I began my career at Northeastern Law during the darkest days of the AIDS epidemic, seeking to understand how the law could help those afflicted. Reading old cases and dusty statutes, I learned how American law developed in the shadow of yellow fever, smallpox and many other ravaging plagues, as governments instituted measures — some sensible, some counterproductive — aimed at stopping the spread of disease. Time after time, courts upheld such measures, noting that the protection of public health was the highest law.

The history of public health makes clear that there never was a golden age in which America was healthy. And always, those facing the greatest social disadvantages — people enslaved or oppressed by Jim Crow, immigrants, Native Americans and the poor — have suffered most.

Still, progress has come, in fits and starts. In the 19th century, reservoirs and sewers defeated cholera, but the sanitary movement also targeted immigrants and poor communities for their “unhealthy” habits. In the 20th century, the enactment of Medicare helped seniors pay for healthcare; however, increasingly impressive and expensive technologies remained unaffordable to the millions left uninsured. This led to new legal fights and reforms, including the expansion of Medicaid and statutes limiting preexisting condition exclusions.

The AIDS epidemic taught us that civil rights and antidiscrimination laws can serve as powerful public health interventions. The Affordable Care Act codified even broader antidiscrimination protections while further expanding coverage. Yet, its gains were met by setbacks, including the Supreme Court’s decisions in NFIB v. Sebelius, which limited the federal government’s ability to require states to expand their Medicaid programs, and Burwell v. Hobby Lobby, which allowed employers to opt out of the ACA’s contraceptive benefits.

The COVID-19 pandemic brought further legal gains and setbacks. For a time, Medicaid was expanded, evictions were halted and legal measures enabled the rapid development and dissemination of much-needed vaccines. Yet, a backlash against public health laws took hold in the courts, paving the way for their weakening.

Today, in a country with the worst life expectancy among wealthy nations, the Supreme Court appears poised to undermine childhood vaccine mandates; states are passing laws limiting public health powers; environmental regulations are being dismantled; and the Secretary of Health and Human Services is undermining trust in vaccines, access to Medicaid and support for medical research. Lawyers and activists have fought back, leading to the reversal of some of the most egregious actions.

We cannot know what the future will hold for public health, but there’s no doubt that law will help to shape it. And I remain confident that our students and graduates will lead the way in ushering in that better time when, perhaps, Americans will be healthy — at last.