Black History Month usually strikes me as celebratory, an opportunity to hear about the invaluable contributions of Black Americans throughout U.S. history. But Black History Month also serves as an opportunity to hear other, more difficult stories, including those detailing the hardships of emancipation, when the status of Black Americans shifted "from slavery to freedom," as Jim Downs notes in Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (Oxford University Press, 2012). The history of emancipation is typically described in uniformly positive terms. But as Downs explains, emancipation presented life-threatening challenges to newly freed slaves, most notably the prevalence of disease coupled with little or no access to health care.
One point Downs makes repeatedly is that emancipation tends to be described as if there was a singular moment when enslaved Black Americans became freedmen, or to use Downs's gender-neutral term, freedpeople. He argues persuasively that, to the contrary, emancipation was a "grueling process," since neither the Union military nor the federal government considered the logistical and public health issues that would arise when an estimated 4 million enslaved people fled the Southern plantations where they lived, hoping to secure their freedom by making their way to Union troops or nonslaveholding states.
Although few accounts of freedpeople's struggles have survived, Downs probed deep into the historical record to capture a clear picture of how bereft these Black Americans were. Fleeing slaves usually had to travel long distances under threat of recapture and with little food, water, or shelter; some traveled with children, who also needed sustenance and were likely slower than adults. When the Civil War ended, O. O. Howard, leader of the newly formed Freedmen's Bureau, thought the suffering of freedpeople would garner the sympathies of Northern politicians, but in this he was mistaken. One word that recurs repeatedly in Sick from Freedom explains why: dependency. "The fear of dependency," Downs writes, "ran like a cancer throughout the rhetoric of Union officials in the Civil War South." The idea that offering freedpeople any form of aid (including health care) would cause dependency derived from the racist belief that Black people needed white supervision in order to work reliably. Some members of President Andrew Johnson's administration even claimed that freedpeople became ill because they would not work. But without adequate food, clothing, and shelter, freedpeople were extremely vulnerable to disease, especially during the brutal Northern winters. Moreover, the government moved freedpeople from place to place, ostensibly to find work, and this dislocation forced them into crude overcrowded encampments. Squalor begets illness, and freedpeople were often sick with "measles, typhoid fever, diphtheria . . . dysentery and pneumonia"; outbreaks of cholera and smallpox were also reported.
Many freedpeople died, but those who survived began to mobilize and demand health care. Emancipated slaves appealed to the Medical Division of the Freedmen's Bureau, arguing that maintaining the health of the 4 million former slaves who had become U.S. citizens was part of the government's "responsibility to rebuild the South." According to Downs, their largely successful appeal was the point at which "health became embedded in the meaning of citizenship."
These ideological and ethical arguments about the extent to which a government bears responsibility for the health of its citizens still resonate, as we continue to debate how to best manage and administer health care in this country. Judgments about Americans who don't work, yet get free health care, abound. It's hard to believe that accusations of dependency were leveled at Black Americans who fled enslavement, owned little or nothing, had never earned wages (because they were slaves), and had been kept illiterate by law. Using "dependent" as a pejorative label was not only racist but ridiculous. As a nation we're currently in the throes of a reckoning with outdated and toxic views about race. Sick from Freedom suggests that our ideas about dependence, interdependence, and the right to health care need to be similarly modernized.