Juneteenth: Dr. Charlene Brown recognizes the achievements of Black pioneers in healthcare and explores the impacts of racism on health disparities

Dr. Brown is a board-certified physician and entrepreneur with deep expertise in public health, preventive medicine, and technology innovation. She has served as Deputy Health Commissioner and a Medical Officer at the FDA and USAID. Now, Dr. Brown is a public health consultant supporting companies with COVID-19 vaccine uptake, diversity, equity, and inclusion, and more. She is the founder and CEO of CNA Simulations VR and a graduate of Harvard Medical School.

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This year will mark 157 years since Emancipation and the end of slavery in the United States.

Since then, racial discrimination and inequality in schools, workplaces, businesses, and other parts of public life, though they have been largely outlawed, still exist. The impacts of systemic and institutionalized racism on the well-being of millions of Americans have remained prominent ongoing issues within our society. In fact, it’s taken far too long for America to begin to reckon with the impacts of racism on everyone's health and wellness.

In November 2020, the American Medical Association, America’s leading physician advocacy association, declared racism a public health threat. This was a landmark move for an association that refused membership to African-American physicians as recently as the 1960s. Then, later that year, the Centers for Disease Control and Prevention (CDC) also declared racism a “serious public health threat.” You can learn more about the CDC’s “commitment to addressing racism as an obstacle to health equity” on the Racism and Health page on their website.

This public declaration is a historic and necessary step toward creating equitable healthcare solutions for marginalized communities, including Black people, in the U.S. When barriers to equitable care are removed then, all communities can ultimately live healthier lives. That’s why it’s so important that the intersections between racial inequality and health disparities be recognized and addressed.

As a board-certified physician and public health expert, I have seen firsthand how structural and interpersonal racism impacts health outcomes for Black people in the US. In honor of Juneteenth, I am celebrating this landmark declaration by the CDC as one of the earliest and most important healthcare successes of the new decade. Acknowledging and addressing the impacts of racism in healthcare is an overall win for everyone and will ultimately save lives.

What is Juneteenth?

Juneteenth, which is observed on June 19, is the oldest national celebration of the abolishment of slavery in the United States.

The holiday name is a combination of June and 19th. The day is also sometimes called “Juneteenth Independence Day,” “Freedom Day” or “Emancipation Day.”

Celebrated by Black Americans since the late 1800s, Juneteenth commemorates the arrival of Gordon Granger, a Union general, on June 19, 1865, in Galveston, Texas, to inform enslaved African Americans of the end of the Civil War and their enslavement. Although President Lincoln's Emancipation Proclamation attempted to abolish slavery more than two years prior, many owners of enslaved Africans, especially in the Deep South, purposely withheld the news that they were no longer enslaved. Communication among enslaved African Americans was limited, especially across plantations in different states, and it took years before they knew they were liberated.

Today, Juneteenth is celebrated widely in the form of parades, festivals, pageants, and, on a smaller scale, with community block parties and family cookouts. Emancipation from slavery is celebrated in similar ways in many countries around the world. For example the roots of many Caribbean carnival celebrations are in recognition of emancipation from enslavement. As the child of Jamaican immigrant parents, I didn’t understand the connections between carnival celebrations and Juneteenth until I was an adult. There is a beautiful consistency across our various approaches to recognizing and celebrating the emancipation of Africans from slavery.

You can learn more about these celebrations in the US on the official Juneteenth website and in this New York Times article.

How racism and health disparities are connected

Health disparities are rooted in systemic inequalities, and institutionalized discrimination. Economic instability, unsafe living environments, inadequate education, limited healthcare access and quality, and difficult social contexts are some of the most well-known social determinants of health. Black communities and other communities of color face greater health disparities. While racial disparities in health have affected Black people in the US for centuries, they were formally recognized by W.E.B. Dubois in his seminal 1899 book, The Philadelphia Negro. Researchers have explicitly linked higher rates of mortality, hypertension, and other health conditions to racism for decades, yet they faced an uphill battle for credibility within the medical community. Now, the disproportionate case burden and mortality impact of COVID-19 in Black and Latinx communities across the US have brought racism and racial disparities to the forefront of conversations about health equity.

In the words of the CDC, “racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color.”

Health disparities through the lens of a Black woman physician

As a public health professional and as a physician, I’ve witnessed the impacts of both structural and interpersonal racism in almost every part of my career. It shows up in the race-based assumptions that physicians make about patients, treatment choices, and the degree to which we trust what patients tell us. It happens when Black parents are pressured to accept medical recommendations under threat of a call to Child Protective Services or when Black patients are denied pain medication due to the false belief that we have a higher pain tolerance. It’s present every time we mistake race as a biological construct instead of a social one.

In late 2020, Dr. Susan Moore died from complications of COVID-19. Before she died, she described how racism was corrupting the quality of her care from her hospital bed in Indiana. Recent data has revealed that pregnancy-related mortality among Black women is more than three times higher than among non-Hispanic white women, regardless of the womens’ education or socio-economic levels. There is a large body of evidence that also helps to separate the impact of race from socio-economic status, highlighting the likely role that racism plays in healthcare with or without the negative impact of economic social determinants of health.

The attention of America’s leading public health agency to racism and health potentially marks the beginning of a new era in medicine and public health. It is also my hope that norms will continue to shift as we collectively acknowledge and work to limit the negative impact of racism in healthcare in our country.

Celebrating Black pioneers in healthcare

In recognition of Juneteenth, I am calling on all of us to pause and recognize the achievements of Black pioneers in healthcare and the successes that have positively contributed to bringing more attention to health and wellness issues impacting Black communities in America.

Perhaps one of the most prominent Black woman scientists who has garnered worldwide attention during the pandemic is Dr. Kizzmekia Corbett. Dr. Corbett is a microbiologist and viral immunologist who was one of the leading developers of the Moderna COVID-19 vaccine with the National Institute of Allergy and Infectious Diseases.

In March 2020, when just 122 people had tested positive for COVID-19 in the U.S., Dr. Corbett and a group of researchers set out to develop a vaccine for the new coronavirus. Just 13 days later, the team began the first stage of clinical trials — the first of its kind in the world and the fastest progress ever toward a possible vaccine for a novel pathogen.

Dr. Corbett has also worked to address vaccine hesitancy and rebuild trust regarding vaccination processes within the Black community. She was previously the scientific lead of the Coronavirus Vaccines and Immunopathogenesis team at the NIH. Now, she is joining the faculty in the Department of Immunology and Infectious Diseases at the Harvard T. H. Chan School of Public Health.

The distribution of the COVID-19 vaccines in the U.S. — and with that, the contributions of Drs. Corbett, Twum-Danso, Ogbuagu, and countless other Black healthcare professionals and scientists — have played an important part in addressing the global pandemic and helping protect the health and wellness of so many people, including marginalized populations.

Lastly, I will leave you with this: A win for the health of Black people is a win for everyone.

Addressing experiences of inequity affecting the Black community improves overall healthcare systems and that can positively impact other communities seeking care. It’s important to make space for conversations that directly unpack and address racism in healthcare.

Let’s challenge ourselves to make this Juneteenth a day of reflection and action. I call on my fellow healthcare providers of all backgrounds to make a personal commitment to explore how racial biases may impact your interactions with patients. Take an honest look at your feelings and choices. Take a look at the structures that you work in and contribute, however you can, to removing racism from healthcare. It takes all of us to make a difference together.

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