystal Eastman, feminist cofounder of the American Civil Liberties Union and social reformer, in her famous 1906–1907 study of Pittsburgh, Work-Accidents and the Law, wrote of 526 men who were killed in accidents in the steel mills of Pittsburgh and another 509 who suffered serious injuries in just one year, arguing cogently that many of these accidents would have been preventable if work conditions had been different. “Seven men lost a leg, sixteen men were hopelessly crippled in one or both legs, one lost a foot, two lost half a foot, five lost an arm, three lost a hand, ten lost two or more fingers, two were left with crippled left arms, three with crippled right arms, and two with two useless arms. Eleven lost an eye, and three others had the sight of both eyes damaged. Two men have crippled backs, two received internal injuries, one is partially paralyzed, one feebleminded, and two are stricken with the weakness of old age while still in their prime,” she reported.²

Even aspects of the inevitable, such as death and disease, that appear to lie outside human control are also affected by how societies care for their members. That in turn may affect the outcomes of a person’s experiences with health and disease. Race, social class, geographic location, gender, age, immigrant status, and the like all have been shown to have a tremendous impact on access to medical care and the quality of care received, which in turn shape Americans’ length and quality of life.^3,4 These and many other situations are a function of the decisions of some human beings to construct conditions, or allow such conditions to persist, that are clearly detrimental to the well-being of others, and often in ways that were perfectly obvious at the time.

The social and economic arrangements Americans have created and maintained have shaped patterns of disease occurrence, prevalence, distribution, and recovery over the course of the country’s history. Most obviously, an economic and social system dependent on slavery produced untold suffering and death among those most exploited; a commercial economy involving trade between various regions of the country and the world enabled easy transmission of diseases brought by mosquitoes, rats, and other vectors of infection; and the development of cities with large immigrant populations from the countryside and overseas allowed landlords to profit from rents of airless tenements without adequate sewerage or pure water and produced epidemics of tuberculosis, cholera, and other diseases of poverty. Similarly, the disfiguring accidents and diseases caused by toxic chemicals were often produced by the rampant expansion of a laissez-faire industrial system that put profit over human life. And decisions today to ignore the impact of fossil fuels on the climate and on the potential destruction of the health and well-being of the world’s population are perhaps the most glaring examples.

If there is one historical truth that emerges from our history it is that disease is not “caused” by bacteria or viruses or accidents. Rather, it is the conditions we as humans create that provide the nurturing conditions within which they can prosper. As the renowned epidemiologists Rene Dubos once cogently pointed out: Bacteria, he suggested, were only “opportunistic invaders of tissues already weakened by crumbling defenses.” ⁵

References

1. Terkel S. Working: People Talk About What They Do All Day and How They Feel About What They Do. Avon; 1972: xiii.
2. Eastman C. Work-Accidents and the Law. Russell Sage; 1910: 12-13.
3. Krieger N. Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm—an Ecosocial Analysis. Annual Review of Public Health. 2020;41(1):37-62.
4. Braveman P, Krieger N, Lynch J. Health Inequalities and Social Inequalities in Health. Bulletin of the World Health Organization. 2000;78(2):232-233.
5. Dubos R, Dubos J, The White Plague: Tuberculosis, Man, and Society. Rutgers University Press; 1987: 122.

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