Driving to Atlanta in 1931, Fisk University dean of women Juliette Derricotte and three students crashed into a car containing a white couple. As the closest hospital excluded “Negroes,” they received aid at a black home. A student died; so did Derricotte the next day, after being driven sixty-six miles to Walden Hospital in Chattanooga. This outraged blacks. Jim Crow reigned, but they fought for dignity and equality.

Black southerners evinced two broad strategies on healthcare. One accommodated to segregation, while securing financial and political concessions from whites and sustaining black institutions. Such was the case for Lincoln Hospital of Durham, North Carolina (1901), which funded three renovations but still lagged behind white Watts Hospital. Watts's assets aggregated $2,800,000 by 1950 whereas Lincoln's approximated $740,000. The second strategy pursued desegregation of medical staffs, employees, patients, and facilities.

Desegregation had major advocates along the way. These included the black National Medical Association (NMA); black caucuses in dentistry, pharmacy, and nursing; and gradually the white American Public Health Association. Founded in 1895 as the National Association of Colored Physicians, Dentists, and Pharmacists by Chicago surgeon Daniel Hale Williams (1856–1931) and others, NMA supported black physicians prior to and after the American Medical Association admitted them in 1950. Williams, who served as NMA vice president, also founded Chicago's Provident Hospital, the oldest African American hospital, where he performed the first successful open-heart operation in 1893. NMA's membership rose from about 50 in 1904 to more than 500 by 1912. In 1920 it had fifty local and state affiliates and its Journal of the National Medical Association reported on the research and service of members. Their work provided critical support to black medical schools, hospitals, and clinics, as well as in recruiting blacks into health professions. They worked alongside the NAACP, National Urban League (NUL), and other organizations to challenge and end segregated hospital care.

The NAACP and NUL led the fight, using Harvard Medical School graduate Louis T. Wright (1891–1952). The chair of the NAACP's Health Committee, he enlisted Howard Medical School professor W. Montague Cobb (1904–1990) to conduct a major study of medicine and race.