The Health Consequences of Racism: Examining Its Role in Black Women’s Wellness and Care Access
Racism as a Determinant of Health
Despite advancements in public health, systemic racism remains one of the most persistent threats to Black women’s well-being. It shapes access to healthcare, aggravates mental health disparities, and contributes to long-term physiological harm. More than an individual experience, racism in healthcare is a structural issue embedded in policies, medical training, and institutional practices.
Black women’s encounters with the medical system have long been characterized by neglect, bias, and exclusion. This reality is rooted in centuries of scientific exploitation and structural violence. These histories have fostered a deep mistrust of healthcare institutions, influencing Black women’s care-seeking behaviors and health outcomes today. According to the Centers for Disease Control and Prevention, racism itself is a public health threat. It limits access to resources, perpetuates disparities, and weakens opportunities for wellness (Godoy, 2021). Understanding how racism operates as a health determinant requires an exploration of its systemic functions, not just its immediate consequences.
Historical and Structural Foundations of Racism in Healthcare
The racial inequities seen in healthcare today are not accidental. They stem from a long history of medical exploitation and exclusion that has shaped Black women’s lived experiences. From the forced experimentation on enslaved Black women in gynecology to the unethical Tuskegee syphilis study, medicine has often treated Black bodies as sites of control rather than care. These injustices have fostered generational trauma and a deep-seated mistrust of medical institutions. This distrust remains prevalent even among younger and higher-income Black women.
Structural racism operates beyond individual prejudice. It is sustained through policies, provider biases, and economic barriers that limit access to care, quality treatment, and medical autonomy. Research shows that racism affects health outcomes independently of other socioeconomic factors. Even when Black women achieve higher levels of income or education, they still face elevated health risks due to systemic discrimination (Williams, Lawrence, & Davis, 2019).
Current Disparities in Black Women’s Healthcare Experiences
Recent findings from the Kaiser Family Foundation highlight the ongoing reality of racism in medicine. Nearly one in five Black women report being treated unfairly by healthcare providers. Among those who have been pregnant or given birth in the past decade, 22 percent say they were denied pain medication they believed they needed. These numbers reflect not just individual cases of mistreatment but a widespread pattern of medical neglect (Kaiser Family Foundation, 2023).
Beyond explicit discrimination, many Black women practice self-protective behaviors in healthcare settings, anticipating mistreatment before it happens. This phenomenon, described as “vigilant healthcare engagement,” shows how racism alters the way Black women navigate medical care. Even among those with financial security, racial bias in treatment remains prevalent. In the past three years, one in six Black women have reported feeling disrespected in a medical encounter, with younger and darker-skinned women experiencing the highest rates of bias (Kaiser Family Foundation, 2023).
Despite these disparities, policy interventions have led to measurable improvements. Legislative efforts such as expanded Medicaid coverage have improved access to maternal healthcare, reducing mortality rates in states that have adopted these policies (Clark, Searing, & Cohen Ross, 2021). By expanding access to preventive care and reducing financial barriers, Medicaid expansion has provided critical support, particularly for low-income Black women.
Community-Led Initiatives and Grassroots Movements Driving Change
While institutional progress has been slow, Black women-led organizations have stepped in to push for meaningful change. Advocacy groups such as the Black Mamas Matter Alliance have advanced maternal health reforms and promoted culturally competent care models that directly address racial disparities in birthing experiences. These initiatives reflect the importance of centering Black women’s voices in health policy and care delivery.
Beyond the Expectation of Resilience: The Cultural Impact on Wellness
Black women have long been burdened by the expectation of resilience. They are often praised for their ability to withstand pain, yet rarely supported in their healing. The cultural construct of the Strong Black Woman (SBW) frames strength as a survival mechanism, but this expectation discourages vulnerability and delays care-seeking.
As bell hooks reminds us, “to be strong in the face of oppression is not the same as overcoming oppression, that endurance is not to be confused with transformation”. This distinction is critical. The ability to endure racism, trauma, or neglect should never be mistaken for healing or thriving. Strength, in this context, often masks unresolved harm and unaddressed needs.
Reimagining Wellness Through Black Women’s Lens
The path forward requires a radical reframing of wellness. Black women must be at the center of healthcare policies and community initiatives. Wellness must be defined on their own terms, not shaped by systems that were never built for them. This includes setting research priorities, building accessible platforms, and advocating for transformative policies that address the root causes of inequity.
As the Combahee River Collective (1977) stated, “If Black women were free, it would mean that everyone else would have to be free since our freedom would necessitate the destruction of all the systems of oppression.” This captures the essence of intersectional liberation. Dismantling systems of oppression for Black women opens the door to liberation for all. Reimagining wellness is not just about improving care. It is about redesigning the structures of care with justice, autonomy, and cultural relevance at their core.
Angela Davis reinforces this by writing, “My politics and political affiliation are bound up with and flow from participation in my people’s struggle for liberation, and with the fight of oppressed people all over the world against American imperialism.” Her words underscore that health cannot be separated from justice. To transform health outcomes, we must also transform the systems that perpetuate inequity—locally and globally.
True health equity requires more than inclusion. It demands trauma-informed systems, culturally grounded care, and structures that amplify Black women’s leadership in wellness and advocacy.
The Need for Collective Accountability
Racism in healthcare does not exist in isolation. Disparities in housing, education, environmental conditions, and economic opportunity all shape Black women’s health outcomes. Addressing racism in medicine requires collective accountability and cross-sector collaboration. Healthcare, policy, education, and technology must work together, not in silos.
The health consequences of racism are not inevitable. They are the result of choices made by institutions and individuals. That means they can also be changed.
Progress is already happening. Legislative efforts, grassroots advocacy, and culturally competent models are demonstrating that transformation is possible. When healthcare centers Black women’s voices, community-driven solutions emerge, systems shift, and collective healing becomes more than a vision—it becomes reality.
Health should not be defined by mere survival. It must encompass thriving, healing, and the pursuit of wellness as envisioned by Black women themselves.
Research by Watson and Hunter (2015) found that African American women who endorse the SBW schema are more likely to experience symptoms of anxiety and depression. The study also revealed that this endorsement is associated with negative attitudes toward seeking psychological help, including reduced psychological openness and a lower propensity to seek assistance. These findings underscore how cultural expectations of strength can hinder mental health and the utilization of supportive services.
Disrupting this narrative means creating spaces where emotional expression is not pathologized but honored. It means redefining wellness not as mere survival, but as the right to rest, receive, and restore. Healing cannot be treated as a privilege. It is a necessity, and transformation must replace endurance as the standard for well-being.
Reimagining Wellness Through Black Women’s Lens
The path forward requires a radical reframing of wellness. Black women must be at the center of healthcare policies and community initiatives. Wellness must be defined on their own terms, not shaped by systems that were never built for them. This includes setting research priorities, building accessible platforms, and advocating for transformative policies that address the root causes of inequity.
As the Combahee River Collective (1977) stated, “If Black women were free, it would mean that everyone else would have to be free since our freedom would necessitate the destruction of all the systems of oppression.” This captures the essence of intersectional liberation. Dismantling systems of oppression for Black women opens the door to liberation for all. Reimagining wellness is not just about improving care. It is about redesigning the structures of care with justice, autonomy, and cultural relevance at their core.
The sentiment often echoed by Angela Davis and other liberation thinkers reminds us that health and justice are deeply intertwined. True transformation in health outcomes requires us to confront and dismantle the systems that uphold inequity—both locally and globally. Addressing health disparities means recognizing that the fight for wellness is inseparable from the fight for liberation.
True health equity requires more than inclusion. It demands trauma-informed systems, culturally grounded care, and structures that amplify Black women’s leadership in wellness and advocacy
The Need for Collective Accountability
Racism in healthcare does not exist in isolation. Disparities in housing, education, environmental conditions, and economic opportunity all shape Black women’s health outcomes. Addressing racism in medicine requires collective accountability and cross-sector collaboration. Healthcare, policy, education, and technology must work together, not in silos.
The health consequences of racism are not inevitable. They are the result of choices made by institutions and individuals. That means they can also be changed.
Progress is already happening. Legislative efforts, grassroots advocacy, and culturally competent models are demonstrating that transformation is possible. When healthcare centers Black women’s voices, community-driven solutions emerge, systems shift, and collective healing becomes more than a vision—it becomes reality.
Health should not be defined by mere survival. It must encompass thriving, healing, and the pursuit of wellness as envisioned by Black women themselves.
References
Godoy, M. (2021, April 8). CDC director declares racism a ‘serious public health threat’. NPR. https://www.npr.org/2021/04/08/985524494/cdc-director-declares-racism-a-serious-public-health-threat
Kaiser Family Foundation. (2023, September 27). Five facts about Black women’s experiences in health care. https://www.kff.org/racial-equity-and-health-policy/issue-brief/five-facts-about-black-womens-experiences-in-health-care/
The Combahee River Collective statement. COMBAHEE RIVER COLLECTIVE. (n.d.). https://combaheerivercollective.weebly.com/the-combahee-river-collective-statement.html
Watson, N. N., & Hunter, C. D. (2015). Anxiety and depression among African American women: The costs of strength and negative attitudes toward psychological help-seeking. Cultural Diversity and Ethnic Minority Psychology, 21(4), 604–612. https://doi.org/10.1037/cdp0000015
Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105–125. https://doi.org/10.1146/annurev-publhealth-040218-043750
