While Juneteenth has been recognized over the last two centuries as Black Independence Day—a celebration commemorating the emancipation of enslaved Black Americans—it also serves as a cruel reminder of how long our country has to go before overcoming entrenched systemic racism.
It is widely accepted that the first kidnapped Africans to reach European colonies in the Americas for the purposes of chattel slavery did so in August 1619.
It is widely accepted that the first kidnapped Africans to reach European colonies in the Americas for the purposes of chattel slavery did so in August 1619—meaning Black health was ignored from our country’s beginning with health disparities persisting through the next 400+ years.
Dungeons too dangerous to clean and suffocating ship conditions
Black health treatment, or lack thereof, often began in slave dungeons (also known as slave forts, castles and trading posts) built by Europeans traders on the Western coast of Africa. These facilities served to warehouse Africans captured from across the continent while they awaited transport as growing demand for human labor in the New World soared. In these dungeons, individuals were crammed inside of tiny spaces for as long as a year, often without water or ventilation, where they ate, slept (often standing), vomited, menstruated, urinated, and defecated. Conditions within the dungeons were so dangerous that cleaning them was discouraged due to risk of smallpox and intestinal infections.
The captives who made it onto the ship (many perished from disease, suffocation and suicide) were about to embark on the Middle Passage, infamously known as the middle leg of a three-part journey to get inland Africans to the Americas and the Caribbean islands in exchange for products for northern Europe. Dr. Carolyn Roberts, an assistant professor of history of medicine at Yale School of Medicine describes the slave trade as a medically managed enterprise that contributed to the transformation of medical management into an intercontinental pursuit.
Surviving the Middle Passage
Those who survived their time in the dungeon were seen as more fit than their dead counterparts and were likely to generate great profit if they remained healthy (alive). Thus, health was a commodity during the Middle Passage and European doctors were hired to care for Africans on the journey. Still, the travel was brutal. In addition to many of the same atrocities and conditions faced in the dungeons, captives faced seasickness and epidemics of fever, violence and sexual abuse. Some surviving records suggest that until the 1750s, one in five Africans on board died. While the true death rate for Africans transported to the Americas is likely much higher than the two million estimated to have died during the Middle Passage, we will never know for sure as record keeping was abysmal beyond what was needed for underwriting insurance.
It’s important here to note that the very foundation (and justification) of the transatlantic slave trade is false medical theories of Black inferiority and the physical differences between Blacks and whites.
It’s important here to note that the very foundation (and justification) of the transatlantic slave trade is false medical theories of Black inferiority and the physical differences between Blacks and whites. Many of these beliefs are still held by medical professionals today.
Working conditions: protecting the investment, not the person
Upon reaching their destination, many captives, now formally enslaved, suffered from outbreaks of unfamiliar diseases, viruses and bacteria brought over from European colonists such as syphilis, cholera, smallpox, measles and mumps. Additionally, enslaved people were poorly fed, abused, overworked and overcrowded.
Those not impacted by infectious diseases likely suffered from dysentery due to low living standards, poor sanitation and dense human and animal populations. Since white masters never thought of Blacks as human beings but rather human capital, enslaved individuals’ clothes went unwashed, baths were infrequent, dental care limited and housing conditions uninhabitable. Body lice, ringworm and bedbugs were the norm. Only as a last resort did slave owners bring in a doctor, in which case enslaved individuals were not consulted about their care, their condition or their symptoms and the medical report went directly to the slave owner.
Black women were at the forefront of medical experiments in attempts to advance gynecological care.
Brutal gynecological experiments set Black women up for generations of poor maternal and infant outcomes
Additionally, Black women were at the forefront of medical experiments in attempts to advance gynecological care. While this experimentation led to key medical advances still used today, much of the research was conducted without anesthesia and all of it was conducted without consent. While Black women played multiple roles on plantations including laborers and midwives, their primary function was to churn out more Black bodies – or new sources of free labor.
By law, enslaved parents did not have rights to their offspring and often were intentionally separated as punishment. This separation of Black families led to the loss of culture and language in addition to intergenerational trauma and mental health challenges.
Similar to infant mortality, a broad and common measure of the health of a population is life expectancy. While official birth and death records of enslaved individuals are few and far between, some estimates placed the average longevity of Blacks at 21.4 years in 1850, with that of whites at 25.5. In 1860, 3.5 percent of slaves and 4.4 percent of whites were over 60.
Short-lived relief for the newly freed
Following Emancipation and Juneteenth in 1863 and 1865 respectively, a Bureau for the Relief of Freedmen and Refugees was founded to offer a range of support including food, health care, shelter and legal aid to try and improve health among the newly freed. Following nearly 250 years of forced enslavement, many Black communities faced high rates of infectious diseases, infant mortality, severe malnutrition and unaddressed injuries that required resources state and local authorities could not assume post-Civil War. During its 7-year existence, the Bureau never fully fulfilled its mission due to funding and political pressure as Jim Crow era policies were in their infancy.
The century following included many peaks and valleys for Black health that are still felt today. This includes the rise of 19 Black medical schools and the subsequent forced closure of 17 of them following the Flexner Report in 1910, redlining policies that intentionally left Black communities without access to key resources like public transit and pharmacies resulting in poor social determinants of health as well as persistent police harassment and violence that led to Black Americans being overrepresented in the criminal legal system where healthcare is an afterthought.
This Juneteenth, while we celebrate the end of 250 years of forced enslavement, let’s also remember the legacy that it left.
Unwinding the legacy of health disparities continues
Over the past several years, Community Solutions has continued to highlight how healthcare in this country, and therefore health outcomes, is still haunted by slavery and medicine’s dark history. On nearly every measure, Black Americans still fare worse than their white counterparts including on maternal health (mortality and morbidity), infant health (mortality), COVID-19 infection and death rates and life expectancy. The disparities we continue to see necessitate declarations of racism as a public health crisis and a thorough plan to address it as the seeds planted 400 years ago are perennial. This Juneteenth, while we celebrate the end of 250 years of forced enslavement, let’s also remember the legacy that it left.
