Population ecology and the racial integration of hospitals and nursing homes in the United States

Milbank Q. 1990;68(4):561-96.


Although the passage of major civil-rights legislation in the 1960s compelled American hospitals to take concerted steps to achieve racial integration, nursing homes did not come under the same organizational and financial pressures to do so. As a result, nursing homes remained significantly segregated; to this day, there is a greater discrepancy between black and white people's access to long-term-care facilities than to acute-care hospitals. The perspective of population ecology may be used to help account for these disparate historical outcomes; economics, demographics, and more subtle patterns of discrimination continue to reinforce forms of segregation in health-care facilities.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans*
  • Catchment Area, Health
  • Civil Rights / legislation & jurisprudence
  • European Continental Ancestry Group
  • History, 20th Century
  • Hospital Administration / history*
  • Hospital Administration / legislation & jurisprudence
  • Humans
  • Medical Staff Privileges
  • Nursing Homes / history*
  • Nursing Homes / legislation & jurisprudence
  • Organizational Innovation
  • Population Dynamics*
  • Prejudice*
  • Race Relations*
  • United States