Why Black Health Must be Recognized a Social Justice Issue

In the past three months alone, we have all heard these names: George Floyd, Breonna Taylor, Elijah McClain, Jacob Blake, Justin Howell, Sean Monterrosa, Jamel Floyd, Deon Kay, Dijon Kizzee, Damian Daniels and more. I cannot list all the names of Black women and men who have been murdered, as we may never really know all of their names – perhaps because they went missing and no one ever found them, or because it was never captured on film. When George Floyd was murdered, brutally, as shown in a viral video that shook the world, the globe erupted around the systemic racism that claimed 1099 lives in 2019 alone (U. S. News and World Report). Television pundits, social media posts, video postings and bloggers, were prolific, with more than 80 million, postings, videos, blogs, and social messages on this topic in just the first two weeks of George Floyd’s murder. There was pandemonium and outrage. Every major corporation was “standing in solidarity with their Black counterparts”. Many made promises, hired diversity and inclusion consultants, “invested” more in Black businesses and everyone was having conversations on white privilege, anti-racism, unconscious bias, how to have more authentic dialogue, and make changes that resulted in better outcomes for Black people.  Yet, in the past month, the amount of social content posted on racial equity and Black health equity has dropped significantly, which means that we may be moving nowhere fast. 

We are living in the land of the free and the home of the brave, yet Black people are still, after hundreds of years, not experiencing the benefits of the freedoms and equities that other races face across the board. These inequities are also sadly true when it comes to Black healthcare and disparities. According to the American Cancer Society, approximately 202,260 new cancer cases and 73,030 cancer deaths were expected among Blacks in 2019. African Americans have the highest death rate and shortest survival of any racial and ethnic group in the United States for most cancers. Even though rates of African American deaths are lowering, huge disparities remain. In addition these disparities are a result of “lower socioeconomic status and less access to medical care; the proportion of Blacks living below the federal poverty level (21%) was more than double that of whites (9%), and 22% of Blacks had completed four years of college compared with 36% of whites.  Furthermore, people with lower socioeconomic status face more barriers to high-quality health care, including lack of insurance”. When it comes to Black women and breast cancer specifically, the facts are:

?    Black women have more aggressive breast cancers.

?    Black women are less likely to receive potentially life-saving genetic testing.

?    Black women are diagnosed at later stages than white women.

?    Black women are more likely than white women to get triple-negative breast cancer, a kind of breast cancer that is often aggressive and recurs after treatment.

?    Black women begin treatment for breast cancer later than white women.

?    Due to a legacy of exploitation of people of color in the clinical trial/scientific/research settings, Black women have a mistrust of the scientific, healthcare system and providers.

?    Black women have lower enrollment in clinical trials, which makes it more difficult to design treatments for this population, which may contribute to lower mortality rates.

?    Black women are 40% more likely to die of breast cancer.

We cannot allow broken systems to take away Black lives and get away with racist or supposedly anti-racist actions that do not impact health equity. Black health must be recognized as a social justice issue.

1.     Accountability Matters. While billions have been invested in the Black community, there is no accountability that these funds are moving towards ending systemic racism, particularly as it pertains to Black women’s health – breast cancer specifically; and, how these funds are supposedly targeting eliminating barriers and disparities that result in Black women having a 40% higher mortality rate than their white counterparts.  In addition, “What part of these initiatives are new and how many will stand fast and true over time, to make measurable impact when it comes to Black health and disparities – not just serve as a passing marketing aka corporate social responsibility fad because Black lives are the current “in” thing? How of these initiatives are in place so that companies don’t want to look bad by not jumping on the bandwagon? 

What we are seeing is what happens often when a racial issue reaches national or global proportions, the world stops – aghast and holding hands in solidarity, yet, in mere weeks, the anger subsides and people go back to posting pictures about their food, cocktails, toes and innocuous selfies…until it happens again. Here are a few examples of companies that have made commitments to racial equity and justice.

?       Apple has pledged $100 million for a new Racial Equity and Justice Initiative

?       Walmart announced that it will contribute $100 million over five years to create a Center for Racial Equity

?       Target is committing $10 million to the National Urban League and the African American Leadership Forum

?       Home Depot is donating $1 million to the Lawyers’ Committee for Civil Rights Under Law

?       Google has committed $12 million to various groups that fight racial injustice

?       Amazon has committed to donating $10 million to social justice organizations

?       Facebook committed $10 million to groups working on racial justice

At the same time, just as an example, in 2019, Google made $162 billion a year, $13.5 billion a month, $367M in a day, $12 million, which equates to .044% of their earning being set aside for the fight for racial justice. Apple earned $260.17 billion in 2019 annual revenue; 2.6 billion is 1% of earnings, $100M is less than 0.04% of earnings. What are these companies really investing in? While perhaps altruistic in their intentions, these commitments raise several questions:

?                 How many of these actions are just a check in the box, something that they have to do, so they don’t look bad, so they get more Black marketability (translating into sales) by showing ”goodwill”?

?                 How do these actions distribute wealth, provide for social opportunity for Black people in a way that will end specific barriers to economic equity?

?                 How do these actions provide access and opportunity?

?                 How do these actions allow for representation – long term?

?                 How do these actions engage Black people in the decision-making process and development of solutions?

?                 How do these actions partner with trusted leaders who have dedicated their lives to amplifying the voice of marginalized populations, listening to, working side by side with and learning Black people, while co-creating solutions, rather than just throwing money at any Black organization?

?                 With Black people facing the highest death rates across multiple disease states, during COVID-19 and multiple barriers to health, how are these companies giving to small or mid-sized health advocacy organizations to help them build sustainability, rather than to organizations which already have huge budgets and are not making significant impact?

Again, while the levels of “commitment” to Black justice and equity is more powerful than ever, just stating that an organizations stands in solidarity with the Black community and throws money at a problem is not going to fix racism that continues to take Black lives at an alarming rate – by targeted police brutality and through health disparities. Some of the biggest companies in the world are committing to fight against racism, but what is happening after the press release and social media postings have been done? 

As a first generation Liberian immigrant, a 14-year survivor of triple negative breast cancer running a 14-year organization, which I started while in treatment, I have watched corporations give millions to global organizations while grassroots organizations like mine who were on the ground as a trusted partner with patients, scraped for 14 years to get less than 1% of what the larger white-led organizations were getting. Not only was I not invited to the table, but I was often not aware of these “tables” and if I somehow invited myself, was never given the opportunity to “eat” – meaning, I was not invested in, so that I could get the support needed organizationally to be sustainable and support women like me, who have faced multiple disparities.  While these organizations do good work, the average donor when asked where their donations are going will respond with “it’s going to cancer research”, without knowing what kind of research, who this research is impacting, or how the research is working towards ending systemic barriers for the Black population. How are grassroots organizations supposed to be sustainable and when their is no financial parity, with a specific focus on supporting Black-led women's health organizations?

2.     Stop Letting Corporate America Make Money off the Backs of Black People.  When it comes to racism, following the money trail leads to some startling statistics. While these corporations are “making it rain” for Black people right now, with Black spending at $1.2 trillion annually, brands have a lot to lose if their Black consumers stop consuming their goods. According to Nielsen, research shows that Black consumer choices have a ‘cool factor’ that has created a halo effect, influencing not just consumers of color but the mainstream as well,” said Cheryl Grace, Senior Vice President of U.S. Strategic Community Alliances and Consumer Engagement at Nielsen. “These figures show that investment by multinational conglomerates in R&D develop products and marketing that appeal to diverse consumers is, indeed, paying off handsomely.” So, while these commitments to stand in solidarity with the Black community sound good, the fact is that these companies stand to make a lot more money than they are investing. What better way to make more money than to give away lots of it to the community you have spent millions to ethno-target, with no real “down in the weeds” investment, sweat equity and strategic attack on ending systemic barriers for that population?

3.     Black Consumers Need to Start Thinking About How they are Investing their Time and Money and How They Can Leverage their Power for Health Equity. The barriers to health equity for Black women abound – socioeconomic, literacy, geographical (rural areas and lack of transportation), psychological, financial (lower poverty rates), emotional/trauma, trust, representation, lifestyle (access and affordability to healthier foods, etc.) being underinsured, provider bias, lack of education, and communication. Companies building narratives that hypersexualize Black women and using marketing to influence spending on consumer products must begin investing in marketing that will educate, empower, advocate for and support these same women to end health equity barriers as we know them today. One example is this, Cardi-B’s and Megan Thee Stallion’s recent video “WAP” has received millions of views across multiple social media platforms, with people all over the world learning the dances, liking and sharing. Black Hollywood actors and actresses like Kerry Washington, Regina King, Halle Berry, Taraji P. Henson, Queen Latifah, Whoopi Goldberg, Angela Bassett, Vanessa Williams, Jada Pinkett-Smith, Thandie Newton, Gabrielle Union, Megan Goode, Zoe Saldana, Viola Davis, Tracee Ellis Ross, Idris Elba, Kevin Hart, Jamie Foxx, Morgan Freeman, Tyler Perry, Samuel Jackson, Dwayne Johnson, Will Smith and Denzel Washington, generate billions of dollars in revenue for movie companies and their subsidiary enterprises. How powerful would it be to see an equitable or even a fraction of this money, messaging and marketing dollars being spent on shaping the minds, decision-making and lives of Black people when it comes to their health?

4.     Are All These Corporate Giving Actions Really Making Impacts When it Comes to Eradicating Health Barriers? When you look at corporate giving, how much of this giving is really making a significant impact in the implicit, sub-conscious and conscious biases? Are these corporations applying SMART goals to eradicating barriers for Black women when it comes to their health and not just move towards, but actualize health equity? How is it that trillions of dollars are being spent, but these barriers still exist? Our healthcare system is not experienced equally by all, and with such solicitous giving, it may never be. Disparities in our healthcare system is a serious social justice issue which manifests itself in a variety of ways.  

Social justice is defined as having equal distribution of wealth, political and social opportunities, and privilege within a society. Social justice for Black people will happen when we “open the doors of access and opportunity for everyone, particularly those in greatest need,” according to the National Association of Social Workers. “Social justice encompasses economic justice… Social justice is also about having equal opportunity, treatment, rights and participation, much of which is missing from our healthcare system”.

Patients of different races or ethnicities, genders, socioeconomic conditions, and other social categories are not always treated equally, and this oftentimes results in major differences in the quality of their treatment experiences and even their health outcomes. Good healthcare should be considered a fundamental human right in this country, because without good health there can be no life, and without life there can be no liberty nor the pursuit of happiness. Rather than politicize the issue or characterize it as a movement, we should all understand that healthcare equality is necessary for a fair and just society.

An example of a racial disparity in healthcare is that the infant mortality rate for African Americans is 2.3 times that of non-Hispanic whites. African American mothers are also 2.3 times more likely to receive late or no pre-natal care when compared to non-Hispanic white mothers. In addition to this, lung cancer mortality is 22.87% higher among Black men than white ones. Disturbingly, Blacks are also less likely to receive recommendations for lung cancer surgery, at a rate of just 67% compared to 71.4% for white patients.

There are also gender disparities in healthcare that could have negative effects on health outcomes for many patients. Women are underrepresented among both medical researchers and study participants. Penn Medicine recently found that less than 20% of the authors of publications recommending heart failure treatment guidelines are women.  Regarding major clinical trials on heart failure, only 16% were authored by a female researcher. For those that are authored by a woman, 39% of the study participants were women, with that percentage dropping to 26% for trials not authored by a female researcher. This demonstrably proves that more female representation among principal investigators encourages more women to enroll in studies that will improve health treatments for all women.

Socioeconomic obstacles to receiving equitable healthcare are also a major problem. Americans who live in poverty are four times more likely to be without health coverage as those above the poverty line. Not only this, but in the poorest counties in America, the death rate of cervical cancer is twice that of the richest counties. People living below the poverty line are also less likely to be screened or treated early, contributing to poorer survival outcomes.

At the end of the day, paying lip service or throwing dollars at an already underserved population seems to like a slap in the face, at best. It seems to me like companies are taking this opportunity to once again enhance their image and increase their revenue share by jumping on the Black people bandwagon because it’s hot right now, and for me, being a Black woman, a triple negative breast cancer survivor, a 14-year advocate, who built a non-profit from nothing and who works to ensure equity for all women, particularly those who face the most disparities, it’s UNACCEPTABLE and reeks yet again of exploitation. Do not assume that you can just throw dollars at a system, and not use your corporate power to make systemic change and have that be okay. We need your financial investment, as well as your full participation and compassion.   Black lives, Black equity and Black women’s health is not a fad, but a Basic Human Right and a Social Justice issue. As Martin Luther King, Jr. said, “Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality”. Until we come to a place where we are as committed to Black health as a social justice issue and one where care about the humanity of all people equally, there will continue to be late diagnoses, insufficient treatment, and poorer outcomes for Black patients.

I ask corporations this: What is the meaning of your monetary donations and how will it equate to saving our lives? How much of it is moving towards total elimination of wealth and health gaps?

We must have inclusion and equity for all. Several organizations are doing this right:

?                 15% Pledge is an initiative calling on major retailers to commit a minimum of 15% of their shelf space to Black-owned businesses

?                 CEO Action is a collective action on diversity and inclusion from the business community, working to ensure that by 2050 there will be no racial or ethnic majority in the U.S.

?                 The #InclusionPledge calls on organizations to hold themselves accountable for social inequities and is working to end systemic barriers for Black women impacted by breast cancer.

It is unacceptable that our healthcare system is not experienced equally by all Americans. We must right this enormous wrong. As a nation, we have all been confronted by the harsh realities of racism and prejudice in the news, watching as activists shine a spotlight on police brutality and how it effects Black Americans living with racism on a daily basis.  Major disparities in the health and health care treatment of Americans from different social groups has led to severe consequences for patients who belong to marginalized groups, particularly when it comes to health epidemiology and the Black population.

We Black patients have a foot on our neck daily, and those with the least access will continue to die. We must seek to actualize social justice and equality for all people, specifically those facing the highest disparities in healthcare – in words, deeds, accountability, and investments, while responsibly and measurably working towards eradicating every barrier that exists.