From childhood obesity, to racial profiling, from school segregation to a lack of opportunities for men and boys of color, President Obama and first lady Michelle Obama have found ways to creatively spotlight many of the major concerns confronting the African-American community and, most importantly, create a national conversation around these issues. Remarkably however, throughout all of these conversations around race and/or health, there has been a noticeable lack of attention to African-American women, and in particular, their health. Which raises the question: How is it possible to have an African-American woman on one of this country’s most visible platforms and not have a serious dialogue about black women’s health?
Perhaps because she herself projects such a strong image as a physically fit and healthy woman (biceps anyone?), many in the general public may be less aware of the pressing health concerns facing the majority of African-American women throughout the country. By Obama’s age (50), over half of African-American women are obese and 47 percent have hypertension. African-American women aged 45-54 also have two to three times the rate of diabetes, increased levels of breast cancer mortality, higher rates of hysterectomy and a 60 percent greater likelihood of death from any cause than white women in the same age group. Funding agencies like the National Institutes of Health and the Robert Wood Johnson Foundation have special initiatives focused on childhood obesity and the health of boys and men of color. Yet there is no outcry, no movement, and few national initiatives to support black women’s health.
While this is sad, it is, unfortunately, not all that surprising. As outlined most recently by Kimberlé Crenshaw in response to My Brother’s Keeper, discussions about “race” are most often about African-American men. Similarly, dialogues about “gender” most frequently center on white women. Consequently, African-American women’s unique concerns are rarely heard. Scholars refer to this as the “intersectional invisibility” faced by African-American women. This invisibility can be emotionally painful and is unjust by most standards. However when it comes to health, it can also be fatal. This is the primary reason why we need a larger platform for conversations about black women’s health.
Much of the lack of attention to this issue may be rooted in the fact that women, of all races, are typically busy taking care of everyone else — children, husbands, others in their community. And in the African-American community –a community experiencing disadvantages– this natural pattern may be exacerbated. Regina Benjamin, the former surgeon general, who resigned in 2013, is an African-American woman who often spoke about the preventable illnesses that affected her immediate family (AIDS, lung cancer, stroke) and the health concerns of the poor, rural community that she served in Bayou le Batre, Ala. (access, difficulty with co-pays). But she rarely spoke about her own health, or the unique health concerns facing African-American women in a substantive way, except to urge black women not to let fear of ruining their hairstyles get in the way of exercise. Both Obama and Benjamin project images in line with the “Black Superwoman,” the invulnerable caregiver who is a pillar of strength for her family and her community. But who cares for the caregivers?
Of course, health promotion and illness prevention are issues for everyone, and many believe that by improving the health of the nation, we will improve the health of all of its subgroups, including black women. But this is not always the case. Research shows that when new advances and technologies are rolled out, they often benefit the most privileged members of society (whites and individuals with high income levels) first and the gaps between African-Americans and whites typically widen. A recent study sponsored by the Avon Foundation is a good example of this. Between 1999 and 2009 in the 50 largest cities in the United States, the black-white disparity in breast cancer mortality actually increased –primarily because of technological advances in screening and treatment that benefited white, but not black, women.
We need a national “Black Women’s Health” agenda that focuses on obesity prevention and improved rates of screening for breast cancer, high blood pressure and diabetes in African-American women. A Michelle Obama-led campaign with support from the American Heart Association, the American Diabetes Association, and/or the American Cancer Society would go a long way towards increasing the visibility of these issues. It could also lead to targeted funding initiatives and more research to better understand the factors that predispose black women to poorer health, including access to care, differential quality of care, and more upstream factors such as stress and financial strain. Black women earn 66 cents for every dollar that white men earn (this is less than white women and black men), but are more likely than white women and black men to be single heads of household. Thus, they make less money, but have to support more people with it. However, there is very little funding for research on how social conditions affect African-American women’s health.
A national dialogue, convention, or summit around the potential importance of social factors for black women’s health might encourage foundations and governmental funding agencies to reconsider their priorities around this particular topic. A campaign around black women’s health might also increase awareness of and research on health conditions that are less prevalent among the general population, but are more prevalent among African-American women, such as fibroids and autoimmune diseases like Systemic Lupus Erythematosus. Finally, having a prominent African-American woman behind such an initiative would send a message to the rest of the world – that black women’s health matters. And it does. The longer we go on ignoring it, the more lives we stand to lose.
Tené T. Lewis is an associate professor in the Rollins School of Public Health at Emory University. She is also an Op Ed Project Public Voices Fellow.