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, 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.