# data[].attributes.body
In the 1930's to 1960's, Latina Women were being sterilized in Puerto Rico without any knowledge of what they were actually signing because of the language barrier. The process was completely irreversible. About 7% of women were sterilized. They were coerced by the doctors in Puerto Rico claiming it was the only means for contraception, but the truth was they were scared of increasing diversity in the population. -MP, MH, OL, GW

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In 1951, a woman by the name of Henrietta Lacks, complaining of pain, visited a doctor where she was diagnosed with cervical cancer. The doctor removed her tumor lump and sent cells from it to a Dr. George Gey for further inspection--unbeknownst to Lacks. Upon observation they discovered her cells divided continuously--never dying out as other cell-lines had been known to do until then. This made them optimal for conducting research, testing pharmaceuticals, creating vaccines, etc.--and they still continue to be used in the medical industry today! -JW, CH, NG

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50's-70's, kligman's experiments on 1000+ black prisoners in philadelphia prison.

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50's-70's, kligman's experiments on 1000+ black prisoners in philadelphia prison.

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-Head of National Medical Association
-Medical professor at Howard University
At this time hospitals were severely segregated, black patients being treated horribly. Cobb fights for the promotion of universal health insurance. This was when the fight for universal healthcare and the fight for a desegregated healthcare system came together to become the fight for medicare. -MH

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Inequities in the Henrietta Lacks Case- 1971

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Inequities in the Henrietta Lacks Case- 1971

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Lacks' case is an example of lack of autonomy, as well as informed consent. The decision to have her cells inspected and used in research was not up to her; it happened all without her knowledge, and she was unable to provide any consent in the matter. This lack of being informed violates the respect for persons clause, as she did not enter this research voluntarily, and her autonomy was not respected at all. It wasn't until 1971 that her family was finally informed and compensated.

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consent not a legal requirment until 1974

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consent not a legal requirment until 1974

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before 1978 consent was not needed to perform the steralization prosedure. This caused alot of the women giving birth to have a unexpected surgery.

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A judge ruled that neither of the chargers were true, citing "misunderstandings" due to the fact the women primarily spoke
Spanish

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by 2000 more than 300 former prisoners reported injuries caused by the experiments, and 15 of the last test subjects, went missing.

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In 1865, Rebecca Lee Crumpler moved to the South to aid newly freed slaves. She was the first doctor to be a woman and black, an inspiration for many others like her. When she got to the Southern states, she found black people dying at exponential rates due to lack of medical care. She became an employee for the Freedman Bureau Medical Division, a medical institution made specifically for black people to have access to medical care, however, they were underfunded and understaffed and could not provide optimal care. Because of this, Crumpler wrote a book dedicated to black mothers and nurses about how to treat disease, sickness, and ailments at home.

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This podcast episode from the 1619 Project gave us insight into the long history of racial health disparities in the US. -Dr. OB

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transcript

Episode 4: How the Bad Blood Started

Hosted by Nikole Hannah-Jones, produced by Annie Brown and Kelly Prime, with help from Clare Toeniskoetter and Austin Mitchell, and edited by Larissa Anderson, Lisa Chow, Wendy Dorr and Lisa Tobin

In the United States, racial health disparities have been as foundational as democracy itself.

nikole hannah-jones

My Uncle Eddie was my favorite uncle. He was my dad's younger brother, not that much older than me, and he was a complete jokester and cutup. He was the one who was always playing some practical joke on you, or who, in some ways, you always felt was taking things too far, because he just thought everything was funny. So for instance, if you fell asleep in his house, he might light a match and stick it between your toes and let it burn down to wake you because he thought it was funny. He called me Bird, which was my nickname. And we liked to listen to music together. We liked to watch TV together. He was never mad. I never remember him ever disciplining me for anything. And in fact, when my father and I would fight when I was a teenager, I would sometimes pack my bag and go stay with him for a couple of days, and he would never kind of sell me out.

When I got into college at the University of Notre Dame, I think the only person prouder than my mom and dad was my Uncle Ed. And when I graduated, my uncle picked out this all-red outfit from head to toe. He had on a red hat and a red shirt and red pants and these red gators, and he was determined that he was going to show everyone how proud he was of me by out-dressing everyone at the graduation, and he certainly did.

So we just were always very close. Whenever I would come home, we would get breakfast together at Morg's and just talk about life. And all he would tell me all the time was how proud he was of me.

Besides being a lot of fun, my Uncle Ed was also one of the hardest-working men that I knew. He worked a lot of jobs doing things like working in animal processing plants. And the last job that he had was roofing, and he did roofing for a lot of years, often coming home at the end of the day kind of grimy, and sometimes with his joints in his hand so swollen that he couldn't even make a fist. He relished working hard. He was proud that he could provide for his family, even without an education. And then about 2009, he started to feel a pretty severe pain in his back. And that pain began to spread from his back down into his legs. And he started to have trouble moving. And there were some mornings where he would have to kind of crawl out of bed. But around that time, my uncle also got laid off from the job where he was doing roofing, and with that layoff, he lost his health insurance. So like many people, he at first avoided going to the doctor altogether, because he didn't have insurance. But then when it got kind of unbearable, he went to the free clinic. Because my uncle did not have health insurance, they would not give him the tests that he probably needed to find out what was going on with his back. They wouldn't give him an X-ray, they wouldn't give him a CAT scan or a PET scan, and instead, they just tried to diagnose based on what he was telling them. And they told him that he probably just needed an alignment in his spine, that that's what was bothering his back. So they sent him to a chiropractor. My uncle would end up going back about five or six times as his back was getting progressively worse, and the final time that he went to the chiropractor, as the doctor was working on his back, they both heard a big pop. That pop concerned everyone, and so the chiropractor told him, as my uncle kind of gets up off the bed and is barely able to stand up, that he better go to the emergency room right away. When he got to the emergency room, that doctor recognized right away that something serious was going on, and actually gave my uncle the X-ray and the CAT scan that he probably had needed months before. And what that doctor saw scared him.

He saw these spots on the scans that he had taken all over my uncle's back and along his spine. And it's at that point where we find out that my uncle has cancer, and that he'd likely had cancer for many, many months, if not longer. And we learned that the cancer is Stage 4, and it has metastasized throughout his entire body. And because of that, the cancer is terminal.

And it is because of that diagnosis that my uncle was finally able to get access to the insurance that he had needed so badly all those months before. And that's because, with this diagnosis of terminal, untreatable cancer, my uncle was able to qualify for federal disability. And federal disability means because your physical health is so poor and you are unable to work, the government will help you and pay for your insurance and your medical treatment. So it took, literally, my uncle getting a death sentence before he was able to get health insurance. That health care gets him out of those free clinics and into an actual cancer clinic in Illinois. And it's there that the doctors give us the news that had they been able to see him months before, he could have had a fighting chance. But it was too late. And so in those next four months, we just saw my uncle's health deteriorate more rapidly than any of us could have imagined, and his body wither to almost nothing. And in the end, the pain of the cancer was so bad that he didn't even want to fight anymore. So at the age of 50, just two weeks after my daughter was born, my uncle passed away.

I remember in those last days, when he was in hospice and I had just had my baby, I called him to give him the news. He was really weak. He could barely talk. But he said, I'm so happy that I'm going to get to see my baby bird.

And so when my daughter was just two weeks old, I had to wrap her up and put her on an airplane as we flew back to Waterloo to bury my uncle.

["1619" theme music by daoud anthony]

nikole hannah-jones

From The New York Times Magazine, I'm Nikole Hannah-Jones. This is "1619."

O.K., Jeneen Interlandi, where do you want to start?

jeneen interlandi

I think we should start in the fall of 1866, with a woman named Rebecca Lee Crumpler. Rebecca Lee Crumpler is a young black woman who was born free and raised in Pennsylvania by her aunt. Her aunt was a medicine woman. She used to go from home to home tending to the sick, and Rebecca liked to tag along and to help her. She liked it so much that she went on to become a nurse, and she was so good at being a nurse that she makes the really unusual decision to go on and become a doctor. So she eventually goes to the New England Female Medical College, which is a college that was specifically built to train women in medicine, and that's really extraordinary. Because around the time she graduates, there's about 54,000 doctors in the country, and only 300 of them are women, and only one of those women is black. And that woman is Rebecca Lee Crumpler. And so about a year after she finishes medical school, the Civil War comes to an end, and she makes another unusual decision, which is to completely uproot her life and to head down to the South.

archived recording (speaker 1)

Do you remember when the Civil War was being fought?

archived recording (speaker 2)

Well, I can't remember much about it, but I remember this much.

jeneen interlandi

Because four million people have just been released from slavery into freedom.

archived recording (speaker 2)

And I thought old master was dead, but he had been off to the war and come back. You know, and old master didn't tell you no one was free.

archived recording (speaker 1)

He didn't tell you that?

archived recording (speaker 2)

No, he didn't tell -

jeneen interlandi

And Crumpler knows that it's going to be a huge challenge to help these people assimilate into society and to address their many basic needs, including health care.

nikole hannah-jones

I spent a lot of time reading the slave narratives. And we're not really taught that emancipation came, and someone would walk on the plantation and say, you are free. But nothing came with that. These were people who just literally were told, you're free to go, but given no resources to go with.

jeneen interlandi

Even just with basic shelter.

jeneen interlandi

They didn't have places to go.

archived recording

I was about 9, 10 years old, maybe more. Stayed right there. We didn't know where to go.

archived recording (fountain hughes)

We had nowhere or nothing. We didn't have nothing. Just like your cattle, we were just turned out.

jeneen interlandi

So they were forced to take up residence in abandoned prisons, former military barracks, empty churches, refugee camps.

jeneen interlandi

They're crammed together in very close living quarters. They don't have the tools necessary to maintain good hygiene.

jeneen interlandi

And as a result of all of this, they're getting sick. But they can't tap into any health care system, because at that time, there really isn't any organized health care system to speak of. Most medical care is provided at home by family members, or by doctors who would actually visit the house. And the only hospitals that exist are much more like institutions for the very poor or for people who get sick and don't have any family members to take care of them. And those facilities were private, and they were run by charitable groups. And when the newly emancipated turned to those facilities for help, they were turned away. They were told no.

And they start dying in really high numbers, so much so that in some towns and cities, their bodies are littering the streets.

This is a massive public health crisis. And so to deal with this crisis, the federal government creates what ends up being the nation's first federal health care program. It's called the Freedmen's Bureau Medical Division. And this is what Rebecca Crumpler is heading south to do. She's going to Virginia to treat the newly emancipated through this new medical program.

nikole hannah-jones

And what does she see when she gets there?

jeneen interlandi

So when she gets to the South and she starts working, she sees that this new program is a complete mess. The hospital she has gone to, just like all of the other hospitals in this program, are completely under-resourced. They don't have enough beds or sheets or linens. They don't have enough medicine. They don't have enough quarantine facilities, and they're in the middle of a smallpox outbreak. And there's this horrible shortage of doctors. There's only about 120 doctors employed by the entire program.

nikole hannah-jones

So you're saying that the federal government at that time was only supplying 100 doctors to serve the entire emancipated population of 4 million people?

jeneen interlandi

Yeah, so this is one of the crazy things about the Freedmen's Bureau Medical Division, which is, it was founded in utter ambivalence. Officials wanted their communities clean enough to prevent diseases that might eventually spread into white communities, but they don't want to provide any free assistance, because they're worried that it's going to create dependency among the black American community. And so what they do is they open these hospitals, and they staff them with a few doctors. But then they close them down at the first sign of progress, and they refuse to send resources that their own doctors, including Crumpler, are requesting. They're saying, can we have additional staff to address the smallpox outbreak? No. Can we have more blankets and more bedding? No. Can we have an extra facility for quarantine so that the diseases don't spread? No. And so unsurprisingly, black people continue to die at very, very high rates.

nikole hannah-jones

In that hospital in Virginia where Rebecca Crumpler has gone, what specifically is standing in the way of hospitals like that getting more support?

jeneen interlandi

Well, one of the things was, as you have all of these people dying from preventable things, a theory emerges.

And the theory goes that this high death rate is actually just nature taking its course. So black people aren't dying for want of basic necessities, they're actually dying because they're biologically inferior to whites and ill-suited for freedom. The argument became that African-Americans specifically were literally going extinct, and that to provide any type of funding or resources to fight that would be wasteful and foolish, because you're just trying to prevent the inevitable. And this theory actually gains pretty wide traction. There's a congressman from Ohio who uses it to argue against the Freedmen's Hospitals in the U.S. House of Representatives. He takes to the House floor, and he says, quote, "No charitable black scheme can wash out the color of the Negro," can "change his inferior nature or save him from his inevitable fate."

nikole hannah-jones

So what you're saying is that this theory of extinction was so mainstream that you could actually hear it being argued on the floor of the House.

jeneen interlandi

Yes, that's correct. And so, because that theory became so mainstream and so kind of generally accepted, the lack of funding and the lack of resources persists, and the Freedmen Hospitals continue to struggle. And the ambivalence is so profound that at a Freedmen's Hospital in North Carolina, when doctors detect smallpox in a couple of their patients, bureau officials are terrified of the disease spreading into the community, but they also don't want to invest the resources to treat it and to prevent that spread. So they put out an order to burn their own hospital down.

nikole hannah-jones

So this is the first example of government-funded health care, and it is an example of something that was set up to fail.

jeneen interlandi

That's exactly right, and as that hospital burns to the ground, there is this feeling that black people have that they're on their own, that the government created this system to help them, but that they didn't really want to help them, and so that they were going to have to take care of themselves.

And Rebecca Lee Crumpler understands this, and she decides to write a book. It's called the "Book of Medical Discourses in Two Parts." And it's not addressed to her colleagues in the white medical community or to segregationists in Congress. It's addressed to the black community, specifically to black mothers and black nurses. And what she tells them in this book is how to take care of themselves, how to prevent diseases like cholera, how to treat basic ailments like hemorrhoids and bronchitis. And what's so profound about this book is that she's telling black Americans, you're not inferior. You're not going extinct. You can take care of yourself. And this is kind of the first example of something that echoes down through the ages, which is black medical professionals taking matters into their own hands. And in the coming decades, they open medical schools, they build hospitals, and they organize themselves to push back against this system that's trying to shut them out completely.

jeneen interlandi

So fast forward -

jeneen interlandi

- to January of 1947 -

jeneen interlandi

- and President Truman's State of the Union address.

jeneen interlandi

It's actually the first State of the Union that's televised, and he opens with this joke about how both chambers of Congress have been taken over by Republicans.

jeneen interlandi

And so one side of the room is much more full than the other side of the room. And as the New York Times reports, you can clearly see his smile when he makes this joke.

A little more than halfway through his speech -

jeneen interlandi

He turns to health care.

jeneen interlandi

What he wants is a government-run health insurance program that everybody pays into ahead of time and that people can draw from when they need it.

jeneen interlandi

What he's essentially talking about is universal health care.

So by the time Truman's giving this address, the nation's health care system has grown up a bit from the days right after the Civil War, but not by much. All of the hospitals that were created through the Freedmen's Bureau have been closed down except for one that's in Washington D.C. And other hospitals have been built, but there's not nearly enough of them, especially in the South. And to make matters worse, the hospitals that do exist are all segregated. In fact, a "separate but equal" clause had actually been written into the law. And what that meant was black patients had to either go to their own black facilities, which were few and far between in a lot of places, or they were relegated to the basement wards of white hospitals, and those wards were small, and they did not provide as good care as you got in the white facilities.

nikole hannah-jones

And there were also lots of rules about who white nurses could serve in these hospitals, because I know I've read Jim Crow laws that said white nurses couldn't serve black patients - particularly black men - and this is also true for doctors, right?

jeneen interlandi

Well, for nurses, specifically, because there was a lot of concerns about keeping white women away from black men. So you maybe had a couple of white doctors that would check on black patients. But again, even the white doctors that would attend to the black patients would do that after they took care of all of their white patients, so it was second-class in every conceivable way. But it's not just black Americans who are not getting enough care. It's many poor white Americans as well. So at that time, most Americans were not insured. And the insurance that did exist was employer-based, which means you had to get a certain type of job where the employer actually offered this benefit, and then you could have it. The problem for black people and for poor white people is that they didn't have those kinds of jobs that offered health insurance, so they had to pay out of pocket. Basically, the whole system is not working, and Truman sees this as one of the most pressing problems the country is facing. And so he decides that national health insurance is the fix.

jeneen interlandi

And this government-sponsored health insurance initially has really widespread support.

jeneen interlandi

But then, days after Truman wins the election, the American Medical Association, which is the largest and arguably the most powerful professional organization for doctors in the country, launches this massive campaign to take it down.

And what you have to understand about the A.M.A. is that it's an almost exclusively white organization at that time. Virtually all of its local chapters exclude black doctors completely, and just a few years earlier, the organization had refused to protest the separate but equal clause that legalized hospital segregation. Plus, this is a time when health care costs are rising and private insurance is really taking off. And what the A.M.A. understands is that a national health insurance program is probably going to hurt their profits. And so they've actually been fighting against this idea for years. And now, with Truman's national health insurance program, they take that fight to a whole new level. They've hired a P.R. firm. It's actually the first political consulting firm in the country. And together, they devised this plan to completely torpedo universal health care.

nikole hannah-jones

And what does that fight look like?

jeneen interlandi

What it looks like is all-out war. It's radio ads. It's newspaper ads. It's magazine ads. They're delivering pamphlets and mailers to people's homes. In the end, they send some 100 million pieces of literature all across the country. And what's on that literature and what's in those ads is a campaign slogan. It says, "Keep politics out of medicine." They call Truman's plan socialized medicine. They labeled Truman as a communist - and you have to remember, this is during a time when communism was a real scare - and they terrify people with this idea that if Truman gets his way, government officials are then going to be able to intervene in private medical decisions. And when they do, they're going to destroy the sacred doctor-patient relationship. And that campaign works. Popular support for the bill suddenly plummets. It fails to get through Congress, and the health care system the nation is left with at the end of this fight is still too expensive for most Americans to afford and as segregated as it has ever been.

[music]

nikole hannah-jones

Jeneen, when did all of this start to change?

jeneen interlandi

So it really starts to change with a man named Montague Cobb.

Montague Cobb is this fascinating character. He's a beloved doctor and medical professor at one of the only black medical colleges in the country at that time, Howard University. Over 41 years, he teaches thousands of medical students about anatomy, and he's kind of famous for playing classical music on his violin and reciting poetry for his students while they're dissecting cadavers.

He's already established himself on the national stage. During the fight between Truman and the American Medical Association, Cobb was one of the only doctors to defend Truman's plan and defy the A.M.A.

jeneen interlandi

You know, there's not a lot of recordings of Cobb out there, but there is a documentary from the 1980s called "Step by Step," where Cobb himself talks about this time.

archived recording

Steps were also being taken by Dr. Cobb to end segregation in the medical profession.

archived recording (w. montague cobb)

I think our first point of overt attack was on the theme of old clothes to Sam, the Negroes' hospital dilemma.

archived recording

Cobb used the analogy of whites giving hand-me-down clothes to blacks to illustrate how they also gave blacks hand-me-down hospitals.

archived recording (w. montague cobb)

This one isn't new, but it's better than anything he has or could get.

jeneen interlandi

He's also been outspoken about hospital segregation for years, because he recognized how deadly it could be. There's all these horror stories - they're true stories - of black Americans who are mistreated or denied care at white hospitals and die as a result. There's this one example, from 1931, where a light-skinned black man gets into a car accident, and he's taken to a white hospital. It's Grady Memorial Hospital. This is in Atlanta. And doctors there, they mistake him for a white patient, so they start treating him. And it's only when his family comes to the hospital that they realize he's actually black. So what do they do? They pull him off the examining table and they send him to the black ward across the street, where he later dies.

So these kinds of stories were common knowledge. And Montague Cobb really wanted to change that, so he launches a national conference on hospital desegregation, and he pulls people in from all over the country to come and talk about this issue every year. And he really implores his white colleagues to take the matter seriously and to think about it, but he didn't get very far. Even with all of those efforts, not much changed, and he realized eventually that left to their own devices, white hospitals are going to stay white.

Then, in 1963, he takes the reins of the nation's leading black medical organization. Because remember, the A.M.A. has this history of excluding black doctors. So what black doctors have had to do is create their own professional societies, and the leading one is called the National Medical Association, or the N.M.A. And it's at this moment, when Cobb is in this leadership position, that the fight for universal health insurance that started decades back and the fight for a desegregated health care system that started at the end of the Civil War finally merge into one fight. And that fight is about Medicare.

[music]

archived recording

Ladies and gentlemen, the president of the United States.

archived recording (lyndon b. johnson)

My fellow Americans, we have had many a hard-fought presidential campaigns.

nikole hannah-jones

So what was the role of Medicare in all of this?

jeneen interlandi

Well, the proposal for Medicare is actually born from the ashes of Truman's failed national health insurance program.

jeneen interlandi

After that plan dies in Congress, people who want something like it conclude that they need to think smaller and more incrementally.

jeneen interlandi

So beginning under President Kennedy and continuing under President Johnson, their efforts target what is perhaps the most uncontroversial group anyone can think of -

jeneen interlandi

- old people.

jeneen interlandi

Once again -

jeneen interlandi

- the A.M.A. comes out in full force against the idea.

jeneen interlandi

They use all the same tactics and all the same arguments that they used last time around -

jeneen interlandi

- to convince the American public that this is a terrible idea and that it's going to destroy health care as they know it.

jeneen interlandi

But this time, under Montague Cobb's leadership, the nation's black doctors come out in full force to support Medicare.

jeneen interlandi

They lead protests, they lobby Congress, and they launch their own public relations campaign explaining to the nation that, in fact, this won't destroy medicine. This will make medicine more equitable. And their message is what it's been for a long time: Health care is a human right, and that any program that expands access to health care is the duty of a free and democratic society.

["1619" theme music by daoud anthony]

jeneen interlandi

Meanwhile, the fight for civil rights is escalating all across the country outside of the medical world.

jeneen interlandi

And of course, that effort culminates in the Civil Rights Act of 1964, which says that discriminating on the basis of race is unconstitutional.

jeneen interlandi

And more specifically, it says that the government can pull federal dollars from any facility or entity that does not comply with the law, and that includes hospitals.

jeneen interlandi

But the vast majority of hospitals do nothing. They don't just suddenly desegregate, and it's unclear when - or even if - they're going to face any consequences at all for that. And this is where Medicare comes in, because Medicare is like a new pile of federal money that's dangled in front of hospitals across the country. But in order to get that money, hospitals have to comply with federal law, like the Civil Rights Act. They would have to actually desegregate. So as Congress begins to debate the bill, Montague Cobb knows that this is the moment to both create a national health insurance program and desegregate the nation's hospitals. And when he's called upon to testify, he says that after two decades of arguing and equivocating, it is past time for the nation's leaders to take, quote, "definitive action to expand access to health care."

[music]

jeneen interlandi

And at the end of his testimony, he recites this hymn by George Matheson, and it goes, "O love that will not let me go, I hide my helpless self in thee. I give thee back the life I owe, that in thine ocean depths its flow may richer, fuller be."

And then he tells Congress, "Like this love, the benefits of Medicare cannot be taken away." And he asks them, "Can we deny this small assurance to those on whose shoulders we stand?"

jeneen interlandi

And so Medicare passes, and what happens is within four months of implementation, nearly 3,000 hospitals desegregate. But of course, the health disparities between black Americans and white Americans persist to this day. Black women are three times more likely to die of causes related to pregnancy than white women. Black people with H.I.V. tend to get worse care than white people with the disease.

One study found that black patients with diabetes did worse than white patients, even when they had the same doctor.

Black Americans die at higher rates from many cancers that would have been treatable had they been caught earlier.

[music]

yaa gyasi

My name is Yaa Gyasi, and I'm going to read a short piece I wrote called "Bad Blood."

Upon closer inspection, the leaf her 2-year-old was attempting to put in his mouth in the middle of the playground on that lovely fall day was in fact a used tampon. She snatched it from him and Purelled both of their hands before rushing them back to their apartment on Dean. She put him in the bath and scrubbed, and by the time her husband found them, they were both crying. "We have to leave New York," she said after he put the baby to bed. "Let's move back home." "There are tampons in Alabama," he said, and then, "What's the worst that could happen?" It was the question they'd played out since graduate school, when her hypochondria had been all-consuming. Back then, leaning into her fears, describing them, had given her some comfort, but then they had Booker and suddenly the worst looked so much worse. "He could get an S.T.D., and then we'd be the black parents at the hospital with a baby with an S.T.D., and the pediatrician would call social services, and they would take him away, and we'd end up in jail." "O.K.," he said slowly. "That would be bad, but it's statistically very, very unlikely. Would it make you feel better if we called the doctor?" She shook her head. Her husband only used the word "statistically" when he wanted to avoid using the words "you're crazy." She knew that the doctor would just tell her to trust him, but she also knew that when the worst happens in this country, it often happens to them. She comes by her hypochondria and iatrophobia honestly. When she was growing up in Alabama, people still talked about their grandfathers, fathers and brothers who had died of bad blood. That was the catchall term for syphilis, anemia and just about anything that ailed you. The 600 men who were enrolled in the Tuskegee Study were told they'd get free medical care. Instead, from 1932 to 1972, researchers watched as the men developed lesions on their mouths and genitals. Watched as their lymph nodes swelled, as their hair fell out. Watched as the disease moved into its final stage, leaving the men blind and demented, leaving them to die. All this when they knew a simple penicillin shot would cure them. All this because they wanted to see what would happen. For years afterward, her grandmother refused to go to the hospital. Even at 89, perpetually hunched over in the throes of an endless cough, she'd repeat, "Anything but the doctor." Bad blood begets bad blood. She's more trusting than her grandmother, but she still has her moments. Like many women, she was nervous about giving birth. All the more so because she was doing it in New York City, where black women are 12 times as likely to die in childbirth as white women. And in that very statistic, the indelible impression of Tuskegee. The lingering, niggling feeling that she is never fully safe in a country where doctors and researchers had no qualms about watching dozens of black men die - slowly, brutally - simply because they could. When she held Booker in her arms for the first time and saw her grandmother's nose on his perfect face, love and fear rose up in her. "What's the worst that could happen?" her husband asks, and she can't speak it - the worst. Instead, she tries to turn off the little voice in her head, the one that wants to know: How exactly do you cure bad blood?

[music]

In the United States, racial health disparities have been as foundational as democracy itself.

Hosted by Nikole Hannah-Jones, produced by Annie Brown and Kelly Prime, with help from Clare Toeniskoetter and Austin Mitchell, and edited by Larissa Anderson, Lisa Chow, Wendy Dorr and Lisa Tobin

Listen and subscribe to our podcast from your mobile device:
We'll be back with the next episode of "1619" in October. On today's episode:

Jeneen Interlandi, a member of The New York Times's editorial board and a staff writer for The Times Magazine.

Yaa Gyasi, the author of the novel "Homegoing."

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Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation's first federal health care programs.

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Protesters marching against hospital segregation and health care inequality in front of the American Medical Association's Chicago headquarters in 1963. Credit... Bettmann, via Getty Images

Background reading:

"One hundred and fifty years after the freed people of the South first petitioned the government for basic medical care, the United States remains the only high-income country in the world where such care is not guaranteed to every citizen," Jeneen Interlandi writes.

The Times Magazine asked 16 writers to bring pivotal moments in African-American history to life. Read Yaa Gyasi's story "Bad Blood" here.

The "1619" audio series is part of The 1619 Project, a major initiative from The Times observing the 400th anniversary of the beginning of American slavery. Read more from the project here.

Tune in, and tell us what you think. Email us at 1619podcast@nytimes.com. Follow Nikole Hannah-Jones on Twitter: @nhannahjones.

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Episode 4: How the Bad Blood Started (Published 2019)

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transcript In the United States, racial health disparities have been as foundational as democracy itself. nikole hannah-jones My Uncle Eddie was my favorite uncle. He was my dad's younger brother, not that much older than me, and he was a complete jokester and cutup.

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Apology issued by City of Philadelphia for unethical prison experiments - Oct. 2022

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Apology issued by City of Philadelphia for unethical prison experiments - Oct. 2022

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On Thursday, October 6th, 2022, the city of Philadelphia officially issued an apology regarding the treatment of Black inmates in prison, who were conducted experiments upon. https://www.npr.org/2022/10/07/1127406363/philadelphia-apologizes-experiments-black-inmates#:~:text=PHILADELPHIA%20%E2%80%94%20The%20city%20of%20Philadelphia,need%20for%20a%20formal%20apology.

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Apology issued by City of Philadelphia for unethical prison experiments - Oct. 2022

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Apology issued by City of Philadelphia for unethical prison experiments - Oct. 2022

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The city of Philadelphia admitted to conducting unethical medical experiments on mostly back people