This holiday weekend marked two significant days – Juneteenth and Father’s Day. On the surface, these days are unrelated, but they help us reflect on health inequity in the United States. Juneteenth has created a space to discuss the ongoing battle for social justice, including racialized health disparities. The rates of disease and death that have devastated Black Americans are abnormal. Yet, health inequity has become so commonplace that we appear to have come to accept it as a natural occurrence. Such a perspective overshadows the pain and suffering Black Americans endure, like being twice as likely as White Americans to lose their father to premature death.[1] Unfortunately, there are many Black Americans who honored Juneteenth while grieving the loss of a father. Therefore, I propose that the journey of emancipation will remain incomplete so long as racialized health disparities exist because premature deaths have inhibited and continue to inhibit Black Americans from living a full life.
Using Juneteenth as a point of departure for assessing health equity is useful because there has never been a time in American history when racialized health disparities have not existed. This is why historians Evelynn Hammonds and Susan Reverby argued for a “historically informed analyses” that reveal the underlying factors that contribute to health inequity.[2] History helps us uncover how the past shapes the present, including why Black Americans are more likely to die prematurely than White Americans. For example, historian Jim Downs, in Sick from Freedom, unpacked how disease and death became the consequence of emancipation during the American Civil War. Many formerly enslaved persons who absconded from plantations sought refuge under the protection of the Union Army; however, military officials relegated them to overcrowded and unsanitary contraband camps that became breeding grounds for premature death.[3] As a result, tens of thousands died from various diseases, namely smallpox. Black abolitionist Harriet Ann Jacobs, in her visit to a contraband camp in Washington, D.C., noted that as she glanced and locked eyes with the “sick and dying,” tears streamed down their face, communicating the message, “Is this freedom?”[4]
Despite the public health crisis that formerly enslaved persons faced, they did not sit idly by and die in vain. They exercised their agency and conceptualized healthcare as a civil right. Formerly enslaved persons successfully petitioned the federal government for health care, leading to the establishment of the Medical Division of the Freedmen’s Bureau in 1865, which worked to construct makeshift hospitals to serve their community. The quality of healthcare was lacking, as the Bureau’s hospitals were underfunded and understaffed. It also did not help that Bureau physicians suggested that Black people’s biological inferiority justified their high rates of disease.[5] Nevertheless, Downs illustrated how freedpersons understood access to healthcare as “fundamental to their freedom.”[6] The federal government disagreed because the Freedmen’s Bureau officially shut down in 1872.
Following the Plessy v. Ferguson decision (1896), which solidified Jim Crow’s “separate but equal” doctrine, the descendants of freedpersons continued to fight for access to quality health care. Jim Crow ensured that they would receive unequal health care at best, if any, resulting in the Black Hospital Movement.[7] Eventually, the Brown v. Board of Education decision (1954) overturned the separate but equal doctrine, prompting the National Association for the Advancement of Colored People (NAACP) to shift its focus toward health care. This focus directly influenced the Simkins v. Moses H. Cone Memorial Hospital decision (1963) that legally desegregated health care.[8]
Though health care is technically integrated today, Black Americans still have a higher probability of receiving unequal treatment. Case in point, a 2025 study reported that Black Medicare patients are disproportionately admitted to underperforming hospitals despite living closer to highly rated facilities. Some sociologists have argued that residential segregation is a fundamental cause of racialized health disparities; however, health services researcher Ellese-Roselee Akré, who led the study, concluded, “What we are seeing is segregation within the health care system itself,” which thereby increased Black Medicare patients’ odds for premature death.[9] The results of the study highlight the significance of other factors that contextualize health inequity, such as implicit bias.[10] For instance, even when being treated in a highly rated facility, Black Americans experienced more adverse patient safety events than White Americans.[11] They receive unequal treatment regardless of the quality of the hospital.
Black Americans’ limited access to quality health care may be part of the reason their premature death rate is increasing in the United States. Researchers who measured premature deaths in the United States between 2012 and 2022 found that these incidents have increased among all adults aged 18 to 65 years. Yet, Black Americans’ death rate increased by 38 percent versus 27 percent for their White counterparts.[12] Consequently, the former has a greater risk of dying before they ever qualify for Medicare. At the same time, residential segregation has produced modern-day contraband camps that continually reproduce social and environmental determinants of health. Notwithstanding the notable progress since emancipation, premature death continues to inflict irreparable harm among Black Americans.
There are various perspectives to engage regarding Juneteenth, but I think we should consider what freedom means as Black Americans continue to die prematurely. Slavery and Jim Crow are no longer realities they face. At the same time, there is a continuum of underlying factors that perpetuate racialized health disparities. If history keeps repeating itself, then it is our responsibility to explore this history to better assess how and why Black Americans are losing their loved ones well before their time. Death is an inevitable reality for every American, but Black Americans will never be free until we improve the environments in which they live and the quality of health care they receive.
Photo by Eyasu Etsub on Unsplash
Footnotes
[1] Debra Umberson et al., “Death of family members as an overlooked source of racial disadvantage in the United States,” Proceedings of the National Academy of Sciences 114, No. 5 (2017): 916, https://doi.org/10.1073/pnas.1605599114
[2] Evelynn M. Hammonds and Susan M. Reverby, “Toward a Historically Informed Analysis of Racial Health Disparities Since 1619,” American Journal of Public Health 109, No. 10 (2019): 1349, https://doi.org/10.2105/AJPH.2019.305262.
[3] Jim Downs, Sick from Freedom: African-American Illness and Suffering During the Civil War and Reconstruction (New York: Oxford University Press, 2012), 7-8, 38.
[4] “Life Among the Contrabands,” The Liberator, September 5, 1862.
[5] Downs, 10.
[6] Downs, 166.
[7] See Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York: Oxford University Press, 1995).
[8] See David Barton Smith, The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System (Nashville: Vanderbilt University Press, 2016).
[9] Lindey Culli, “New Study Identifies Racial Inequality in U.S. Hospital Admissions,” Johns Hopkins Bloomberg School of Public Health, February 12, 2026, https://publichealth.jhu.edu/2026/new-study-identifies-racial-inequality-in-us-hospital-admissions.
[10] David Williams and Chiquita Collins, “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health,” Public Health Reports 116, No. 5 (2001): 404, https://doi.org/10.1093/phr/116.5.404.
[11] Anuj Gangopadhyaya, “Do Black and White Patients Experience Similar Rates of Adverse Safety Events at the Same Hospital?,” Urban Institute, July 2021, https://www.urban.org/sites/default/files/publication/104559/do-black-and-white-patients-experience-similar-rates-of-adverse-safety-events-at-the-same-hospital_0.pdf.
[12] Irene Papanicolas, “Racial Disparities in Premature Mortality and Unrealized Medicare Benefits Across US States,” JAMA Health Forum 6, No. 11 (2025), https://doi.org/10.1001/jamahealthforum.2025.4916.
