It has been 400 years since the first enslaved Africans arrived in the British colonies, yet the bodies of many Americans today are still marked by the effects of that horrible institution. Across the nation, African American adults have death rates from heart disease that are about one and a quarter times higher than white adults. African American women experience pregnancy-related deaths three to four times more than their white counterparts.
As primary care physicians working in a community health center across from the Latrobe Homes housing project, down the street from the jail complex, both of us go to work each week to confront the massive health inequities that are realities for African Americans in Baltimore and across the United States.
Michelle Simmons, a mother and grandmother on the Johns Hopkins Center for Health Equity community advisory board, can feel the weight of this history on her family’s health. She grew up watching her parents struggle, sometimes having to choose between buying medicine or dinner. Her loved ones suffered from heart disease, emphysema, diabetes and cancer. Her mother died of a heart attack at 68, and her cousin died from diabetes at 62.
And, the histories of the public health often overlook the discoveries and contributions of enslaved African Americans — like the African slave Onesimus, who taught the principles of smallpox inoculation to Boston minister Cotton Mather in 1721.
These histories often erase the role of public health institutions in exacerbating health inequities. Most infamously is the role of the United States Public Health Service in initiating and continuing the Tuskegee Study of Untreated Syphilis from 1932-1972, openly deceiving 600 black sharecroppers and their families in Alabama and sought to prevent treatment for syphilis over the next 40 years.
The histories we tell often omit the role of the health care system in perpetuating health disparities, whether through delivering disparate care, regardless of income or insurance coverage; inadequate support of the providers and systems that serve poor and minority communities; institutions’ discriminatory admissions and hiring practices; and the lack of inclusion of African Americans and other minorities in positions of leadership.
We are also encouraged that under the Baltimore City Health Department B’More for Healthy Babies program, which provides local families with maternal and infant health services and support, the infant mortality rate per 1,000 live births in Baltimore City fell by 38% — from 13.5 to 8.4 — between 2009 and 2015. These efforts are slowly reducing the health divide that has characterized the African American experience since 1619.
For other meaningful interventions — and to undo the damages in this long arc — city, state and federal policies need to be informed by a combination of historical analysis, community engagement, epidemiological research and implementation science, conceived and carried out with people whose daily lives reflect the legacy of historical and ongoing injustices. Health professionals and scholars cannot succeed without understanding the bitter roots of these health inequities. Injustice cannot be resolved without acknowledging and addressing its origins.
Dr. Lisa A. Cooper (firstname.lastname@example.org) is a Bloomberg Distinguished Professor at the Johns Hopkins School of Medicine and the Bloomberg School of Public Health and director of the Center for Health Equity at Johns Hopkins. Dr. Jeremy Greene (email@example.com) is a professor of medicine and the history of medicine at the Johns Hopkins University School of Medicine.