Health Security for All? Racial Discourse in Presidential Health Speeches from Roosevelt to Biden

Context: Racial inequality remains a central, entrenched characteristic of American health and health care, and racial discourse strongly shapes health politics and policy. Despite this, discussions of race and health are rare in a core site of health policymaking–the presidency–though this varies across historical periods and political parties. This study examines the prevalence and nature of racial discourse in 90 years of presidential health speeches, from Roosevelt to Biden, addressing, in particular, a debate about whether racial discourse rose or fell after the Civil Rights Era. Methods: Quantitative content analysis and qualitative analysis of 1,359 presidential health speeches from Roosevelt to Biden. Findings: Attention to race was higher among Democrats than Republicans. It rose sharply during the Civil Rights Era and the COVID-19 pandemic but fell during the intervening period, with most presidents discussing race and health less than same-party Civil Rights Era benchmarks, Johnson and Nixon. The qualitative analysis shows that presidents of both parties mainly engaged in positive (though sometimes paternalistic) racial discourse, but often combined it with universalist or technical language, perhaps meant to reduce White backlash. Conclusions: The study speaks to debates about the prominence, nature and causes of racial discourse in policy-making and shows how presidents balance racial particularism and universalism.