Detail of a relief depicting a musician, originally from the Red Chapel of Hatshepsut at Karnak. On major religious holidays all Thebes came alive with music and merrymaking and entertainers performed for the pleasure of the masses.
Take the case of disability communities in Puerto Rico, who faced catastrophic harm in the wake of Hurricane Maria in 2018. To call the hurricane a “natural disaster” is to obscure the way United States colonialism laid the groundwork for the devastation. U.S. economic austerity policies left the island subject to poor infrastructure, a shaky electrical grid, patchy medical systems and inadequate public services — all of which were stressed to breaking point when the hurricane hit. And when it comes to disability, eligible Puerto Ricans receive an average of $74 a month, a fraction of the disability benefits provided to U.S. citizens on the mainland.
Social inequality can be a death sentence. Consider Benilda Caixeta, a wheelchair user living in New Orleans who relied upon the city’s paratransit system for accessible transportation, a service notorious for its unreliability in the best of circumstances. As Hurricane Katrina advanced, she worked for days to arrange transportation to evacuate. But despite repeated promises, her driver never arrived. When floodwaters rushed into her apartment, Caixeta drowned — waiting for transit that never came.
When we tell Caixeta’s story, we face a choice: We could use her story to illustrate the essential vulnerability of people with disabilities; or we could use it to tell a political story about disability discrimination, about transportation systems that are inequitable and unreliable even in fair weather — and that fail, utterly, in the face of a storm. The political story makes plain that Caixeta’s inability to evacuate isn’t a personal tragedy caused by disability, but a public failure: a devastating indictment of the deadly cost of ableism and inequality.
I was 12 when my 17-year-old brother died. He was not shot by police or targeted by white supremacists, but racism killed him.
Richard had bipolar disorder, and our family relied on Medicaid for health care. After a brief stay in one of very few mental health facilities that accepted Medicaid in Chicago, he became extremely ill with a high fever and trouble breathing. We took him to the hospital, where he was not tested or x-rayed. Instead, he was given an inhaler and told to take ibuprofen. When his condition worsened, we went back to the ER, where staff diagnosed him with pneumonia in both lungs. He was admitted to the ICU and put on a ventilator. Five days later, as my mother and I finally took a break from living in the ICU to shower and change clothes at home, Richard died.
It is not a question to me whether Richard would have received better care if he wasn’t Black. There is a straight line from his Blackness to the health care options available to him to his treatment to his death.
Racism is a public health crisis. It manifests in dramatic inequities in health outcomes across the board — including three times as many COVID-19 infections among Black people and nearly twice as many deaths than white people. It manifests in the daily grind of discrimination and stress on Black bodies. It manifests in where we live, the health care available to us, and how we are treated. It manifests in which mothers must mourn sons who died too early, which sisters grow up without brothers.
Because of the long legacy of redlining and an economic system built on racism, Black Americans are disproportionately relegated to living in poverty-stricken areas. And since most health outcomes are determined by things like poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing — the social determinants of health — in all of these areas, Black people have to overcome 400 years of the deck being stacked against us.
If we do manage to get care, we often receive a poorer version in comparison to white people. In 2016, half of white medical students and residents surveyed held false beliefs about biological differences between Black people and white people — beliefs with deep roots in slavery, when physical violence was seen as acceptable because people believed enslaved Black people had “thicker” skin than white people. The medical students and residents with these false beliefs rated Black patients’ pain lower and made less accurate treatment recommendations.
Black women are doubly dehumanized. For centuries, we have been denied the rights and resources to make our own decisions about our bodies. Our desires are dismissed, our pain is ignored, and our needs go unmet. And it kills us. It’s why Black women are more than three times as likely to die of pregnancy and childbirth-related causes.
The racism in the U.S. health care system is borne out in these numbers, and in stories like my brother’s … and mine.
In 2018, I made the decision to get an abortion. I went to a local clinic in Brooklyn. I did not feel ashamed about having an abortion, but I was treated as if I should be. I was forced to have two visits with two ultrasounds before the procedure, and was ordered to go from room to room without being given any information about what was going on or what would happen next. I was seen by several doctors who didn’t even attempt a decent bedside manner and couldn’t pronounce my name.
The first doctor simply told me, “You can’t smoke cigarettes or drink alcohol,” without giving me any information on my options or asking me if I’d like to continue the pregnancy. I had to ask several times for information on abortion. I was then reluctantly, coldly told that medication abortion was “out of the picture” because insurance wouldn’t cover it. I felt like I had no control over my body.
If this was my experience in Brooklyn, in a state with liberal abortion laws, I can only imagine what people in states where access to abortion is even more restricted must be experiencing.
Trust me when I tell you: Black people feel pain. And we thrive in spite of it. For decades, Black people — Black women in particular — have been at the forefront of the movements to hold this country accountable to its promise of equality and justice — the Civil Rights movement, women’s suffrage, the LGBTQ+ movement, and reproductive justice. Black women started Black Lives Matter, now recognized as among the largest protest movements in U.S. history.
It isn’t enough to tear down statues of Confederate generals (as much as they should be). As American white supremacy meets this moment of reckoning, Black people still suffer from health inequities because of racism and a for-profit health care system. We will only see change when we start to break down and rebuild the longstanding institutions that have historically been used as tools of oppression. We need to tackle the racial inequities in health care head on. Racism as a public health issue needs to be widely understood, especially by all who enter the medical field.
The health care system is killing us, as surely as police are. No more Black people should die from racist violence, or from illnesses that could be treated with just a little more care. No more Black women should experience the dehumanization I felt while getting care that is my right to have.
Racism is a public health issue, and all lives will matter when Black lives do.
-Leanna at PPFA
Leanna Burton is a media assistant in the Communications & Culture division at Planned Parenthood Federation of America. She was born and raised in Chicago, IL and studied journalism at City University of New York - Brooklyn College. She is also a musician and freelance writer whose main focus is lifting the voices of people in underserved and undervalued communities.
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