“In the minds of our grandparents, black and white, that’s just the way it was,” said Nathaniel Wesley Jr., a health care consultant and authority on hospitals that serve a primary black patient population. “It was our way of life.”

So African-Americans built their own hospitals. Black-owned or –operated hospitals were prominent in the South and in northern cities from the time of slavery until the Civil Rights era of the early 1960s.

“Originally created to provide health care and education within a segregated society, they evolved to become symbols of black pride and achievement,” Vanessa Northington Gamble writes in her book, Making a Place for Ourselves: The Black Hospital Movement, 1920 to 1945. “They supplied medical care, provided training opportunities, and contributed to the development of a black professional class.”

In the pre-Civil War South, a few large plantations assembled clinics for slaves. In 1832, in Savannah, Ga., the first white-run hospital for blacks, the Georgia Infirmary, was established “for relief and protection of aged and afflicted Africans,” Gamble writes.

After the war, whites built segregated hospitals for blacks. The movement changed radically in 1891 in Chicago, when Dr. Daniel Hale Williams, a black surgeon, established Provident Hospital and Training School on the city’s South Side.

“Some members of the black community accused [Williams] of perpetuating segregation,” Gamble notes. “One minister went so far as to curse the building and pray that it would burn to the ground. Williams was able to overcome such criticism because of the wide biracial support that the hospital received.

“Furthermore, the founder perceived the hospital not as an exclusively black enterprise, but as an interracial one that would not practice racial discrimination with regard to staff privileges, nurse training school applicants and the admission of patients.”

Four years later, Williams helped found the National Medical Association, the nation’s largest black physicians association. In 1908, black nurses — who also counted on black hospitals for training — formed the National Association of Colored Graduate Nurses. The nurses group disbanded in 1951, apparently prematurely; 20 years later, the National Black Nurses Association was formed. Black hospitals flourished, their numbers hitting 118 in 1919, Gamble writes. In 1923, the NMA formed the National Hospital Association to encourage establishment of black hospitals. In all, about 500 were established.

The number fell rapidly when African-American physicians gained admitting privileges to white hospitals starting after World War II, and communities no longer felt the need to support such institutions. The National Hospital Association succumbed in the 1940s when the NMA stopped supporting it.

A few black hospitals remain. Scholars are left to argue over their legacy. Some say that America’s racial divide persists and black hospitals are uniquely positioned to address the needs of African-Americans. Others acknowledge that the divide exists but is slowly narrowing, and in any case, segregration is never a good thing.

And while disparities in care remain, health care leaders are focused on eliminating them. The American Hospital Association launched the 123forEquity Pledge to Eliminate Health Care Disparities. Its Institute for Diversity in Health Management educates hospital leaders on how to ensure that their executive team, staff and boards reflect the ethnic, social and socioeconomic diversity of the communities they serve.

Editor’s Note: This article was adapted from “A Place for Ourselves” written by Philip Dunn, which appeared in the book, “100 Faces of Health Care” published by the AHA.