The North Star of Awareness

Change is one of the few certainties of life. Our world is always changing, but due to advances in information technologies, we are more aware of it now than we have ever been before. One notable change we see today is a greater awareness of the cultural history of our nation, and how the actions or inactions of previous generations have contributed to who we are today.

Most Americans are better aware of the sobering reality that people of color, women, and others defined as “minority” cultures contributed mightily to the creation of the United States of America. Enslaved Black Africans and subsequent generations of both enslaved and free Black Americans have a storied history of tolerating unequal social liberties despite their laudable contributions to the creation and advancement of our nation. The shadow of generational discrimination still looms among us to this day. Our job is to shake off the status quo that existed prior to the 21st century and make positive societal changes which will allow equal opportunities for all Americans.

The American Board of Family Medicine (ABFM) is publicly committed to addressing health equity. This means ABFM promotes equal treatment of all patients, eliminating health disparities based on race, class, gender, ethnicity, or any other
defining characteristics. This commitment recognizes the reality of how an asynchronous awareness of American history has contributed to the propagation of conscious and unconscious biases toward other human beings who do not look like us or think as we wish.

Let me pause at this point to share a brief story with you. In the summer of 2022, our nation began to stir in what many describe as the post-pandemic era. One of the first large gatherings I attended in my hometown was a Juneteenth Celebration at the Levitt Dayton Pavilion in downtown Dayton, Ohio.

Even in this outdoor space, many attendees were wearing masks for protection from the lingering presence of COVID-19. Most of the estimated 8,000 guests were simply relieved to gather on a beautiful summer evening and celebrate their emerging freedom from sheltering in place.

With the sounds of the band on stage echoing in the background, I strolled around the lawn covered with a diverse tapestry of people. I saw several people of color outfitted in authentic African clothing, while others wore tee shirts celebrating the anniversary of Juneteenth. During my walk, I happened to overhear one of the attendees asking someone seated nearby, “Why do they call it Juneteenth? It seems like they could have thought of a better name than that.”

The comment stopped my wandering thoughts dead in their tracks. It was obvious that the person who uttered those words had no ill intent in saying them. They were just as unaware then as I had been five years earlier, when I learned about the genesis of “Juneteenth.”

After President Lincoln issued the Emancipation Proclamation on January 1, 1863, it took more than two years for the news to reach the outermost territories of Texas. There, news of the Emancipation Proclamation and the freedom of the Black slaves arrived on June 19, 1865, when Union Major General Gordon Granger issued the freedom order in Galveston, Texas. This resulted in an annual celebration of freedom that began on June 19, 1866. Juneteenth celebrations gradually spread across the southern states. These celebrations took on many different names, such as Emancipation Day, Freedom Day, Jubilee Day, or Black Independence Day.

With the migration of African Americans from the southern states (aka The Great Migration) and the civil rights movement of the 1960s, the awareness of this African American celebration continued to grow. The language which held the most historic significance came from the freed slaves of Texas, who first celebrated on the nineteenth day of June in 1865, “Juneteenth.” It was the signature word attached to the Juneteenth National Independence Day Act, which President Biden signed into law in 2021, declaring June 19th a federal holiday. Although its roots are grounded in African American heritage, Juneteenth has grown to become a multicultural celebration.

My daughter, Ciara, attended Asbury College and I came to visit her in Lexington, Kentucky, which also happens to be the home of the American Board of Family Medicine. While visiting, I had the opportunity to stroll about the downtown area. During my walks, I discovered how rich the area is with acknowledged history. The city is filled with Lexington Historical Society plaques that teach future generations about who we once were.

On the north side of Lexington’s majestic courthouse is the Lexington Farmer’s Market on Short Street. This area has a storied history of commercial trading of goods and services.

It remains a vibrant business area in the downtown area. One Saturday afternoon I happened to walk to the south side of the courthouse where I discovered a placard labeled with the title “Cheapside.” It chronicled the historic fact that this was where Black slaves were bartered and sold on the back steps of the courthouse of justice.

It was not until this year that I became aware Kentucky was one of five “border states” teetering between slavery and abolitionism during the Civil War. Although a declaration of secession was drawn up by the Kentucky legislature, it was never approved. It was not until the 13th amendment was ratified that Kentucky became the last of the border states to officially abolish slavery on December 18, 1865.

Texas was the last state to legislatively give freedom to former slaves between 1868 and 1874, long after the events of the first Juneteenth celebration occurred in Galveston. To create a better future for ourselves, we must accurately remember the past. We must celebrate the hard-earned victories that so many before us fought to achieve.

Progress does not always happen in a linear fashion. The road toward equal opportunity for all is a tortuous journey. There is no designated beginning or predetermined expiration date for equality. It will require the collective efforts of us all to enact the change necessary to create true equality for all people. ABFM actively contributed to this ongoing conversation for change in 2020 by launching a Health Equity Performance Improvement activity which offers a variety of innovative resources Diplomates can use in addressing health care disparities within their respective communities.

Around the same time, ABFM collaborated with the American Academy of Family Physicians (AAFP) on five self-assessment modules related to health equity. Those topics include:

• Striving for Health Equity
• Addressing Social Determinants of Health
• Supporting Vulnerable Populations
• Championing Economics and Policy to Reduce Health Disparities
• Understanding the Impact of Climate Change on Public Health

Additionally, for nearly a decade, ABFM has collected data on Diplomate race and ethnicity to conduct Differential Item Functioning (DIF) analysis. This research was done to assess whether unintended bias exists within our certification examination questions.

We will continue to enact any necessary change that reflects our commitment to health equity. No patient should receive inferior health care due to the color of their skin, and no Diplomate or medical professional should be similarly disadvantaged by institutional discrimination. That is ABFM’s pledge.

As we continue to evolve in our understanding and knowledge of the people who share this planet with us, may truthful awareness be the North Star that guides us to a better future – where every day is Independence Day.