June 2021- Juneteenth National Independence Day

A word from the author— Happy June NCP friends! This article is coming out a little later this month in order to properly celebrate the newest named National holiday—Juneteenth. On Thursday, June 17, 2021, President Joe Biden signed legislation recognizing June 19TH as Juneteenth National Independence Day. This day marks the end of slavery in the United States. This declaration of a new federal holiday, the first since 1983, was one of the many “ripple effects” that came from the COVID-19 Pandemic. This important day in our Nation’s history will surely have positive impacts in many facets of life, but today I want to focus not only on recognizing Juneteenth, but acknowledging the impact of this federal holiday on the healthcare system as a whole. Please help me celebrate today by reading more below and sharing with your friends and family!

What happened on June 17, 2021? President Joe Biden said that signing legislation into law on Thursday establishing June 19 as Juneteenth National Independence Day -- a US federal holiday commemorating the end of slavery in the United States -- will go down as "one of the greatest honors" of his presidency.

"I have to say to you, I've only been president for several months, but I think this will go down, for me, as one of the greatest honors I will have as president," Biden said at the White House during a signing ceremony.

"I regret that my grandchildren aren't here, because this is a really, really, really important moment in our history. By making Juneteenth a federal holiday, all Americans can feel the power of this day and learn from our history -- and celebrate progress and grapple with the distance we've come (and) the distance we have to travel," Biden said.

The ceremony, which took place in the East Room, included some 80 members of Congress -- including members of the Congressional Black Caucus, local elected officials, community leaders and activists. The President specifically noted that Opal Lee, the activist who campaigned to establish Juneteenth as a federal holiday, was in attendance.

The History Juneteenth commemorates June 19, 1865, when Union Major General Gordon Granger announced the end of slavery in Galveston, Texas, in accordance with President Abraham Lincoln's 1863 Emancipation Proclamation. Only a handful of states currently observe Juneteenth as a paid holiday.

Biden, speaking at the White House alongside Vice President Kamala Harris, repeated the sentiments he relayed when he commemorated the Tulsa race massacre earlier this year, that "great nations don't ignore their most painful moments."

"They embrace them. Great nations don't walk away. We've come to terms with the mistakes we made and in remembering those moments, we begin to heal and grow stronger," the President said.

The holiday is the first federal holiday established since Martin Luther King Jr. Day in 1983 and becomes at least the eleventh federal holiday recognized by the US federal government. The US Office of Personnel Management announced Thursday that most federal employees will observe the holiday on Friday since Juneteenth falls on a Saturday this year.

The legislation, which was passed by Congress on Wednesday, June 16, 2021, gained momentum following Black Lives Matter protests sparked by the police killing of George Floyd last year. It was also spurred after Democrats won the White House and control of the House of Representatives and the US Senate.

The bill passed the House on Wednesday with a 415-14 vote after the Senate unanimously passed the legislation the day before.

The bill had bipartisan sponsors that included Democratic Rep. Sheila Jackson Lee of Texas, Republican Sen. John Cornyn of Texas and Democratic Sen. Ed Markey of Massachusetts.

At the White House on Thursday, Biden lauded members of Congress for the bipartisan effort, saying, "I hope this is the beginning of a change in the way we deal with one another."

The Impact During the ceremony, the President said it was not enough to commemorate the holiday, but to use it as a day of reflection and action.

"We can't rest until the promise of equality is fulfilled for every one of us in every corner of this nation. That to me is the meaning of Juneteenth," Biden said.

Biden also underscored how his White House agenda is working to deliver equality and emphasized that the promise of equality is not going to be fulfilled "so long as the sacred right to vote remains under attack." The President specifically pointed to restrictive voter laws in some states, calling them "an assault that offends our very democracy."

Lee told reporters ahead of the final passage of the bill, "what I see here today is racial divide crumbling, being crushed this day under a momentous vote that brings together people who understand the value of freedom."

Wisconsin Republican Sen. Ron Johnson had previously blocked the bill in 2020, saying that the day off for federal employees would cost US taxpayers hundreds of millions of dollars. But Johnson dropped his objection this week despite his concerns, which paved the way for the bill's passage in the Senate.

The Origin of Juneteenth On June 19, 1865, Union General Gordon Granger went to Galveston, Texas and issued an order freeing thousands of enslaved Americans. Juneteenth (a mash-up of June and 19th) acknowledges the moment enslaved people in the most remote part of the Confederacy learned—two months after the end of the Civil War and two years after President Lincoln issued the 1863 Emancipation Proclamation—that they were finally free.

It was not until Major Granger's announcement that the chains that kept Black Texans in bondage were finally broken. His announcement was met with emotions that ranged from shock to jubilee. Black people took to the streets to celebrate their newfound freedom -- a privilege that wasn't granted to them on July 4th, 1776.

Juneteenth, though a celebration, is an example of justice and freedom delayed for Black Americans. The holiday is a chance to reflect on history and the ongoing work toward equality.

The Impact As the nation prepares to observe Juneteenth 2021, however, racism and inequity, both overt and subtle, continue to be persistent realities of the Black American experience. Housing discrimination, employment and education inequality, police brutality, gerrymandering and voter suppression, hate speech and political bias are just a few of the familiar forms they take.

Bringing Awareness to All One hundred and fifty-five years later, Juneteenth continues to be a major fixture in Black culture. On June 19th of every year celebrations range from pageants to block parties in Black communities across the nation. But like many youths from all racial parties, I didn't learn about Juneteenth in primary school or my advanced placement history class. As a white female, I feel uneducated about black history and wish that a more realistic view was delivered during my time in school. As an adult, I try to educate myself, and have real conversations with friends of all different races to help enlighten my world view. Speaking with friends in the black community, they have told me that they too were not educated in school, but rather educated about Black history by their families, educators that taught them about the critical happenings of their fight for liberation.

June 19th has always been marked on Black people's calendars, but this year is the first time it showed up on Google's calendar -- and seemingly those of many non-Black Americans. Major companies like Nike and Twitter have recently released statements announcing the recognition of the holiday. These changes come after a new wave of public statements denouncing racism and promises to "do better" after the tragic murders of Ahmaud Arbery, George Floyd, Breonna Taylor, and Tony McDade -- all unarmed Black people who were killed by the fatal strike of racism.

The Impact of Juneteenth on Healthcare In addition to the urgent need to confront health inequities, medicine as an institution is taking a hard look at some of these inequities’ root cause: structural racism. One of the lesser-discussed examples of structural racism is the disparity in healthcare and health literacy access that continues to contribute to chronic disease, hospitalization and mortality among Black Americans.

In the past year, the Centers for Disease Control (CDC) and the American Medical Association (AMA) declared racism a public health crisis. Racism—systemic, cultural, interpersonal—is a barrier to health equity and optimal medical care. The AMA recently adopted a policy that recognizes race as a social, not biological, construct. One aim of this new policy is to see racism, not race, as a social determinant of health. This reveals a growing awareness of how “race as a risk factor” is present in numerous clinical guidelines and algorithms, and how this can impact medical decision-making that potentially worsens health disparities.

Before the COVID-19 pandemic, many studies highlighted racial health disparities. Black Americans have lower rates of insurance coverage, higher prevalence of chronic diseases, and lower life expectancy. The Black maternal mortality rate remains three times higher than that of white women. A 2017 study in Pediatrics revealed racial inequity in small preterm babies: California hospitals tended to deliver better care to white infants while Black and Latino infants were more likely to receive care in lower-performing hospitals. A 2016 study from the University of Virginia found 50% of medical students and residents believed that Black people are more tolerant of pain, a myth perpetuated during the slavery era.

The COVID-19 pandemic has exacerbated gross inequities with its disproportionate burden on Black communities. Black patients are three times as likely to be diagnosed with the virus and twice as likely to die from COVID-19. Even as vaccines prove effective and immunization rates rise across the nation, vulnerable populations most affected by the pandemic face persistent structural inequities in vaccine distribution and delivery.

If we took an oath to do no harm, then we must first recognize harms that threaten patients’ lives. Racism is a public health threat, and the road to becoming anti-racist can help deliver more optimal care. Within the challenges lies an opportunity to learn, to act, and to improve the health of our communities. These large and small steps can bring us closer toward health equity.

The Healthcare Disparity- A Bigger Picture One racial justice issue that doesn’t get discussed nearly as much as it should be, is healthcare equity. According to the CDC, African American adults are less likely to see a doctor due to high costs, lack of accessible care, or other barriers. Institutional racism means the health concerns of black patients are often taken less seriously than white patients, and serious health issues are often diagnosed later. The CDC reports that African Americans ages 18-49 are twice as likely to die from heart disease than whites, and African Americans ages 35-64 years are 50% more likely to have high blood pressure than whites. They are also more likely to suffer from conditions such as diabetes and strokes at an earlier age, as experiences of racism in healthcare often deter people of color from getting the preventative screenings needed to catch the warning signs of these issues.

These health inequalities are also pronounced in the black LGBTQ community. Black gay and bisexual men are more affected by HIV than any other group in the United States; in 2017, they accounted for 26% of total new HIV diagnoses and 37% of new diagnoses among all gay and bisexual men, according to the CDC. Queer women, and in particular black queer women, are less likely to have regular preventative care such as mammograms and cervical cancer screenings. Black transgender women experience profound health and wellness inequality. An estimated 44% of black transgender women are living with HIV. Transgender women of color are also disproportionately targeted in violent hate crimes and make up the majority of transgender murder victims.

True racial justice cannot exist while these barriers to health and wellness still exist. All healthcare systems need to commit to end the silos that keep minority groups from accessing the care that they deserve. One important initiative is the Racial Justice and Equity Collaborative, an employee resource group created by Fenway Health (a Public Health initiative) staff to address the impact of racism in healthcare by maintaining an ongoing space for conversation and training specific to race in the workplace.

For over 40 years, many healthcare systems have operated under the principal that healthcare is a right, not a privilege. Let us all keep that simple yet powerful belief in mind as we recommit to fighting racism wherever we find it and building a better world for all.

The Facts In healthcare, we are data and research based. On the topic of Juneteenth and the Healthcare System, the data speaks for itself. The toll that health inequity has taken on the Black community is extensive. Data from the Centers for Disease Control and Prevention (CDC) indicates that members of this population:

 Are less likely to see a doctor due to high costs and lack of accessible care  Aged 18-49 are twice as likely to die from heart disease  Aged 35-64 are 50% more likely to have hypertension and diabetes, the leading causes of kidney disease  Have faster progression to and higher rates of kidney failure  Are likely to develop diabetes, uterine fibroids, and strokes at earlier ages  Tend to be diagnosed with serious medical conditions later, after the conditions have progressed  Are less likely to be taken seriously when they voice health concerns  Experience barriers to participation in clinical trials  Have higher rates of treatable or preventable causes of blindness, such as cataracts, glaucoma, and diabetic retinopathy  Are disproportionately steered toward invasive treatment options for fibroids  Have a death rate from COVID-19 that is 3.6 times higher than that of White Americans  Experience a higher burden of HIV/AIDS and prolonged COVID infections  Have less trust in institutional systems, including healthcare

Research strongly suggests that the social determinants of health–lifestyle choices, social and physical environments, economic stability, quality education and access to healthcare–are leading drivers of these poor health outcomes. Disproportionate rates of infection and healthcare access limitations among Black patients during the COVID-19 pandemic helped to shine a light on these inequities, and they must be addressed.

The Way Towards Healthcare Equality This year, many state and local governments, as well as private organizations, are using their Juneteenth observances as an opportunity to discuss these persistent healthcare disparities, and for good reason. Large-scale efforts to close these substantial gaps have only just begun, but they are being undertaken in earnest throughout the country on the local, state and federal levels. Hospitals, school districts, library systems, cultural institutions, law enforcement, powerful advocacy groups and politicians are all working to learn and teach, broaden perspectives and opportunities, and ease access to valuable resources. The effort comes too late to repair the damage of the past, the path is bumpy and mistakes are being made along the learning curve, but it’s a beginning, and it signals hope.

In order to achieve this, healthcare systems across the nation must remain deeply committed to highlighting these issues on Juneteenth and beyond, and providing intuitive, compassionate and substantive support to continuously counteract their devastating short-term and generational effects by working every day to expand health literacy and empower participant communities to be their own self-advocates.

References https://fenwayhealth.org/celebrating-juneteenth-healthcare-equity-and-racial-justice/ https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/87133 https://responsumhealth.com/juneteenth-and-healthcare-disparities-in-black- communities/ https://www.oregonclinic.com/about-us/blog/juneteenth-and-healthcare https://federalnewsnetwork.com/workforce/2021/06/most-feds-off-friday-as-biden-set-to- make-juneteenth-a-federal-holiday/ https://www.cnn.com/2021/06/17/politics/biden-juneteenth-bill-signing/index.html