Contributor: Corine Toomer
To learn more about Corine, click here.
Black women’s health matters, yes. This statement of fact is not to say that everyone’s health does not matter. However, I contend that Black Women’s health needs a great deal more attention at this time. This is not new; the COVID-19 crisis only exposed the myriad health disparities associated with Black people who have a disproportionately greater chance of dying of complications associated with the disease compared to the white population. Recognizing that Black women’s health is in need of attention is the first step. I will outline some of the immediate challenges and offer recommendations to work towards attaining improved health for Black women.
Specifically, there are four major health areas of concern:
- heart disease
- maternal health
50,000 Black women die annually of heart disease (American Heart Association, 2021). In 2017 they had a 60% greater incidence of hypertension compared to their non-Hispanic white counterparts. (Office of Minority Health, 2020) In the case of diabetes, non-Hispanic Black women have a 56% higher prevalence of diabetes (National Health Interview Survey, 2020, p.4), and those who develop gestational diabetes have a 63% greater chance of developing type 2 diabetes in the future. (Bower, 2019, p.1)
Both heart disease and diabetes are often associated with obesity. In spite of the potentially successful management of diabetes and/or cardiovascular disease, weight loss is imperative to gaining optimal health. Four in five Black women are overweight or obese. In 2018, Black women were 50% more likely to be obese compared to non-Hispanic white women. (OMH, 2020)
Most disconcerting are maternal health and pregnancy outcomes; mortality and comorbidities significantly impact young women and their families despite often being preventable. Black women are three to four times more likely to die from childbirth than non-Hispanic white women. (CDC, 2019) These disparities are not solely a function of being uninsured or of a lower socioeconomic status, as they also impact those who are affluent, highly educated, and have extensive health insurance coverage.
When a healthcare provider examines a Black woman who is overweight and hypertensive, would certain assumptions be made or biases come into play when assessing her lifestyle? Would that influence the quality of her treatment? When Black women’s voices are not heard, distrust and poor medical care, even death, can result.
This outcome occurred in the cases of Kira Johnson and Shalon Irving. Both were affluent, educated, and had private insurance. However, following their pregnancies, symptoms ensued, and requests for care were ignored; the results were fatal. Another example was Serena Williams’ pregnancy. With a history of blood clots, she complained of shortness of breath and it was dismissed. Thankfully, she persisted and ultimately was treated appropriately. (Roeder, 2019)
These cases illustrate how health disparities are also influenced by race/ethnicity, which is a social construct, and can inform how one is viewed, perceived, and often determines the quality of medical care one receives. This reality is often due to the biases, beliefs, and myths that some healthcare professionals have continued to believe from years past as well as those alive and well in the present. And in some instances, this perspective reflects outright racism.
As with the population as a whole, Black women’s health is affected by zip code, which may impact safety and physical activity options, food choices and access to healthy options, salary, type of job, family, friends, and colleagues and the nature of those relationships, as well as health insurance status and the degree of coverage. All play an important role and must be addressed in working towards solutions to improve Black women’s health.
As we examine these race and gender healthcare disparities in 2021, in a developed nation like the U.S., one may wonder how such health disparities could exist. My assertion is that it lies in the intersectionality of gender and race. Crenshaw described intersectionality as, “...a sound basis for understanding multiple contexts of Black women's lives as racialized and gendered subjects” (Serrant, 2020, p. 4) Blout further (2019) suggests, “Race is not a risk factor. It is the lived experience of being a black woman in American society that is the risk factor.” (Roeder, p. 26)
Living in the United States as a Black woman comes with significant challenges, and affluence, position, or education do not ensure smooth healthcare system navigation nor quality, equitable care. It is imperative that Black women in particular exercise their agency in pushing the system to deliver equitable health outcomes.
Here are 6 actionable recommendations that may help Black women move closer to optimal health and well-being (all of which would mean a better experience and better care for women as a whole):
- Coordinate efforts to match Black women with healthcare professionals who are culturally sensitive to their unique challenges.
- Increase the number of programs that encourage Black women and other underrepresented and marginalized populations to prepare to study medicine and other allied science careers. Data demonstrate health outcomes are often improved when patients are treated by those of the same race or ethnic group. (Huerto and Lindo, 2020). This finding may particularly be true if a patient has such a preference relative to those providing care.
- Build upon the success of the telehealth model to help patients manage chronic conditions. When the necessary technology support is available and the practitioner is skilled in delivering care virtually, telehealth can provide greater access, lower costs to the patient (e.g., less time off from work, for example), and offer greater opportunities to coach for maintenance, diet modification, and exercise.
- Increase funding for faith-based programs such as US WellCare (2019) using a multidisciplinary approach with weight reduction and wellness (vs. illness) as its focus.
- Provide new mothers with symptom concerns the steps they can take to help ensure that appropriate treatment algorithms are followed. Home monitoring devices can be leveraged to address problems in high-risk pregnancies and the post-partum period.
- Recognizing there is a sordid history of abuse, disrespect, and abhorrent treatment of Black women by healthcare professionals and scientists, recruiting diverse populations in clinical trials is critical to the development of evidence-based guidelines and treatment protocols. Further, Brawley (2020) suggests that, because of IRB and other requirements for eventual approval for use in patients, inclusion may mean better care is received, at least during the trial.
COVID-19 has forced us to face the clear opportunity before us to focus on improving the health of Black women. Perhaps with genuine commitment by healthcare stakeholders, equitable government funding, true patient-centricity and community engagement, and progressive philanthropy, the recommendations noted above can be implemented.
Black women must do their part. They should commit to seek out culturally sensitive healthcare professionals, make their care expectations clear, learn as much as possible regarding preventive care and any chronic conditions they may have, and embrace support resources such as health coaches. Spiritual leaders, family, and friends are welcome.
One thing is clear - extra attention is needed. Progress can be made when we all recognize the health and well-being of Black women matter, and matter just as much as that of others who have benefited from the access and quality of care so often denied or not otherwise available.
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