The Black History of Public Health: From Legacies of Racism and Resistance to Futures of Equity and Justice

Just like individual health is shaped by inherited genetics and sociocultural patterns, community health is shaped by the cultures, perspectives, practices, and systems we collectively inherit from our pasts. In the United States, our cultural inheritance—legacies passed down through generations—includes deep-rooted structures of violence and hierarchies of racialized power that pre-date the U.S. itself. Our cultural inheritance also includes legacies of resistance, strength, resilience, and leadership that transcend oppression and offer solutions to some of our nation’s most entrenched problems.

Ten years after Patrisse Cullors, Alicia Garza, and Opal Tometi founded Black Lives Matter in 2013, the U.S. continues to grapple with an extended period of racial reckoning. Considered the largest movement in U.S. history, Black Lives Matter protests surged even throughout the COVID-19 pandemic. But, while national attention spotlighted George Floyd and the life-and-death impacts of racism from one angle, outside of that spotlight, another historical legacy was repeating itself: Black, Indigenous, and People of Color were dying at disproportionate rates from COVID-19, public rhetoric veered into racism, mistrust held interventions hostage, and Black leaders struggled to make their voices heard in public health.

Looking back through the history of the public health field and its intersections with healthcare, crisis response, urban planning, and other fields, we can trace legacies of racism and resilience that impact our lives today, as well as the future of well-being for our Nation. One particularly relevant example is the comparison between the 1918 influenza and COVID-19 pandemic responses, and how those responses impacted Black versus white Americans. Racist response strategies in 1918—like blaming Black people for their higher death rates, cordoning off Black neighborhoods to protect white neighborhoods, and failing to adequately collect or analyze data from Black communities—left echoing legacies which resurfaced in 2020. Legacies of resilience—like Black-led mutual aid networks, parallel care systems, and Black media taking leadership to fight racist narratives—also echoed through 2020 and beyond, providing infrastructure for BIPOC communities to self-advocate, care for themselves, and develop equitable solutions that benefited all Americans.

Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward

Resource - Journal Article

Learning through our ongoing new reality of COVID-19 has demonstrated that a return to the status quo—“getting back to normal”— is insufficient. Collectively, we need to leverage this momentum and drive transformative change now to advance equitable well-being for ourselves and for future generations. The first step is naming the legacies that we have inherited, truly understanding the nuanced ways they impact all of us today, and learning how to carry with us into the future only legacies that advance equitable well-being for all.

Confronting the Racist Legacies within Public Health

Health inequity in the U.S. is driven by legacies of long-standing racism throughout our institutions and systems. These legacies have manifested in many ways, including the white-washing of public health history, the exclusion of Black people from public health and healthcare, and the impacts of racist practices—both historical and present-day. Due to the wide-reaching impacts on well-being, uprooting racist legacies in public health offers an opportunity to tangibly advance health equity. Understanding where our racist histories come from, the harms they have caused, and how they shaped our current context is one important step in reversing ongoing negative impacts.

Throughout history, Black people in the U.S. have experienced conflicting, racist messages: they are more prone to disease than white people, yet are supposedly immune to some diseases; and they are unworthy of the same care white people receive, yet are unable to care for themselves and must rely on white providers and systems for care. They have simultaneously been excluded from healthcare education and practice settings, while being expected to provide care to white people by looking after white children, staffing white hospitals during crises, and filling service positions to build and support white care infrastructure. Racism manifested in every facet of public health history, including:

Enslaved peoples had little to no healthcare, but were expected to care for white people, especially white children and people giving birth
Black nurses and other health practitioners were targeted for being “unlicensed,” especially when providing traditional medicine—attempts to legally control Indigenous medicine, knowledge, and culture
Hospitals, doctor’s offices, medical schools, etc., were segregated, and yet, Black doctors and nurses were called on to serve at white hospitals in the U.S. during World War I
Scientific inquiry and medicine followed racist lines
Black people were believed to be immune to Influenza in 1918, just like they were believed to be immune to the Spanish flu and Yellow Fever in 1793—something repeated during the initial COVID rhetoric in 2020
Fake mental health diagnoses—like drapetomania and dysaethesia aethiopica—were created to justify enslavement
Forced sterilizations among Black people

When racism in the field of public health failed to adequately control Black bodies, adjacent fields like urban planning, public policy, and policing followed suit in trying to control and restrict Black people. Racist “solutions'' like redlining, racially restrictive covenants, Jim Crow laws, and the war on drugs were all put forth as ways to ensure safety, health, and well-being for the nation. When we look at the full historical narrative, it is impossible to divorce any of these atrocities from public health, due to both the original intent and the resulting health impacts.

In part, this depicts white-washing public health history—ensuring the narratives that we know and learn are controlled by the dominant, white lens. White-washing involves ignoring racism in our past and denying the current impacts of racist legacies, as well as ignoring and erasing the significant contributions of Black individuals throughout public health history. Importantly, it white-washing also means ignoring Black communities’ immense strength, resilience, and power that is apparent when we begin peeling back the layers, listening to people with lived experience, and understanding our history. In the field of public health, this also involves minimizing the Field’s role in creating existing health disparities, denying the intention or scale of negative impacts, and failing to connect the dots with today’s health inequities.

These issues and their repercussions are far from stuck in the past. Public health’s racist legacies directly influence negative health outcomes today, including:

Discrimination and racial biases in care settings lead to lower quality care for BIPOC, even when insurance status, income, age, and severity of conditions are comparable
Extreme disparities in maternal and infant mortality rates and care between Black and white populations
Gaps in access to and quality of mental health care for Black individuals, as well as culturally-embedded stigma and negative views of mental health care
Black communities’ overall fear and mistrust of care systems and public health in general, which can lead to underutilization and under-engagement
Continuing to blame differences in disease prevalence and health outcomes on race, ethnicity, culture, or other community characteristics
Ignoring the impacts of important health issues on population sub-groups, such as Black people with HIV/AIDS

Screen grab of Why is Racism a Public Health Issue?

Why is Racism a Public Health Issue? Episode 7 of "That's Public Health"

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Brought to you by APHA

The Forgotten History of Black Education in America

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Brought to you by FC

Published on 02/15/2023

Black Lives Matter: A Commentary on Racism and Public Health

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Photo of young Black child with short hair sitting on the ground with their head in their hands.

Race-Based Stress and Intergenerational Trauma

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Brought to you by Community Commons

Published on 09/16/2022

Uplifting Black Leaders, Systems, and Solutions

Indigenous Black and Brown knowledge and care systems have existed longer than any system or legacy in the U.S., including racism. Indigenous communities on the African and American continents had infrastructures that provided care, health, and well-being. As history evolved and colonization, slavery, and racism progressed, so did decolonization, resistance, resilience, and survival. All systems of oppression exist—and have always existed—alongside powerful systems of anti-oppression.

These forces drove justice and rights movements, parallel care systems, mutual aid networks, and leadership in BIPOC communities. Today, we inherit these legacies, just like we inherit legacies of racism. By committing to Black leadership, systems, and solutions, we can leverage these legacies of resistance to advance health equity, justice, and transformative change. This begins with acknowledging Black contributions to public health, and understanding, supporting, and funding solutions that already exist within BIPOC communities.

A few of the many Black contributions to public health include:

Onesimus, an enslaved African, introduced the African method of inoculation (variolation) against smallpox in Boston in 1721, almost a century before Edward Jenner’s smallpox vaccine
Dr. Solomon Carter Fuller, the United States’ first known Black psychiatrist, was an early Alzheimer’s researcher and was the first to translate much of Alois Alzheimer’s work into English
Dr. Charles Richard Drew, an African American surgeon and researcher, organized America's first large-scale blood bank
W.E.B. Du Bois, the first Black American to earn a PhD from Harvard University, was a sociologist and civil rights activist whose research on Black Southern households uncovered how slavery still impacted the lives of African Americans
Henrietta Lacks, a young Black woman, died of cervical cancer in 1951. Her cells were taken without her knowledge or consent and widely shared for research. Now referred to as HeLa cells, they have been instrumental in “key scientific discoveries in the fields of cancer, immunology, and infectious diseases.”
The Freedom House Ambulance Service, an all-Black team of paramedics who pioneered the profession from 1968-1975 in Pittsburgh
The founders of the reproductive justice movement
Black media, which is committed to combatting and correcting racist narratives, including those stemming from public health
Civil rights movement and Black Lives Matter leaders
The Black Panthers, the Free African Society, and other early founders of formalized mutual aid networks

In addition to contributions to the wider field of public health, BIPOC communities have always had their own health practices and systems. These practices and systems never went away, despite efforts by white institutions to bully, abuse, ignore, and legislate them out of existence. Instead, in many cases, these practices moved into parallel care systems—alternative systems of care that function alongside, but independent and separate from, the mainstream (white) care system. For Black communities, parallel systems of care include practitioners of traditional African medicine, traveling nurses and birth workers visiting patients in their homes, mutual aid networks, and historically Black medical schools, hospitals, and clinics that prioritize culturally-embedded care for Black communities. They also have included Black community services and media sharing accurate, antiracist information about Black health and healthcare.

Comparing the racist legacies from the previous section with these legacies of resistance and resilience illuminates the inherent superiority of BIPOC communities in advancing their own health and well-being. By mainstreaming this understanding and looking to BIPOC leadership in public health, we can help advance health equity for all.

The Nocturnists: Black Voices in Healthcare

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Black History Month: A Medical Perspective

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‘Solidarity, Not Charity’: A Visual History of Mutual Aid

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Black Americans Have a Clear Vision for Reducing Racism but Little Hope It Will Happen

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Case Study: Black History and COVID-19

One timely example of applying Black leadership to the field of public health is the COVID-19 response. In their 2020 study, three Black women researchers examined the relationship between the 1918 influenza and COVID-19 pandemic responses, specifically through the lens of the Black American experience. Their work demonstrates the complex ways that public health crisis response draws on and reinforces our historical legacies of racism and resilience. They explore negative impacts historically and today, but focus on the strength, resilience, and resistance of Black communities.

Pulling together learning from both historical trends and current contexts, they offer the following blueprint—a critical list of “do’s and don’ts” for approaching public health concerns through the lens of BIPOC community leadership and health equity.

The Disproportionate Impact Of COVID-19 On Black Health Care Workers In The U.S.

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The State of Black America and COVID-19: A Two-Year Assessment

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Mapping racial inequity amid COVID-19 underscores policy discriminations against Black Americans

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Brought to you by Brookings Institution

The Black New Deal: Black Oakland Demands in Light of COVID-19 and Rates of Black Death

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Brought to you by APTP

Multi-Solving for Public Health

These issues are not isolated to the field of public health. Public health and well-being are impacted by society as a whole and, in turn, impact society as a whole. When addressing legacies of racism and working toward an equitable future, it is critical that we recognize the interconnectedness and interdependence of both racism and public health.

Many of the legacies leading to public health inequity today are from the racist legacies of other sectors, such as urban planning, housing and real estate, banking and finance, medicine, mental health, social work, food, and the environment. Similarly, all of these sectors are impacted by today’s public health contexts and the racist legacies that shaped it.

Bringing together key sectors and issues to multisolve—collaboratively solve for multiple issues simultaneously—is a critical step in addressing racist legacies and building health equity. Particularly important issues to center in this conversation include:

Police violence
Black maternal and infant health and mortality
Healthcare access, quality, and costs
Incarceration and the criminal justice system
Education and the school-to-prison pipeline
Black mental health
Voter suppression
The racial wealth gap
Environmental racism
Racism, hate, and discrimination

By bringing public health together with other fields—like urban planning, healthcare, social work, and education, for example—allows us to more efficiently and effectively address systems-level causes and outcomes of these key issues. Similarly, addressing racism systemically requires a highly collaborative approaching integrating all sectors.

Thriving Together: Belonging and Civic Muscle

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Multisolving 101: Co-Creating Vital Conditions for Thriving Together

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Leveraging Black History for Health Equity

The legacies of racism and oppression in public health have long histories that will take significant, concerted effort to overcome. Because of the strength of so many BIPOC individuals and cultures, we have also inherited long legacies of resistance, strength, resilience, and leadership that transcend oppression. These legacies offer hope, as well as concrete solutions to advance equitable well-being for all.

Some concrete ways that changemakers, communities, and organizations can take action include:

Centering Black voices—including Black disabled, queer, trans, incarcerated, and impoverished voices—in all areas of our lives, from our social media feeds and workplaces, to public policy and public health

Committing to antiracism, racial justice, decolonization, and culturally responsive practices, workplaces, policies, and systems
Personally taking antiracism and cultural humility trainings taught by BIPOC trainers, and advocating for increasingly advanced trainings in these subjects for our workplaces, schools, and boards
Naming and acknowledging Black history and contributions, especially within public health and other spaces where white histories have been prioritized
Teaching Critical Race Theory and real history through BIPOC lenses in schools
Confronting racist legacies, including whitewashing, BIPOC exclusion, and racist media narratives about Black bodies
Cultivating Black leadership, and prioritizing the perspectives, ideas, and solutions of Black leaders
Supporting and funding Black care practices and systems, including mutual aid
Advocating for racial justice and health equity, especially as it relates to key issues like police brutality, Black maternal and infant health, the racial wealth gap, and incarceration