Toward health equity in academic nursing and healthcare systems, part 1: Historical and theoretical foundations.

Health inequities in the United States are not accidental but structural-deliberately created and systematically upheld. This first paper in a two-part series examines how American founding values, cultural norms, and historical practices established inequity as an enduring feature of healthcare and academic systems. Although the nation professed ideals of freedom and justice, Black and Brown communities were excluded through policies grounded in Anglo-Saxon supremacy and White solidarity. Wealth extracted from enslaved labor exceeded $3 billion by 1860, and later programs such as the GI Bill reinforced disparities through discriminatory implementation. These systems promoted narratives of individualism that obscured structural racism and normalized inequity. Academic and healthcare institutions actively built and legitimized these structures. Universities advanced pseudoscientific theories-such as phrenology and false claims about racial differences in pain tolerance-that validated racist practices. Physicians carried out nonconsensual experimentation on enslaved and marginalized people, from J. Marion Sims's surgeries on enslaved women to the Tuskegee Syphilis Study. The unauthorized use of Henrietta Lacks's cells shows how exploitation persisted into modern biomedical research and corporate profit. These histories shape present-day inequities, visible in biased medical algorithms, flawed diagnostic tools, inequitable resource allocation, and institutional mistrust. Health inequities cost the United States $320 billion annually, projected to reach $1 trillion by 2040. Understanding these roots is essential for the transformative strategies outlined in Part 2.