Black health activism in the United States emerged at a time when the American welfare state was expanding and black rights were decreasing. From 1890 to 1950, a period of legalized segregation, many African Americans saw their struggle for improved health conditions as part of a political agenda for black rights, especially the right to equal access to government resources. Although it was difficult for a group with little influence on government to affect public policy, black activists struggled to draw federal attention to black health issues. They tried to make the health needs of black America a legitimate political concern for the nation. With great caution they entered the debate on the role of the state in the care of its citizens. Black health reform was gendered to the extent that men held most of the formal leadership positions and women did most of the grassroots organizing. Much like the black civil rights movement of the 1950s and 1960s, "men led, but women organized." 1 Black men played an important role in the black health movement as doctors,ministers,journalists, businessmen, and educators. Yet, men's leadership often came and went, while women's grassroots activity persisted.