Dear friends,

When Judge Ketanji Brown Jackson sat before the Senate Judiciary Committee to be considered as a Supreme Court Justice, history was present and personal. Judge Jackson’s parents, Johnny and Ellery Brown, who sat in the Senate chamber behind her, grew up in the Jim Crow South, where they had no choice but to attend lawfully segregated schools. Many hospitals at the time were lawfully segregated, too. The Browns taught their daughter that “unlike the many barriers that they had had to face growing up, my path was clearer, such that if I worked hard and believed in myself, in America I could do anything or be anything I wanted to be,” Judge Jackson recalled.

Her nomination to be the first Black woman Supreme Court Justice—to interpret a set of laws that, a mere generation ago, sent her parents to separate and unequal schools and hospitals—demonstrated that the history of racism is in fact present and personal throughout our society, across sectors from education to law to, yes, health care. 

That history continues to shape the experience and outcomes of American health care—and a new series of stories on the HealthBegins blog explores this through the work of one community and one health system in Greensboro, North Carolina. The stories were inspired by a remarkable moment—a spontaneous, personal moment in a HealthBegins learning session in which Laura Vail, Cone Health’s Systemwide Director for Population Health Equity, acknowledged her health system’s history of segregation.

“Institutional racism is deep in you, and you carry it forward for decades,” Vail said, reflecting on a presentation by Greensboro Housing Coalition Executive Director Josie Williams about historic disinvestment in Black neighborhoods. “So it’s not only the redlining that impacts people’s health, it’s the way the health system participates or ignores the history.”

In response, Williams, who has worked for years to elevate her community’s voice with the health system, said to the assembled group, “Take note: that type of acknowledgment did not happen prior to the last several years. … It helps me to continue to see light in a tunnel for … this person at Cone at this leadership level to acknowledge and lift that up without me having to bring it up.” (Watch a video of this inspiring moment here.)

Segregation at Moses H. Cone Memorial Hospital had nationwide consequences. Eleven Black Greensboro patients, physicians, and dentists ultimately sued the hospital to allow them entry, and a U.S. Federal Court sided with the plaintiffs in 1962, legally ending healthcare segregation nationwide. Just six years ago, Cone Health publicly apologized to the last living plaintiff, Dr. Alvin Blount, for its role in that history. Yet the effects of institutionalized racism still reverberate in clinics and health systems across the country—in access, practice, outcomes, participation, and trust.

We have a precious opportunity to change that now. We are living in another watershed era for advancing racial justice and health equity. And just as the reforms of the Civil Rights era reshaped the society in which Judge Jackson grew up, we have the awareness and momentum now to undo inequities across sectors and transform America for the next generation.

In health care, that means actively seeking awareness of our own institutions’ histories. As health systems around the country make commitments to equity, it’s more incumbent on us than ever to make sure we understand our history, how recent and direct and personal it is, and how the present movement toward equity is part of a long arc. And then to work within and across sectors, from law to health care and far beyond, to redress the harm of institutionalized racism and then find a path beyond redress to real racial equity—as Cone Health is striving to do now.

I hope the work of Cone Health and the Greensboro Housing Coalition serves as an opportunity for just such reflection and re-commitment to this mission. As you read and watch these stories, I urge you to reflect on these questions:

1. Do you personally know your institution’s history in relation to racist policies? Have you and your colleagues talked about it?
2. How does the residue of institutionalized racism continue to shape our present, from patient and provider experiences to health outcomes?
3. Imagine what the Cone Health apology meant or didn’t mean for Dr. Blount, the only plaintiff who lived to receive it. How many health systems have yet to do even this? How many leaders have yet done what Laura Vail did, not just in public forums with press releases, but in private, unscripted, intimate spaces that require candor and vulnerability?
4. What does it mean to redress the harms of this living history? And then, additionally, commit to center equity? 

The Supreme Court nomination hearing, among many other experiences, continues to drive home how much we are shaped by and continue to create history. As we do our daily work in hospitals and health systems around the country, how many of us understand that we have a role to play in this new watershed era, in clearing paths for the Judge Jacksons of tomorrow? That while her path was clearer, it is not yet cleared? If we grasp from these stories how much history defines our present, and how much our work to repair its harms can transform opportunities, then I believe the answer should be all of us.

With gratitude,

Rishi Manchanda, MD, MPH.                                             Sadena Thevarajah, JD