Atlanta: “The Public Health Capital of The World”

Atlanta is a multicultural hub that has influenced the world through music, fashion, cuisine, culture, and even public health. It is home to many world-famous organizations, ranging from the World of Coca-Cola museum to the Centers for Disease Control and Prevention (CDC). Beyond the CDC, Atlanta also is also home to research institutions that influence public health and innovation, including  Emory University, Georgia State University, the Georgia Institute of Technology, and many others. This city has had a pivotal role in many of the world’s historical health movements and problems, and this influence over health has earned Atlanta the title of the “Public Health capital of the world.”  However, Atlanta’s role in public and global health has also been shaped by this city’s historical relationship with race and inequality. Currently, African Americans make up around 50% of Atlanta’s population, and the experiences and influences of Black people in Atlanta is key in this city’s relationship with public health. To uphold this city’s reputation as the public health spearhead of the world, Atlanta must continuously confront the relationship between race and public health. 

Atlanta’s journey with public health began with the opening of the Communicable Disease Center (CDC) on July 1, 1946. This organization began with the goal of preventing malaria from spreading in the South, at a time when the South was the heart of the malaria zone. In 1947, the CDC bought land in Clifton Road in Atlanta from Emory University, an area that is now known as the CDC headquarters. Additionally, the agency expanded its focus to include all communicable diseases and to aid in state health departments’ efforts. Today, CDC is recognized as the nation’s premier health promotion, prevention, and preparedness agency. [1] The CDC’s development of a global health protection platform has influenced the global response to influenza, emerging zoonotic diseases, HIV, malaria, polio, and more. [3]

The CDC was not the only influential public health figure in Atlanta history. In the early decades of twentieth-century Atlanta, African American women were leaders and promoters of their community’s health and mediators between the white power structures of Atlanta and the Black community. African American women of the Neighborhood Union, a Black women’s organization founded in Atlanta in 1908, integrated with the Atlanta Anti-Tuberculosis Association to organize one of the most successful anti-tuberculosis associations in the South. The ATA was initially made up of only white reformers, and the involvement of African American women from the Neighborhood Union in the ATA was crucial due to the fact that African Americans were 2.5 times more likely than white people to die from tuberculosis during that period. At the time, the city offered little in the way of public health care for Black citizens. Working with the white Atlanta Anti-Tuberculosis Association provided African American women reformers with an outlet for reaching out to Black residents of the city to combat the physical ramifications of segregation. [2]

The spread of tuberculosis in Atlanta forced the city to confront and engage in the intersections of class, race, and gender in health due to the racist imagery that was used to characterize the disease.  White reformers demonized African Americans as disease carriers, which was a portrayal that arose from white fears of Black working women and their movements across racial lines. This was especially true for African American domestic workers that worked in white homes.  It wasn’t until 1914 that Black and white women reformers began a tentative discussion of how to incorporate black members into the Anti-Tuberculosis Association (ATA). Lugenia Burns Hope, a prominent African American leader in the Neighborhood Union, was able to draw on networks that were already created by black clubwomen to partner with white public health workers in Atlanta to develop a program for city health. This program was created based on the shared belief that physical health is fundamental to citizenship. Hope lead this work under the belief that the formation of healthy communities and disease eradication were all a part of a larger and necessary community-building initiative for African Americans. [2]

The actions of leaders such as Hope created a system of public healthcare for Black Atlanta residents, all in the midst of the racial violence Black people faced in the South during the early twentieth century.  Black women spearheaded various reform campaigns, such as advocating for school and neighborhood sanitation, opening a settlement house and a health clinic, and more. Through their leadership, these women challenged segregation, racial violence, and political disfranchisement to influence the public health of Black Atlanta residents. [2] Their efforts forced the city to approach and address these barriers to health head-on during major public health crises. 

Similar to the segregated past of public health movements in Atlanta, many of this city’s well-known hospitals share this history of racial division. For example, Grady Memorial Hospital is known as a pillar of public medical and surgical care in the Southeast. When Grady Memorial Hospital first opened its doors in 1892, it was directly in the heart of Atlanta’s Black community. It was built with separate and unequal facilities and services for Black and white patients, creating the concept of “the Gradies.” This segregation went on well into the twentieth century, until the 1960s when The Atlanta Student Movement, supported by Dr. Martin Luther King Jr., led protests outside of Grady to advocate for the desegregations of hospitals.  On June 1, 1965, a memo from hospital superintendent Bill Pinkston stated that “All phases of the hospital are on a non-racial basis, effective today.” [8]

This relationship between race and public health in Atlanta is not limited to history.  According to a study that was published in Cancer Epidemiology in 2016, Atlanta has the widest gap in breast cancer mortality rates between African American women and white women of any U.S. city. [4] Atlanta is also the city with the nation’s highest death rate for Black men with prostate cancer, as Black men experience 49.7 deaths per 100,000 residents compared to the 19.3 mortality rate for white men. [6] The racial disparities in health in Atlanta were further highlighted as the city grappled with the COVID-19 pandemic. A study conducted in 2020 in the Metropolitan Atlanta area highlighted the issue that older, Black, male patients with underlying conditions were more likely to be hospitalized with COVID-19. [5]

To uphold Atlanta’s reputation as the public health capital of the world, this city must continue to expand the work that addresses health disparities locally, nationally, and globally. The CDC has acknowledged this need through the inclusion of racism and health in their areas of study.  Atlanta, specifically, is attempting to also address this with the HR78 Georgia Bill, which is a resolution declaring racism a public health crisis in Georgia. Beyond acknowledgment and research, this work must involve Black Atlanta community members to truly address the racial disparities in this city’s health in a holistic and sustainable way and to influence the way that health disparities are addressed globally. 

1. https://www.cdc.gov/healthyschools/bam/basics/our-history.htm
2. Judson, S. (1999). Civil Rights and Civic Health: African American Women’s Public Health Work in Early Twentieth-Century Atlanta. NWSA Journal, 11(3), 93—111. http://www.jstor.org/stable/4316683
3. Tappero, J. W., Cassell, C. H., Bunnell, R. E., Angulo, F. J., Craig, A., Pesik, N., Dahl, B. A., Ijaz, K., Jafari, H., Martin, R., & Global Health Security Science Group (2017). US Centers for Disease Control and Prevention and Its Partners’ Contributions to Global Health Security. Emerging infectious diseases, 23(13), S5—S14. https://doi.org/10.3201/eid2313.170946
4. Hunt, B. R., & Hurlbert, M. S. (2016). Black:white disparities in breast cancer mortality in the 50 largest cities in the United States, 2005-2014. Cancer epidemiology, 45, 169—173. https://doi.org/10.1016/j.canep.2016.07.018
5. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 – Metropolitan Atlanta, Georgia, March—April 2020. MMWR Morb Mortal Wkly Rep 2020;69:790—794. DOI: http://dx.doi.org/10.15585/mmwr.mm6925e1
6. Fletcher SA, Marchese M, Cole AP, et al. Geographic Distribution of Racial Differences in Prostate Cancer Mortality. JAMA Netw Open. 2020;3(3):e201839. doi:10.1001/jamanetworkopen.2020.1839
7. https://www.atlantahistorycenter.com/blog/a-history-of-the-cdc-in-atlanta/
8. Lovasik, B. P., Rajdev, P. R., Kim, S. C., Srinivasan, J. K., Ingram, W. L., & Sayed, B. A. (2020). “The Living Monument”: The Desegregation of Grady Memorial Hospital and the Changing South. The American surgeon, 86(3), 213—219.