President Abraham Lincoln signed the Emancipation Proclamation on January 1, 1863. The proclamation declared that “all slaves held in states in rebellion against the United States would be forever free.” News slowly spread across the country, finally reaching the shores of Galveston, Texas, on June 19, 1865, where Union Army General Gordon Granger announced the proclamation. This date, known as Juneteenth, is celebrated by many African Americans as the end of the shameful institution of slavery in Confederate states. Although Juneteenth is a reason to celebrate the progress made by African Americans, the holiday also represents a time to reflect on how far we as a country must still go to achieve equity for all citizens. As the newly freed slaves quickly learned, emancipation is not the same as equity.
The Salem Press Biographical Encyclopedia chronicles how, over the next hundred years, our country repeatedly failed to protect its most vulnerable citizens, with the author of “Jim Crow in the U.S. South,” describing how many states implemented laws that allowed segregation and discrimination against African Americans in many aspects of life, including healthcare. Additionally, discriminatory policies such as redlining allowed individuals and institutions alike to deny services as well as housing and business loans to African Americans and other minority communities. These laws and policies had long-lasting and damaging effects on the health of communities of color. According to a 2013 study published in the American Journal of Public Health, abolishing Jim Crow laws via the 1964 U.S. Civil Rights Act was associated with a considerable improvement in black infant mortality rates. Additionally, a 2020 study in the same journal found historical redlining was associated with a higher risk of preterm birth for residents of New York City living in specific neighborhoods. And a study published as recently as 2021 discovered higher breast cancer mortality rates in redlined census tracts in Atlanta.
Another factor impacting health equity is the historical distrust between the African American and medical communities. Consider the case of Henrietta Lacks, who was diagnosed and later died of cervical cancer. Researchers removed cells from her body after she passed away, without the consent of her family, and then used her cells (called HeLa cells) to create treatments for cancer and cures for infectious diseases. Her family never received compensation. The Tuskegee experiment—which was briefly described in an earlier blog post—is yet another infamous example of a cause for distrust in medical professionals by many in the Black community. There are several more stories about the history of mistreatment of African Americans within medical research, which are covered in detail in the book Medical Apartheid by Harriet Washington. All these events have a long-lasting impact and could be associated with modern-day health equity issues.
As we commemorate Juneteenth, there are several steps those of us in the field can take to improve health equity for our most vulnerable populations:
- Learn our history: Although we are not responsible for and cannot change the past, we must know and learn from it to create a better future for vulnerable populations. Research health disparities in your area and consider the reasons why those disparities exist.
- Self-reflect: Review and consider if any current rules, policies or business practices negatively impact vulnerable populations.
- Engage and listen: Identify and invest with impacted communities and organizations focused on improving health equity. Take time to actively listen to their concerns and work together to develop solutions.
- Foster inclusive decision-making: In your next leadership meeting, take a moment to observe who is in the room. Is someone there to represent and advocate on behalf of the vulnerable populations you serve?
Martin Luther King Jr. once said “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” We have an opportunity to create a healthier future for all if we dedicate our time and resources to addressing these inequities. As we celebrate Juneteenth, let us remain grateful for how far we have come, but never forget the long road to equity ahead of us.
Johnathan W. Leonard is associate director of local affordability for United Healthcare in Houston, and an ACHE member (email@example.com).