In his classic 1899 book, the Philadelphia Negro, W.E. B. Du Bois provided a detailed characterization of the “negro problem” in America (Du Bois 1899). His insightful analysis indicated that the higher level of poor health for blacks was one important indicator of racial inequality in the U.S. In the late 19th and early 20th century the dominant medical paradigm attributed any observed racial difference in health to innate biological differences between racial groups (Krieger 1987). In contrast, Du Bois (1899) saw racial differences in health as reflecting differences in “social advancements:” the “vastly different conditions” under which blacks and whites lived. He argued that although the causes of racial differences in health were multi-factorial, they were nonetheless primarily social. The list of contributing factors included poor heredity, neglect of infants, bad dwellings, poor food and insanitary living conditions. For example, consumption (tuberculosis) was the leading cause of death for blacks in Philadelphia and Du Bois (1899) indicated that the causative factors were primarily environmental. He stated that “bad ventilation, lack of outdoor life for women and children, poor protection
