Most of the racially debated issues these days can be summed up by the terms “critical race theory” and “wokeism” – terms that have become the defining issues of our time even though half the people can’t explain them and the other half use them for political gain to dictate how history is taught, stripping it of any mention of slavery, racism, and LGBTQ+ people. So, I’d like to reframe the debate and ask whether there is a middle ground where we can reject racist hatred while attempting to understand it and teach the truth about past social injustices to present and future generations – to keep our children from hating our country and each other.
I thought this was a noble proposition given that my wife and I recently moved to a southern town and attended its celebration of Juneteenth, which brought the community together with arts, dance, music, spoken word and an educational panel discussion. I learned that our town, officially known as Indian Trail, takes its name from the city’s history as a trade route that connected Petersburg, Virginia, to the Waxhaw Indian settlement and nearby gold mining areas in North Carolina.
There is also some debate whether Indian Trail is situated along the path referred to as the “Trail of Tears,” a network of routes used for the forced displacement of approximately 60,000 Native Americans from the southeast U.S. to present-day Oklahoma between 1830 and 1850. It didn’t strike me as a coincidence that my hometown would be named “Indian Trail” unless it was somehow part of the actual “Trail of Tears.”
One of the likely routes comprising the “Trail of Tears” bisects Indian Trail and is now a major thoroughfare named “Independence Boulevard” – an incredible slight to the Cherokee Nation – over 5,000 of whom perished during their westward journey across the Mississippi River, many originating from North Carolina and buried in unmarked graves along the way. Even worse, Independence Boulevard is officially named Andrew Jackson Highway in homage to the seventh president of the U.S. who signed the Indian Removal Act into law and was a prominent slave trader considered by many to be an “ideal slave-owner.”
Driving west on the “Highway” takes me to uptown Charlotte in about 20 minutes. In the same amount of time, heading east, I can reach historic Monroe, North Carolina, a city marked by violence against the minority Black community during the civil rights movement years of the 1960s and where people still defend the display of the Confederate flag and monuments.
As I learned about the dark history surrounding my newly adopted hometown I thought, “Who will make reparations for the Native Americans and African Americans so unfairly treated here over the past two centuries?” Although I have long known about injustices embedded in the fabric of our society, it was Juneteenth that crystalised the connection between racism and the medical profession – by heightening my awareness of the case for reparations in general, and the case for health reparations, in particular
While Juneteenth is widely observed as a celebration of Black American history and heritage, commemorating the emancipation of the last of enslaved African Americans on June 19, 1865, the holiday also highlights health impacts of structural racism – namely, the disparity in health care and health literacy access that continues to contribute to chronic disease, hospitalization and mortality among Black Americans. The toll that health inequity has taken on the African American community is extensive, as reflected in data compiled by the Centers for Disease Control and Prevention.
Additional data presented by The Commonwealth Fund showed a surge in preventable deaths in every state in 2021, fueled mainly by COVID-19, with Black, Hispanic, and American Indian/Alaska Native people experiencing the highest mortality rates in many places. Researchers also noted that many Americans with mental health needs face barriers to obtaining care, and millions of people – particularly in the South – are wallowing in medical debt.
I was saddened to learn that North Carolina does not have the best track record when it comes to healthy living: the state ranks 39th in the country for access to mental health treatment, and it ranks in the lower half of all states in overall health outcomes and healthy behaviors.
Our town’s celebration of Juneteenth reminded me that health inequalities also extend to the LGBTQ+ community. Many LGBTQ+ individuals continue to face stigma and discrimination based on their sexual orientation, gender identity, or gender expression. As a result, research shows that the LGBTQ+ population struggles disproportionately with mental illness, substance use, and suicide.
Medical bias and social stigma particularly towards transgender and gender diverse (TGD) people is widely prevalent in the U.S. The TGD community is faced with health disparities, discrimination, harassment, and lack of access to quality health care. Gender-affirming care should be regarded as health care that can reduce health disparities and save lives. This cannot be understated in light of the increasing violence against the LGBTQ+ community and LGBTQ+ people of color – particularly transgender people – who are disproportionately affected by hate crimes.
Individuals and organizations that attempt to limit access to treatment or ban therapy intended to maintain the health and welfare of marginalized groups – African Americans, Native Americans, Latinx, Native Hawaiians, Native Alaskans, LGBTQ+ and TGD – restrict their lives and freedoms. These groups must be stopped, along with their hate-fueled ideologies, until they learn to embrace the incredible diversity and heterogeneity of the U.S. population. To me, that is the essence of Juneteenth: a time to reflect on past racial injustices and rectify ongoing health inequities in wide swaths of the populace – and maybe, just maybe, help restore our faith in humanity.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.
