WHEN I first heard of HB 544, I assumed it was a lark, and imagined a satirical byline from The Onion: “NH GOP to Educators: Discussing Racism is Racist.”

As I learned more about the bill, it was clearly no joke.

Pulled from the pages of Donald Trump’s rescinded mandate in versions now advanced by Republican legislatures nationwide, NH 544 would censor “unlawful propagation of divisive concepts” among state contractors. The contractors — schools, universities, hospitals, essentially any “persons, individuals, corporations, or businesses of any kind” — that conduct business with our state no doubt represent a sizable proportion of the Granite State’s economy. The “divisive concepts” themselves are rooted in the notions of structural racism, which undergird our country and its history.

Is it “unlawful,” I wondered, for my colleagues or for me to teach University of New Hampshire premedical students that America’s racist expertise inspired copycats from German Nazis to Afrikaner apartheidists? Would patients lose their oncologist if while lecturing in Dover about health equity I characterized our national origins — founded by genocidal slavers, built by enslaved people, at best ambivalent and definitely late to outlaw slavery — as fundamentally racist?

Placing limits on speech seems to be the bill’s intent, according to its sponsor (and self-described Free Stater), Rep. Keith Ammon. During public testimony on February 21, he also acknowledged slavery as among America’s “original sins,” but qualified that “the design of our country allowed our country to evolve and rectify the sins of the past.” While I cannot speak to the “design” he mentioned, I hope it’s not the Civil War, which slaughtered 600,000 Americans to “rectify” slavery.

It is tempting to think that in those heady days after the War of Northern Aggression, but before America was Made Great Again, that we ended our 400-year love affair with racism. Though prior generations passed the (divisive!) 13th, 14th and 15th Amendments to end slavery and establish citizenry, America couldn’t quit White supremacy. Eventually the (divisive!) civil rights movement culminated in the (now gutted, also divisive!) 1965 Voting Rights Act, so that America might send Jim Crow packing.

Instead, Jim “evolved.” Outfitted with red-lines and sundown towns, gerrymandered districts and filibustered legislation, Old Jumpin’ Jim evolved into towering scalpels of structural racism, aseptically dissecting wide swaths of Black health, wealth and voices “with surgical precision.”

Effects of structural racism are plainly visible through the lens of health equity. Take COVID. The virus preferentially razes Black, Brown and Indigenous neighborhoods populated by “essential workers” to whom WFH is but a three letter acronym of four letter words. Our publicly financed vaccination campaign — at least in certain states — demoted these front-line heroes from essential to dispensable.

Sadly, as a health services researcher, I know these disparities are foregone conclusions. Structural racism permeates health care delivery and affects the tools we need to study it. When we assess health care, we start off expecting Black patients to do worse. For example, to compare cancer survival rates across the Granite State, we’d start by looking at expected differences across geography. If Concord has older people than Manchester, we’d expect to see higher death rates in Concord. So, to better compare apples with apples, we statistically “correct for age” in Concord. We routinely do the same for marital status, sex, and race — as longevity favors the wedded, women, and Whites, respectively.

While the longevity gap between Black and White is at last closing, don’t students — and the rest of us for that matter — deserve to know why Blacks have worse health? Or should we continue to simply “correct for race” and whitewash a fundamentally racist medical history that, at best, marginalized Black American health? A medical history born in the capture, enslavement, rape, torture, and displacement of entire populations, one that dabbled with pseudo-scientific techniques such as phrenology and eugenics, and was codified into racist policy by physicians. (The American Medical Association, founded in 1847 — openly — did not admit Black doctors until the 1970s.) Teaching this history draws a straight line, through to ubiquitous and ongoing structural racism, seen today in partisan federal lawsuits, bleak medical deserts and surging voter suppression laws that disproportionately deprive Blacks of insurance, hospitals, and representation.

To be clear, I believe America today is more just, more tolerant, and more inclusive than the America of Jim Crow or our Founding Fathers. I also happen to agree with Rep. Ammon that together, we can design a better future. But to work, those designs presuppose “teaching, instruction, or training” about our fundamentally racist roots and its modern remnants. New Hampshire cannot expect “unity and equality” by gas-lighting the pervasiveness of structural racism and its effects. New Hampshire cannot claim to Live Free while “prohibiting the dissemination” of racism’s discomfiting truths. For these reasons, New Hampshire must oppose HB 544.

Nirav Kapadia MD, MS is a radiation oncologist at the Dartmouth Hitchcock Medical Center / Norris Cotton Cancer Center and a cancer health services researcher at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine in Lebanon. He is also medical director of the Susan and Richard Levy Health Care Delivery Incubator at Dartmouth. He lives in Hanover.

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