The Emancipation Proclamation was issued on January 1, 1863, freeing all slaves living in Confederate states. However, it wasn’t until June 19, 1865 that enslaved African Americans in Galveston, Texas learned that the Civil War was over, and they were free. It is important to remember that the proclamation did not free all slaves; instead it only freed slaves in Confederate states while slaves living in Union states that bordered the Confederacy were not freed until the ratification of the 13th Amendment on December 6, 1865.
Lincoln was ambivalent about freeing the slaves and the country has been ambivalent about the equality and role of African Americans ever since. While Juneteenth is celebrated as a day to commemorate the ending of slavery in the United States, it is also yet another reminder of how black people are always forced to wait for good news to come, and how we are forced to wait even longer for change to come as a result of the good news.
One hundred years after the Emancipation Proclamation, Martin Luther King Jr. wrote in his Letter from Birmingham Jail, “For years now I have heard the word ‘Wait!’ It rings in the ear of every Negro with a piercing familiarity. This ‘wait’ has almost always meant ‘never.’ … We must come to see with the distinguished jurist of yesterday, that ‘justice too long delayed is justice denied.’ We have waited for more than 340 years for our constitutional and God given rights.”
African Americans still waiting for equal treatment
And now, 57 years later, African Americans are still waiting to be treated as equal and valuable members of American society. One hundred and fifty-seven years after the Emancipation Proclamation African Americans are still viewed as “less than” by many in the United States. The results of this “lesser” status are easily documented in reports on health outcomes, employment, housing, education and incarceration.
As a physician, I am acutely aware of how long we have waited for health equity and how far from it we remain. I continue to be distressed by persistent disparities in health outcomes by race in this state and in the country as a whole.
Here in New Jersey, the average life expectancy for blacks is three years less than that of whites and 15 years less than Asian life expectancy. African Americans die at disproportionately higher rates from eight of the 10 leading causes of death in the state. African American death rates from both diabetes and kidney disease are twice the white death rates. African Americans are 21 times more likely to die from HIV disease and 12 times more likely to die from homicide. A black infant born in Trenton today will on average live to be 73 years old, while a white infant born 12 miles away in Princeton Junction will live on average 14 years longer, dying at age 87. That same black infant is three and a half times more likely to die in the first year of life when compared to a white infant, and the mother of that black infant is nearly five times more likely to die during the peri- and postnatal periods than is a white mother. And of course, we now must add COVID-19 to the list of illnesses that disproportionately kill African Americans. A recent study from Yale estimates that African Americans are nearly three and a half times more likely to die from COVID-19 than whites in the United States. While the degree of excess mortality from COVID-19 in New Jersey is not as stark as in other parts of the country, disparity in COVID deaths exists here as well.
Jarring insights into the disparities
Increasingly, we have come to understand that the most significant contributors to overall health in the United States are social determinants of health. The World Health Organization defines social determinants of health as “…the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
An examination of some of these social determinants for African Americans in New Jersey provides jarring insights into the inequities in health outcomes that exist here. If we look at key economic indicators in the state, we see that median net worth for white households is $309,396 compared to $5,900 for black households. This represents more than a fifty-fold difference. Median household income for white households is $84,000 compared to $47,300 for black households. This is essentially half the income of whites in the state and 40% of the median household income for Asians.
On the education front, New Jersey has some of the most segregated schools in the country. The vast majority of black and Hispanic children attend schools that are over 70% black and Hispanic. In schools that are 99% black and Hispanic, 80% of the children live in poverty. The segregation in schools is the result of segregation in housing throughout the state and this segregation results from a long history of federal, state and local laws and policies that seek to disadvantage African Americans in particular. An article published in The Lancet in April 2017, states that “ …residential segregation is associated with adverse birth outcomes, increased exposure to air pollutants, decreased longevity, increased risk of chronic disease and increased rates of homicide and other crimes.” A three-year investigation by reporters from Newsday documented widespread evidence of unequal treatment of minorities by real estate agents on Long Island. The investigation showed that African Americans were discriminated against nearly 50% of the time when looking for housing. I would submit that we have no reason to believe that a similar investigation conducted in many of New Jersey’s suburban communities would not yield similar results.
All those killed away from the cameras
At the heart of all the disparities in health, education, housing, employment, income and wealth is the long legacy and persistence of racism and white supremacy in the United States. This persistence of racism and white supremacy led to the weaponization of race that was used to try to control a black Harvard-educated bird-watcher in Central Park. More importantly, it is racism and white supremacy that led to the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, Rayshard Brooks, Sandra Bland, Tamir Rice, Eric Garner — and so many others who have been harassed and killed outside of the view of cameras.
Racism also eats away at black bodies due to the chronic stressors of living in a racist society. It is becoming increasingly clear that exposure to persistent and unremitting racism is a contributing factor to increased infant mortality, maternal mortality and chronic illness in the black community.
This Juneteenth, as we commemorate the end of slavery during this period of increased attention to racial inequity in the United States, we need to once and for all firmly commit ourselves to ending racism in our state and throughout the country. Maya Angelou once said, “The plague of racism is insidious, entering into our minds as smoothly and quietly and invisibly as floating airborne microbes enter into our bodies to find lifelong purchase in our bloodstreams.” In the era of the COVID pandemic, let us commit ourselves to overcoming an even more deadly plague — racism and white supremacy.