Slavery from 1619-1865. Structures of racism to maintain white supremacy. Post-emancipation structures of racism to maintain white privilege. Jim Crow laws, segregation, redlining, targeting black people. Racial bias in the justice system. Results: concentrated poverty and social determinants of health, include poor access to healthcare, poor housing conditions and physical environment, poorly funded schools, and poor access to capital. Increased cardiovascular disease (CVD) and stroke risk factors, coupled with toxic stress results in an increase in the burden of CVD and stroke, along with poorer CVD and stroke outcomes.