Juneteenth, and the history that shapes our health

Reckoning with the past, to shape a healthier future.

These essays aim to tackle what is most fundamental to the pursuit of health. Centrally, this means addressing ideas, recognizing that all we do in pursuit of health fundamentally starts with the ideas we embrace. However, these ideas are shaped by a broad range of forces, including, perhaps centrally, our history. Our history shapes our health. Where we come from, our family circumstances, our access to education and safe neighborhoods, the conditions of our past all influence our health in the present.

Just as we have a history as individuals, we also have a past collectively, as members of a society, as citizens of a country. Just as our past as individuals profoundly affects our health in the present, our health as a people cannot be understood without consideration of our common history. Our present is shaped by a range of intersecting legacies. These include the legacies of various philosophical systems, such as the Enlightenment, the legacies of wars, of colonialism, of technological progress, of movements for social justice.

And, in the US, they include—centrally, tragically—the legacy of slavery.

It is an inescapable fact that the origins of the US were deeply bound to the practice of slavery, in all its injustice, theft, violence, and human misery. The country cannot be understood without considering this shameful period in our history or without engaging with how the legacy of slavery shapes the present day.

This week, we will celebrate Juneteenth, a day when we reflect on the legacy of slavery, acknowledge the progress we have made and the work still to be done in reckoning with this legacy. Juneteenth marks when, on June 19, 1865, in the last days of the American Civil War, Union General Gordon Granger issued General Order No. 3. The order, which was issued over two years after President Abraham Lincoln signed the Emancipation Proclamation and two months after Robert E. Lee surrendered his forces at Appomattox Court House, freed enslaved persons in Texas, the last place in the United States where slavery persisted.

The issuing of General Order No. 3 contains within it the tragic paradox of American history. On one hand, it marks a moment of liberation, of hard-fought gains in the struggle for justice and equality. On the other hand, the fact that it was necessary at all—the fact that we had slavery in the first place—reflects how deeply injustice had taken root in the US, and how it is on all of us to do the hard, necessary work of addressing it. This is arguably reflected in the delay in recognizing Juneteenth as a federal holiday, which was only accomplished in 2021. Such delay is typical of the frustratingly slow pace at which the US has addressed the challenges posed by racism and the legacy of slavery. The issuing of General Order No. 3 was a great day and worth celebrating, but we should not forget that the end of the Civil War marked the start of a century of Jim Crow, lynchings, and second-class citizenship for black Americans, the effects of which are still with us to this day. This legacy is not easily washed away; rather, it is the work of each generation of Americans to come to grips with it anew, to keep advancing the slow but real progress we have made, towards creating a better, more just country.

Why did we wait so long? Why did we drag our feet on addressing injustice, a problem of such urgency that it should have been the priority of every generation to solve? There are many answers to these questions, but, perhaps fundamentally, we failed to address injustice because doing so is simply hard. It is hard to try to come to grips with the scale of a moral atrocity like slavery. It is hard to think about how this crime against humanity is not really that far removed from our own time and is still influencing our society in ways we may not want to admit. It is hard to look honestly at who we are, where we have been. It is hard to do this as individuals and it is hard to do this as a society.

Yet we must look. If we do not, we risk letting the legacy of injustice—as well as ongoing injustices that persist in the present moment—go unaddressed, to the detriment of our collective health. In public health, it is on us to refuse to turn away from these challenges; instead, we should engage with the inequities and injustices that keep populations from being fully healthy.

This means looking at all the ways the health of black Americans is still, in 2024, held back. Black Americans persistently experience greater risk of a range of health challenges, from diabetes, to gun violence, to maternal mortality. The reasons for these challenges are complex, but any consideration of them must include the historical conditions that have placed black Americans at a disadvantage. Juneteenth, in addition to being a day of celebration, is a time to acknowledge the challenges we still face in addressing the injustice that causes these health gaps. It is a moment to double down on our efforts to create a healthier world where, by reckoning with the past, we can move towards a better future.

It is true, of course, that we have made substantial progress in addressing the challenge of racism in this country, that the spirit that led to the end of slavery and Jim Crow continues to animate efforts to roll back injustice in the US. It is also true that we have not done enough, that the persistence of black-white health gaps is just one example of the work that is left to do. There is a counternarrative in this country that says that, actually, we do not need to engage with history, that we have arrived at a moment when we can stop talking about the past. Slavery was a crime, this narrative says, but it was long ago, far removed from the moment we are in. It is true that slavery in the US ended over one hundred and fifty years ago, but history and health are like a river, and what happens in the present flows from far upstream. In the US, slavery remains a foundational upstream determinant of health.

In answer to those who say addressing this history is too hard, too uncomfortable, it is important to remember that the reason the present is better than the past is because prior generations were willing to face the ugliness in our national story, to reckon with how we have fallen short of our highest ideals. This reckoning is as difficult as it is necessary, reflecting how the work of building a better future is rarely easy. The path that leads us to a healthier world is not a well-maintained sidewalk on a sunny street. It is more akin to the paths taken by characters in fables, leading through dark forests populated by much that is unpleasant, that challenge us, that force us to confront who we are and who we have been. As we travel down this path together, the progress we have made should motivate us to go further, work harder, towards a healthier world.

A version of this essay appeared as a message to the Boston University School of Public Health community.