Melissa Fox, MHA, FACMPE, FACHE
Chief Operating Officer, Acenda Integrated Health
“I’m sick and tired of being sick and tired.”
Fannie Lou Hamer, 1964
The complex intersectionality of factors which impact the health disparities and longstanding health conditions of Black Women have been generations in the making. From the earliest days of this country and the origins of the American health care system, Black Women have been subjected to a poisonous brew of individual and system-level racism, sexism, and discrimination. But, the time has come for a reckoning within a system which continues to be infected by some of this country’s worst impulses, and a dismantling of the toxicity which permeates healthcare in the U.S. once and for all. Black Women are sick and tired of being sick and tired.
The historical context of the Black Woman’s experience in America has clearly shown that there is an unequal burden which negatively affects her physical, mental and economic health. For instance, Black Women are paid less, experience higher unemployment rates than other women, have demonstrated disparities related to cardiovascular disease, anemia, cancer rates and maternal mortality — all of this while being more likely to be a head of household and supporting more dependents with less resources.
It is particularly important to note that the history of healthcare in America as it relates to Black Women is rooted in the earliest days of slavery when their roles were defined by barbaric laws which dehumanized them and reduced them to vessels used primarily for economic gain. In 1662, Virginia passed a law which decreed the enslaved status of a child was determined before birth by the enslaved status of the mother, meaning that the reproductive health of enslaved women of African descent were disregarded so their bodies could be used to create generations of slave labor. Black Women were also historically subjected to brutal and inhumane experiments in the earliest days of gynecology as a medical specialty, and there are numerous documented instances of medical research conducted on Black Women without their knowledge or consent.
In order to begin eliminating the toxicity which negatively affects the equitable and effective delivery of care for Black Women, it is important to create a strategy which addresses several key factors:
- Build methods of clear and quantifiable accountability – Health systems, managed care organizations, private funders, governmental health departments, and collaborative health care partners (including organizations addressing the social determinants of health) must develop quantifiable metrics related to reducing/eliminating health disparities. The metrics should be measurable, visible, urgent, community-informed and specific. The measures should be inclusive of the multiple barriers which not only prohibit access to direct care, but also the internal culture which allows toxicity to fester. And most importantly, there needs to be a level of accountability if results are not achieved in a timely manner.
- Eliminate financial rewards and reimbursement mechanisms which perpetuate racial and ethnic disparities – At the Federal level there has been a recognition of the fact that some pilot program designs created disincentives for health care providers to reduce disparities. Thankfully much-needed shifts are beginning to occur, though there is still much work to be done.
- Create actionable and community-based feedback structures which allow the people who are most impacted by toxic systems to provide input on developing solutions. This input goes beyond a generic community-based survey. This level of feedback is an ongoing engagement of key voices on specific interventions, patient care, and even planned care models for populations with historically high disparities. These individuals and organizations can help systems identify potentially toxic components of their operations in order to be better prepared to address and eliminate the issue.
- Develop strategic advocacy groups and maintain visibility with elected officials (know the statistics in your community, know your “ask”) There is power in numbers, so by aligning the expertise and influence of community advocacy groups related to the health and wellness of Black Women, you’re able to leverage the combined impact. It is critically important to be well-versed in the health statistics of your community so you are able to build an advocacy plan which is reflective of your needs. This information can be used to propose care/support models with local health providers, and it can also be referenced as part of an outreach strategy with local and state legislators.
- Develop community education and empowerment programs. Toxic practices cannot prevail if you know your worth and advocate for what you deserve.
Breaking down the toxic systems which have resulted in health disparities related to Black Women will not be easy. These broken systems were not caused by Black Women, and we absolutely cannot dismantle them alone. However, with a consolidated, honest and steadfast approach, we can begin to shift the historical trajectory and ensure that future generations will achieve the health and wellness they so rightfully deserve.
Bakare, L. (2022, September 21). How black women can navigate pay-gap gaslighting. Harvard Business Review. Retrieved February 22, 2023, from https://hbr.org/2022/09/how-black-women-can-navigate-pay-gap-gaslighting
Chinn, J. J., Martin, I. K., & Redmond, N. (2021, February). Health equity among black women in the United States. Journal of women’s health (2002). Retrieved February 22, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020496/