This chapter explores the intersection of biological and social vulnerabilities in understanding health disparities among institutionalized individuals in the past. Using data from the Mississippi State Asylum, they investigate how systemic racism, poverty, and overcrowding contributed to heightened mortality, particularly among Black and/ or African American patients, during pandemics such as the 1918 influenza pandemic and tuberculosis outbreaks. The authors argue that addressing these historical injustices is critical for informing contemporary public health policies aimed at improving care for people with disabilities, particularly in institutional settings, by focusing on social determinants of health and prioritizing equitable care as a social justice imperative.