Du Bois names tuberculosis as "not a racial disease but a social disease." Increasing understandings of germ theory during this era have begun to increase general awareness that germs don't recognize racial lines. In some places, this begins to force the racial integration of the health care system, but in others, it prompts the establishment or expansion of segregated healthcare for Black people.

Du Bois and Dr. Booker T. Washington represent two different strategic approaches to change. Washington focuses on providing skills and education to Black community members, and Du Bois focuses on poverty and social conditions as the primary causes of Black health struggles.