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 just in access to care but in a long history of systemic exclusion, exploitation, and 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 forgotten history, highlighting the Black medical pioneers who gave their all—and sometimes their lives—so others could thrive.

Told through the extraordinary life of her great-grandfather, Dr. Lawrence St. Clair Ferguson, a Jamaican-born physician who practiced in Philadelphia during the Spanish Flu pandemic, Carr’s exploration is both intimate and sweeping, taking readers from segregated hospital wards to the frontlines of recent public health crises. Tracing Ferguson’s journey—from his early years in colonial Jamaica to his fight to practice medicine in a racially divided America—Carr reveals the long-standing barriers Black doctors have faced, the systemic efforts to erase their contributions, and the consequences that still shape healthcare today.

Through vivid storytelling and meticulous research, Carr introduces us to trailblazers like Onesimus, an enslaved African who brought inoculation to the colonies; Dr. Rebecca Crumpler, the first Black woman to earn a medical degree; and Dr. Charles Drew, whose pioneering work in blood transfusion transformed modern medicine. These were not merely doctors; they were fighters, innovators, and advocates who persevered against relentless discrimination, reshaping medicine and carving paths for future generations. Carr also exposes the mechanisms used to disempower Black doctors, including the American Medical Association’s campaign to exclude Black practitioners from membership, internships, and hospital staff positions.

Here Carr uses the arc of her great-grandfather’s life, and the broader history of Black medical professionals, to expose the root causes of today’s healthcare disparities. She reveals how a century of exclusionary policies has led to the urgent shortage of Black medical professionals and a lingering distrust in medicine—barriers that continue to cost lives today.

Bold, moving, and essential, The Price of Exclusion is a fresh and necessary history, as well as a testament to the resilience and ingenuity of Black medical pioneers past and present. An urgent narrative during a time when diversity, equity, and inclusion efforts in medicine are under political attack, The Price of Exclusion forces us to reckon with the past while imagining a future where healthcare truly values every single life.