Rethinking the Quiet Revolution: Noncompliance, Mortality, and Public Discourse in the Era of Hospital Desegregation

Abstract

This dissertation investigates hospital desegregation in Mississippi, with special attention to hospital holdouts—institutions that remained segregated despite federal pressure and financial incentives. The Civil Rights Act of 1964 prohibited discrimination in federally funded institutions, and with the implementation of Medicare in 1966, nearly all 3,000 previously segregated hospitals were integrated within a few months to receive federal funding from the Medicare program. This became known as the “quiet revolution” of hospital desegregation. Compared with other areas of desegregation, hospitals have garnered far less empirical investigation and social science interest. This work interrogates the “quiet revolution” by examining compliance, mortality outcomes, and local newspaper discourse in Mississippi during the hospital desegregation years of 1966 to 1970. I describe the onset of hospital desegregation, highlighting the uneven and slow pace of compliance across several Mississippi counties. These findings also reveal that Black mortality increased in counties that were fully desegregated as early as 1966, and counties with hospital holdouts had the highest mortality rates throughout the period. Local newspaper discourse illustrates county-level narratives and strategies of resistance that reorganized practices into new implicit forms of de facto segregation. These patterns show that hospital desegregation was not a quiet revolution, but rather a contested process that may have preserved inequality within hospitals. These results provide evidence that hospitals, as inequality-generating machines, were important sites of contestation for equality during the Civil Rights Era.