Why Our Impact Matters More Than Ever

Racist experiences are degrading, toxic, and debilitating for Black women, and studies show our bodies’ response to them can be seen at the cellular level. Thirty years ago, public health researcher and professor at the University of Michigan’s Population Studies Center, Arline Geronimus, described what she called “weathering” and the “allostatic load” that Black women bear, causing them to age faster than white women. Although Geronimus’ research was largely ignored, she discovered that stress raises our risk for certain cancers, infant and maternal mortality; triggers our metabolic response (the way we metabolize food); and raises our risk for diabetes, hypertension, and obesity-related conditions—all of which put us at a higher risk of dying.

Black women report that their lives are increasingly stressful, both at home and at work.

Stress is compounded by chronic diseases that seem to prey upon the Black community. The number of Black Americans with diabetes is astounding—2.2 million according to the National Institutes of Health. But for Black women, Type 2 diabetes has reached epidemic levels, with 1 in 4 women age 55 years and older living with the disease. Additionally, from 1968 to today, the percentage of Black Americans diagnosed with diabetes has increased a staggering fourfold. In March 2022, we released our National Diabetes Agenda. The Agenda outlines policy recommendations that could help prevent diabetes and reduce health inequities, including prediabetes screening programs and wider access to affordable care. It also highlights the Black Women’s Health Imperative’s Change Your Lifestyle. Change Your Life. program, a year-long, evidencebased program that helps participants at risk of developing diabetes make positive lifestyle changes. This lifestyle-change program is offered as a resource provided through the BWHI’s cooperative agreement with the Centers for Disease Control and Prevention (CDC). There are encouraging signs that the medical community is finally waking up to racism’s destructive effects—but systemic change must move faster. We all know that systemic racism isn’t going anywhere on its own. We are gratified that BWHI's work has raised general public awareness around these issues and that some in the healthcare system are finally listening to our demands. Because if we’re going to fix our broken healthcare system and require real behavior change and real equity, we must require behavior change at the provider level and produce more studies, more clinicians, more doctors, and more changes to make the U.S. healthcare system more inclusive to Black women. And we strongly suggest starting by building trust, improving outreach, and funding diversity for more effective drugs and more accurate clinical results for better health outcomes in Black women. Despite systemic racism and access barriers to optimal well-being, Black women are a vital force in moving our culture and communities forward. Historically, Black women have played an integral role in the desegregation of public schools, public transportation, and communities. Today, we remain fierce advocates for equality and one of the most active groups of voters in the country, but we face a barrage of challenges daily that impact our health.

Why Our Impact Matters More Than Ever

Today more than ever, we live the reality that Black women are worthy of quality care. The appointment of Justice Ketanji Brown Jackson is yet another benchmark of excellence attained. Judge Jackson will also serve as an inspiration to Black mothers and all working mothers. As she espoused in her confirmation hearings, she "did not always get the balance right" when juggling her career and motherhood. "But if you do your best and you love your children … things will turn out OK." To hear this from Judge Jackson, a woman at the top of her field and no stranger to breaking barriers, was reassuring for so many Black women and mothers who are constantly under pressure to be perfect. Judge Jackson revealed that imperfection is okay. As Black women in America, we see ourselves in Judge Jackson, and we have learned how important it is to prioritize self-care. Notably, Judge Jackson also took a hard stance on abortion rights during her confirmation hearings, stating that Roe v. Wade is "settled law." Federally protected abortion rights are particularly important for Black women, as we face disproportionate barriers to accessing sexual and reproductive healthcare. But now those rights are in serious jeopardy and almost certain to be declared unconstitutional by the conservative majority of the U.S. Supreme Court. Roe has given Black women the bodily autonomy we've historically been denied. In so doing, the landmark decision has contributed to the physical, emotional, and financial health of millions of Black women. Overturning Roe v. Wade would mean that there would be a small patchwork of states that provide abortion services. This would significantly limit access to women who are financially challenged and can't afford to travel across state lines to obtain reproductive health care. Such a decision will also negatively impact the lives of the most vulnerable of us—our young Black girls who are victims of incest, rape, and sex trafficking and are not yet ready for parenting. This outcome would be particularly devastating for Black women, who already face massive hurdles to receiving abortion services and are more than three times as likely to die during childbirth as white women. We know that the single most cited reason Black women give for seeking abortion care is the inability to afford a child. If Roe is indeed overturned, they are and their children would likely be condemned to a lifetime of poverty and poor health outcomes. No matter the court’s decision, BWHI will continue to fight to protect Black women's right to bodily autonomy and their physical and economic well-being.

Why We Focus On Wellness

Our work highlights health inequities, raises awareness, and influences medical systems and legislation centering on Black women's concerns and elevates them to the national stage. We are on a mission to transform the inequities of our current reality into systems that can support optimal health and well-being outcomes for Black women. The following key insights illustrate why our work remains critical.

THE FACTS

• Black women continue to experience excess mortality relative to other U.S. women, including—despite overall improvements among Black women—shorter life expectancies1 and higher rates of maternal mortality. • Moreover, Black women are disproportionately burdened by chronic conditions, such as diabetes, anemia, cardiovascular disease (CVD), and obesity. Health outcomes do not occur independent of the social conditions in which they exist. • The higher burden of these chronic conditions reflects the structural inequities within and outside the health system that Black women experience throughout their life course and contributes to the current crisis of maternal morbidity and mortality. The health inequities experienced by Black women are not merely a crosssection of time or the result of a singular incident. • Black women experience intimate partner violence at higher rates than women overall. More than 40% of Black women experience physical violence by an intimate partner during their lifetimes (41.2%), compared with 31.5% of all women.

2019 data sources: black-womens-health-insurance-coverage.pdf (nationalpartnership.org) and Fact Sheet: The State of African American Women in the United States - Center for American Progress Health Equity Among Black Women in the United States | Journal of Women’s Health (liebertpub.com) Our Financial Health Impacts our Overall Health:

Systemic issues affect educational opportunities and access to wages that support quality lifestyles. Census data confirms that the full-time work-life earnings of white women remain more than those of African American women regardless of their degrees. And in a majority of single-parent homes Black women are the breadwinners.

THE FACTS

• African American women held 8.58% of Bachelor’s degrees held by women in 2012, though they constituted 12.7% of the female population. • Only 2% of African American women are represented in science, technology, engineering, and mathematics, or STEM, fields, while women make up 24% of the STEM workforce. • 35% of Black business owners are women, and 58% of Black business owners said their business’s financial health was “at risk” or “distressed” during the COVID-19 pandemic. • Black families depend on Black women’s earnings. Eight out of 10 (80.6%) Black mothers are breadwinners and either the sole earner or earn at least 40% of household income. • Black women found just 4% of startups and businesses owned by

Black women earn significantly less than businesses run by other women. • The poverty rate for African American women is 28.6%.In comparison, the poverty rate of white, non-Hispanic women is 10.8%. • The poverty rate of African American lesbian couples is 21.1% versus 4.3% for white lesbian couples. • African American women are three times more likely than white women to be incarcerated. The American Civil Liberties Union (ACLU) asserted in 2011 that incarceration mainly affects Latinas and Black women, as they are often the primary caregivers for their children and are also disproportionately victimized.