Anti-Blackness: The beliefs, attitudes, actions, practices, and behaviors of individuals and institutions that devalue, minimize, and marginalize the full participation of Black people.
Most discussions on anti-Blackness (racism, white supremacy) tend to focus on issues of injustice via the criminal justice system, educational inequalities or various discriminations in housing, banking, employment, etc. When the idea of anti-Blackness is applied to healthcare, the focus tends to be on historical wrongs like the Tuskegee Experiment or contemporary inequities in healthcare access.
But what often goes unaddressed is the seeming pandemic of negative health outcomes arising from anti-Blackness in all aspects of everyday life. Through this lens, it is no stretch of the imagination to surmise that anti-Blackness is a health crisis so all-encompassing, that it could be considered the number one killer of Black people.
Though future articles will explore how anti-Blackness in education, public policy, the criminal justice system, etc. lead to negative health outcomes and often death for Black adults and children, this article will focus on the healthcare space.
What is anti-Blackness
In the report “Anti-Blackness/Colorism” by Janvieve Williams Comrie, Antoinette M. Landor, Kwyn Townsend Riley and Jason D. Williamson, “Anti-Blackness is defined as the beliefs, attitudes, actions, practices, and behaviors of individuals and institutions that devalue, minimize, and marginalize the full participation of Black people—visibly (or perceived to be) of African descent. It is the systematic denial of Black humanity and dignity, which makes Black people effectively ineligible for full citizenship.”
To entrepreneur Kimberly Tennile, anti-Blackness is “The insidious and instinctual act of finding anything associated with Black people and specifically African-American culture as inherently subpar and in need of correction, adjustment, or eradication.”
But whatever your definition, anti-Blackness is having horrendous impacts on Black health.
Maternal care
According to the article “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them” by Latoya Hill, Samantha Artiga and Usha Ranji (Nov. 1, 2022),
Black and American Indian and Alaska Native women have higher rates of pregnancy-related death compared to White women.
Pregnancy mortality rates per 100K
- 41.4 – Black
- 26.2 – American Indian and Alaska Native
- 13.7 – White
Moreover, Black women have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women. Infants born to Black women have markedly higher mortality rates than those born to white women.
The article asserts that these maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination via differences in health insurance coverage and access to care, as well as the “primary drivers,” inequities in broader social and economic factors and structural and systemic racism and discrimination.
Research reported in The Journal of the American Heart Association adds:
- Black women of childbearing age were more than twice as likely to have uncontrolled blood pressure than white women of similar age, putting them at an increased risk of pregnancy-related complications.
- This disparity in high blood pressure persisted after adjusting for social determinants of health, health factors and modifiable health behaviors.
- Food insecurity — lack of access to adequate healthy food — one of the social factors that may affect high blood pressure risk, was higher among Hispanic and Black women compared with white women.
On April 10, 2023, the White House issued “A Proclamation on Black Maternal Health Week, 2023” that reiterated what Black women have been screaming for years, that “institutional racism drives these high maternal mortality rates” and that “Black women are often dismissed or ignored in hospitals and other health care settings, even as they suffer from severe injuries and pregnancy complications and ask for help.”
The proclamation then identifies systemic inequities impacting Black maternal health that are in many ways the products of “anti-Black” legislative, housing, environmental and even infrastructure policies and actions, including barriers to safe/stable housing, barriers to travel for prenatal and postpartum checkups, air and water pollution and food deserts.
Pain
Then, there’s the racialization of pain, as Blacks are systematically undertreated for pain compared to whites.
- Half of white medical trainees (our future doctors) erroneously believe Blacks have thicker skin or less sensitive nerve endings than whites.
- Black patients are less likely than whites to be given pain medications and, if given pain medications, they receive lower quantities.(i)
- Black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain.(ii)
- A study of nearly one million children diagnosed with appendicitis revealed that Black patients were less likely than whites to receive any pain medication for moderate pain and less likely to receive medication for severe pain.(iii)
- Physicians were more likely to underestimate the pain of Black patients (47%) relative to non-Black patients (33.5%).(iv)
Diagnoses
Adult and pediatric psychiatrist Dr. Kali Hobson recently highlighted anti-Blackness regarding a “condition” over-diagnosed in Black children — one she compares to “drapetomania,” the racist, made-up “mental illness” physician Samuel A. Cartwright said in 1851 caused enslaved Africans to flee captivity.
“Today, the diagnosis of ODD has similar roots,” said Hobson. “The diagnosis of ODD is significantly over-diagnosed in Black children, specifically Black boys, and has symptoms such as frequently angry or disrespectful, excessively argues with adults or actively refuses to comply with requests or rules. Yet, when faced with oppression and racism, systemically at every level, in schools, in school rules, in policing, in laws, in resource allocation, who wouldn’t exhibit these symptoms? Especially due to racial biases, these symptoms are already overly attributed to (Black people).”
What’s being done to end the crisis
The American Public Health Association’s article “Racism is a Public Health Crisis” states, “In 2018, Milwaukee County, Wisconsin, became the first community to declare racism a public health crisis.” Since May 2020 (after the killing of George Floyd), nearly 200 declarations were passed nationally by city/town councils, county boards, governor/mayoral statements, school boards and public health departments. As of August 2021, 209 such declarations passed in 37 states.
Though these declarations are seen as a positive first step, actions speak louder than words.
Author’s Note: This article is the first in a series of articles focused on “anti-Blackness as a health crisis.” Subsequent articles will focus on how anti-Blackness in education, public policy, the criminal justice system, media (TV, film, music) and social media and social and workplace interactions contribute to negative health outcomes for Black people.
(i) KO Anderson, CR Green, R Payne, Racial and ethnic disparities in pain: Causes and consequences of unequal care. J Pain 10, 1187–1204 (2009)
(ii) KH Todd, C Deaton, AP D’Adamo, L Goe, Ethnicity and analgesic practice. Ann Emerg Med 35, 11–16 (2000).
(iii) MK Goyal, N Kuppermann, SD Cleary, SJ Teach, JM Chamberlain, Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr 169, 996–1002 (2015)
(iv) A study by LJ Staton et al., “When race matters: Disagreement in pain perception between patients and their physicians in primary care.”
