The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation

From award-winning journalist Nicole Carr comes a landmark narrative revealing the untold history of Black medical professionals who have long fought to heal their communities—while confronting a system built to exclude them.

During the COVID-19 pandemic, Black Americans died at nearly twice the rate of their white counterparts—a disparity rooted not only in access to care but in a long history of exclusion, exploitation, and systemic racism. How did we get here, and why, despite generations of Black medical excellence, do these inequities persist? In The Price of Exclusion, journalist Nicole Carr uncovers that history and its urgent consequences, exposing the hidden toll of America’s refusal to value Black doctors and their patients.

At the center is the extraordinary life of Carr’s great-grandfather, Dr. Lawrence St. Clair Ferguson, a Jamaican-born physician who served in World War I and attended medical school during the Spanish Flu pandemic. His journey from colonial Jamaica to a racially divided America provides both an intimate family portrait and a sweeping history of how Black physicians persevered despite segregation, erasure, and relentless barriers to practice.

Through vivid storytelling and meticulous research, Carr resurrects the lives of pioneers who transformed medicine against impossible odds. From America’s first four-year medical school located at a historically Black college in North Carolina to the generations of Black physicians whose contributions were pushed aside by institutions of power, Carr shows how these figures were not only doctors but also advocates and innovators whose work reshaped public health and opened doors for those who followed.

Carr also reveals the systemic campaigns that actively disempowered Black doctors, from the American Medical Association’s exclusionary policies to the devastating closures of Black medical schools after the Flexner Report. That legacy fuels today’s shortage of Black medical professionals and the lingering distrust in medicine that continues to cost lives.

Bold, moving, and essential, The Price of Exclusion is both a necessary history and a testament to the resilience of Black medical pioneers past and present. At a moment when diversity, equity, and inclusion in medicine are under political attack, Carr forces us to reckon with the past while imagining a future where healthcare truly values every single life.