Almost 156 years to the day that federal troops entered Galveston, Texas, to ensure the last enslaved people in the United States received the news that they had been freed, President Biden signed a bill making Juneteenth a national holiday.
It is a victory long overdue, to be sure, but we cannot let this symbolic win overshadow the very real work still left to be done. This watershed moment is an opportunity to further reckon with America’s racist history, face our current health disparities, and rewrite a more equitable future.
Communities of color — especially Black Americans — bore the brunt of the COVID-19 crisis. Their COVID-19 death rate is more than double that of white and Asian Americans and, even now, as more Americans are getting vaccinated, Black Americans have received a lower share of shots. This is the consequence of a convergence of factors that have compounded over time, from understandable hesitation to a lack of access. It’s no wonder that, during the pandemic alone, the life expectancy gap between Black and white Americans, which was already nearly four years, grew by nearly a year and a half.
But the pandemic merely thrust our country’s racial health disparities into sharp relief. Black Americans suffer from higher rates of diabetes, hypertension, asthma, and heart disease. Not only are Black babies less likely to survive infancy — the disparity in infant mortality rates between Black and white people is even higher now than during the antebellum period — but Black mothers are also three to four times more likely to die of pregnancy-related causes. Black children, meanwhile, are less likely to be correctly diagnosed and treated for ADHD.
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Additionally, between the pandemic and the scourge of deadly police violence against Black people in this country, more Americans, including in the health community, are coming to grips with the pernicious effect of systemic racism on people’s health. And yet, we still resist teaching the long history of that racism, and how its deep roots continue to poison the medical field today. Indeed, even as we celebrated Juneteenth, Texas — the state of its origin — recently passed a law restricting how public school teachers are permitted to talk about racism in the past and present.
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That begins with teaching students in the life sciences the truth about our racist past. While many know about the Tuskegee syphilis study, where poor Black men were denied treatment for the disease, or the story of Henrietta Lacks, whose cancerous cells were taken and used for research without her consent, few understand that the history of medicine in this country is rife with the exploitation and neglect of Black people.
During the transatlantic slave trade, kidnapped Africans were subjected to a cursory physical examination by ship doctors — and thrown overboard if they didn’t pass. For those who did make it, a lifetime of poorly ventilated shacks, abysmal nutrition, and respiratory infections awaited them. Enslaved Black women, in particular, were subjected to horrific experimentation for the purposes of gynecological research. Medical schools, including the one here at Harvard University, used Black corpses stolen from graves as specimens for dissection and study.
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At the same time, doctors and scientists across the country were spreading baseless theories about the physical and intellectual inferiority of Black people, even arguing that they had a different skeletal structure than white people. These shameful claims later gained ground in the form of eugenics, a racist pseudoscience that, among other consequences, led to the forced sterilization of countless people, disproportionately women of color.
All these disparities have been compounded by what the medical community calls the social determinants of health — defined as the conditions in which we live and work. For generations, Black communities have faced vast disparities when it comes to the neighborhoods where they live, the schools where they learn, and the places where they’re employed. Not only are they less likely to have access to quality schools and green spaces, but they are also more likely to live in neighborhoods with underfunded or lower-quality hospitals. And even when Black patients visit the same hospitals as white patients, a recent study found that they are sometimes still treated by different doctors, a phenomenon known as “care team segregation” that leads to worse outcomes for the same conditions.
Avoiding the more painful aspects of American history simply increases the risk that we will repeat them. As Richard Wright once wrote, “Black folk, our history and our present being, are a mirror of all the manifold experiences of America. What we want, what we represent, what we endure is what America is.” Marking Juneteenth a federal holiday is an important, yet symbolic, step toward acknowledging that past. We must also ensure that we all learn the truth about our racist medical past and our current racial inequities, so that we are all empowered to build a more just, and more healthy, future for all.
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Michelle A. Williams is dean of the faculty, Harvard T.H. Chan School of Public Health, and Angelopoulos Professor in Public Health and International Development at the Harvard Chan School and Harvard Kennedy School.
