Title VI Promised Equality in Healthcare—But Where’s the Equity?
Lesson Two: Civil Rights and Medicine 101: How Title VI brought equality not equity—and what needs to happen next.
In this Lesson, you will learn :
✅ The political fight to pass Title VI and the Civil Rights Act
✅ Why hospital desegregation was driven by policy and funding
✅ Why racial health disparities persist despite Title VI
✅ Why Title VI remains powerful but poorly enforced
Beyond Desegregation: The Fight for Health Equity Continues
In our last lesson, we discussed Dr. George Simkins Jr., a Greensboro dentist and civil rights leader who played a pivotal role in challenging segregated healthcare facilities.
Quick Recap: In 1962, Dr. Simkins, along with other Black physicians and patients, filed a lawsuit, Simkins v. Moses H. Cone Memorial Hospital, which became a landmark decision, with the Fourth Circuit Court of Appeals ruling that "separate but equal" racial segregation in publicly funded hospitals was unconstitutional.
If you have not check out Lesson one click here!
Despite this legal victory leading to the subsequent passage of Title VI of the Civil Rights Act of 1964, significant health disparities still persist.
If equality was achieved, why does healthcare still feel so unequal?
Because equality gives everyone the same rules—equity ensures those rules work for everyone.
Title VI was a landmark victory, but it was only the beginning.
Let’s explore its origins, the political battles that shaped it, and why the fight for health equity continues.
The Political Battle Behind Title VI
The journey to passing the Civil Rights Act was fraught with intense political struggle.
In June 1963, President John F. Kennedy proposed comprehensive civil rights legislation in response to nation widespread resistance to desegregation and the assassination of civil rights leader Medgar Evers.
Yet, the bill faced strong opposition in Congress, particularly from Southern legislators who employed filibusters and other tactics to block its progress.
No memorial oration or eulogy could more eloquently honor President Kennedy's memory than the earliest possible passage of the civil rights bill for which he fought so long,"
Then, serving notice on his fellow southern Democrats that they were in for a fight, he said: "We have talked long enough in this country about equal rights. We have talked for one hundred years or more. It is time now to write the next chapter, and to write it in the books of law."
- President Lyndon B Johnson to Congress after JFK’s assassination
After President Kennedy's assassination in November 1963, LBJ took up the mantle, leveraging his political capital to push the bill forward.
He emphasized the moral imperative of the legislation, stating, "Let this session of Congress be known as the session which did more for civil rights than the last hundred sessions combined."
Even with a president pushing for this agenda, the bill encountered significant hurdles.
In the House of Representatives, it was stalled in the Rules Committee, leading supporters to threaten bypassing the committee to bring the bill to the floor.
In the Senate, a coalition of 27 Republicans and 44 Democrats overcame a prolonged filibuster, marking the first time in history that the Senate voted to end debate on a civil rights bill.
Yet they persisted and won.
On July 2, 1964, President Johnson signed the Civil Rights Act into law, marking a pivotal moment in the fight against institutionalized and systemic racism.
What Title VI Did Right: The End of Hospital Segregation
Before Title VI, hospitals were brazenly discriminatory and engaged in racist tactics.
Black patients were often:
🚫 Denied care outright if a hospital was whites-only
🚫 Forced into overcrowded, intentionally underfunded “colored” wards with fewer doctors and outdated equipment
🚫 Treated as medical afterthoughts, receiving lower-quality care than white patients
When Medicare and Medicaid launched in 1965, the federal government used funding as leverage—hospitals had to integrate if they wanted access to those dollars.
Within two years, hospital segregation was (officially) over.
Dr. Simkins and his colleagues had fought tirelessly for this moment.
On paper, Title VI delivered equality—hospitals could no longer openly discriminate.
But equality does not equal equity.
Where Title VI Fell Short: Healthcare Disparities Didn’t Disappear
Title VI could end legal segregation, but it couldn’t undo centuries of embedded medical racism.
Here’s what we’re still dealing with today:
Black and Brown patients still receive lower-quality care. Studies show that doctors are less likely to believe Black patients' pain or take their symptoms seriously.
Language barriers still prevent non-English speakers from getting proper care. Hospitals are required to provide interpreters under Title VI—but many fail to do so.
Hospitals that serve Black and Brown communities are still underfunded. While wealthy, predominantly white neighborhoods have top-tier medical facilities, Black and Brown communities often rely on hospitals with fewer specialists, outdated equipment, and long wait times.
This is the difference between equality and equity.
Equality means giving everyone the same access to care.
Equity means making sure that care actually meets their needs.
Why Title VI Still Matters—And Why We Need More
Title VI is still a powerful tool—but it’s only as strong as its enforcement.
Right now, too many hospitals get away with violating Title VI without consequences. That’s why we still see:
❌ Hospitals failing to provide interpreters for non-English-speaking patients
❌ Black mothers being ignored in labor, leading to preventable deaths
❌ Discriminatory treatment decisions, like Black patients receiving less pain medication than white patients with the same conditions
If hospitals refuse to follow Title VI, they should lose their federal funding.
But Let’s be real, how often does that actually happen?
Title VI isn’t enough on its own—it’s up to us to demand stronger enforcement and push for policies that address these ongoing disparities
Next Lesson: The Fight for Healthcare Access Isn’t Over
Title VI forced hospitals to desegregate, but access to healthcare didn’t become a reality for millions until the creation of Medicare and Medicaid.
These landmark programs changed the game—giving elderly, disabled, and low-income Americans the healthcare coverage they’d long been denied.
But here’s the thing:
Medicare and Medicaid didn’t just happen—they were fought for.
And today, they’re still under attack.
🧐 Why did some politicians resist Medicare and Medicaid in the 1960s?
⚖️ How did these programs help enforce Civil Rights laws?
🚨 Why are Medicare and Medicaid STILL facing cuts and restrictions today?
The fight to protect healthcare access is just as urgent now as it was then.
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What policies woud suggest to force health professionals to work for money-losing reimbursement and compensation?