On Juneteenth, a reflection on the historical legacy of slavery

We cannot build a healthier world without addressing the legacy of slavery.

On June 19, 1865, federal troops arrived in Galveston, Texas. Two months earlier, Robert E. Lee had surrendered his forces at Appomattox Court House, effectively ending the American Civil War. More than two years before that, President Abraham Lincoln had signed the Emancipation Proclamation, freeing enslaved populations in states where the Confederate rebellion had been present. Yet these developments had not much affected the practice of slavery in Texas, which had continued until Union General Gordon Granger entered the state and read General Order No. 3, which said, “The people of Texas are informed that, in accordance with a proclamation from the Executive of the United States, all slaves are free.” This prompted celebrations among the newly freed population and marked the end of the enslavement of Black Americans in the US.

The liberation of enslaved populations that day in 1865 became known as Juneteenth. Today, we mark Juneteenth as a pivotal moment in the country’s history and an essential part of the long story of the forces that shape health in our society. Ever since the country’s founding, racism has played a central role in determining America’s health. This began with the direct consequences of slavery—with the unspeakable horror and violence visited on those held in bondage. It later took the form of Jim Crow, redlining, and other institutionalized forms of discrimination, undercutting the socioeconomic foundations of health for Black Americans. While the civil rights and subsequent social movements did much to address these challenges, racism continues to play an inexorable role in keeping us less healthy than we could be by excluding Black Americans from the full range of conditions that support health.

It is impossible to grapple with the roots of this exclusion without an awareness of, and accounting for, the history of slavery, a history which informs our reflections on Juneteenth. The effects of holding millions in bondage continue to ripple in the present, shaping the conditions that create health gaps between Black and white Americans. We see this in everything from Black-white gaps in the material resources that generate health, to the legacy of discriminatory housing policy, to the challenge of mass incarceration, to a range of other present-day inequities. These inequities were starkly evident during COVID-19, when, in the first two years of the pandemic, Black Americans were twice as likely to die from the disease as white Americans, a vulnerability shaped, in large part, by historical disadvantage.     

In the present moment—particularly a present as unsettled as the one in which we are now living—it can be easy to lose sight of the history that informs these challenges. History—even history as significant as slavery and Juneteenth—can seem long ago, irrelevant to the concerns of the moment. Yet this is not the case. In fact, health is downstream of history. The conditions that shape health in the present are inextricably linked to what happened in the past. I have written previously on how history is a determinant of health. Just as the health of an individual is determined by her entire life course, our health as a society emerges from where we have collectively been. Consistent with the importance of history to our health, it is clear that, in this country, our conversation about health is incomplete if it does not include the history of slavery and its present-day influence.

We see history’s influence in many areas. The challenge of gun violence, for example, is informed by the country’s history as a frontier nation, where gun ownership was associated with freedom and self-reliance. And our individualistic approach to health—with its frequent emphasis on personal, over collective, responsibility—arguably stems from our country’s early philosophical emphasis on the rights and freedoms of the individual. Given history’s influence, it makes sense that the effects of slavery are still with us, that it would take longer, even, than the nearly 160 years since the first Juneteenth to fully address something so fundamental to our collective story.  

Despite the salience of slavery to the national story, we have long resisted reckoning with slavery and its present-day echoes. This is perhaps partly revealed by the fact that Juneteenth was only recognized as a federal holiday last year. This belated recognition reflects the long road we have traveled in this country to address the historical basis of racism, its influence on all aspects of the country’s life, and how far we still have to go. Public health has an important role to play in advancing this work by communicating the link between racism and poor health and by making the case that a healthy world is one where we have honestly addressed the historical roots of sickness in our society. It is our job to say that the past is a living presence in our lives, that we cannot simply “move on” from slavery, that its effects are still with us, and that our health depends on us facing them. We need to help clarify how racism is not just a question of individuals treating other individuals poorly, that it is, in fact, a consequence of fundamental structures in our society which have their roots in history. Part of the country’s journey in its engagement with race has been its growing awareness of these structures and of the importance of addressing them.

With this in mind, Juneteenth is a chance for further reflection on the challenge of racism; it is also a time for marking progress. The original Juneteenth was a liberatory event, a moment when a measure of justice, long overdue, was done. The abolitionist movement that grew in strength during the Civil War was advanced by Americans of all colors, all political parties, all social classes. It was a courageous effort to end an historic injustice and a record of the lengths to which human beings will go on behalf of the marginalized and oppressed. Juneteenth is a reminder that, as large as the forces of injustice loom, they can always be matched by people of goodwill working together towards a better world.