Susan Smith writes a history of Black women's health activism and demonstrates the contributions of laywomen to public health work. Laywomen played a key role because segregation limited the number of black medical experts. Health programs Black women created reached a wide audience. Smith explores gender, class, and political dynamics of one phase of the Black struggle for improved health. Smith uses her book to place her topic in the idea of the long civil rights movement.

"The history of Black women's health activism shows that the lines of continuity stretch from the Progressive Era to the New Deal and on into the civil rights era."

Black health reform was gendered. Men held the power and women did the grassroots work. Black health activism in the US emerged at a time when the welfare state was expanding and Black rights were decreasing. Smith shows that middle-class Black activists shaped government policy by injecting concern for Black health into Southern and National public health agenda. The book is split up into two sections: (1) tracing the development of 20th-century Black health movements and (2) investigating the implementation of health policy by discussing case studies of Black women's public health work in the rural south.

My favourite part of this book was the last chapter which looks at the Alpha Kappa Alpha sorority and its involvement in health activism. She looks at them specifically in Mississippi and how in working for health activism they were setting the foundations for civil rights activism that was to come. Smith says The AKA sorority volunteers were an advance guard of a future army of activists who sought to transform the South in the coming years.

Smith ends by showing that African Americans created their solutions to Black health problems. She shows that the healthcare arena continues to be a site for social change and political activism as the nation grapples with how to meet the needs of underserved and uninsured Americans.