Joy Is Not a Luxury

Black Women’s Health as a Diagnostic Lens for the Collapse of US Public Health

By Jameta Nicole Barlow

What Black Women’s Health Makes Visible

Black women’s bodies and health are on the frontlines of the US public health system. Laws that fail to protect women from the men who claim to love them, disproportionately impact Black women. Laws that aim to restrict women’s bodily autonomy and agency, disproportionately impact Black women. Policies and guidelines that restrict when women can get health insurance coverage for regular mammogram screenings, disproportionately impact Black women. Clinical guidelines and practices that overdiagnose Black Americans with schizophrenia-spectrum disorders and misinterpret trauma or mood symptoms as psychosis, disproportionately impact Black women.¹ Black women’s health makes visible how laws, policies, guidelines and practices are not only biased, but fail the most vulnerable of the American population.

Health outcomes for Black women in the United States range from alarmingly high maternal mortality rates to chronic stress and sleep deprivation, which are often framed as anomalies or paradoxes. In a country that highly praises its healthcare system, these issues reveal a much deeper crisis, one driven by austere policies, racial capitalism and the systematic dismantling of collective care infrastructures, as demonstrated by employment disparities, reduced safety nets, increased unpaid care work, inequality in hiring practices, and housing/economic instability.² The health disparities and inequities Black women face are not the result of individual failure or cultural deficiencies, but rather a product of structural inequities that have been entrenched for generations.

Austerity as Policy, Not Accident

The history of public health in the US is deeply intertwined with the politics of austerity. The gradual retreat of the state from the provision of public goods and services, also known as welfare retrenchment, or the structural entanglement of social services whose intertwinement promotes dependency, has disproportionately affected Black women, who were often put in challenging economic situations and had to opt in. Black women’s bodies gave rise to the modern day credit system– itself most certainly a means to control a population who became legally free– through the forced enslavement of their bodies. Moreover, it was a practice that was foundational to the US system, just like the public health system. For example, granny midwives were women who were apprenticed into reproductive services for generations, even throughout US chattel slavery. They provided birthing and herbal remedies and services that gave them additional liberties not afforded to other enslaved individuals, such as the occasional freedom to travel to other plantations, supporting the health and births of both enslaved Black women and, most often, white women who required their services. Their legacies in Black communities were that they were often a primary source of health and service provision, often working with nurses but more affordable than doctors, especially within the US segregation system that often provided unequal services and practices based on race. The 1921 Sheppard Towner Act, also known as the Maternity and Infancy Protection Act, provided federal funding for state-run prenatal and child health programs, aiming to reduce high maternal and infant mortality rates by funding nurses, hygiene education, and health clinics, particularly in rural areas.³ While appearing to be beneficial for pregnant women for its prenatal care, its requirements essentially eliminated the legality of granny midwives to provide services, due to its legal mandates that did not consider the limitations on Black communities education, training and access. As a result, Black communities began to depend more on the healthcare system, instead of the healthcare expertise of their communities, leading to the healthcare entrenchment present today.

While public health institutions have never served Black women adequately, it should be noted that these institutions were never designed to address the intersectional forces of race, gender, and class that shape their lives. Whether through racial segregation in healthcare, insufficient access to maternal care, or the economic barriers that prevent many Black women from accessing preventative healthcare, these structures were always ill-suited to address the needs of Black communities. Over time, these limited services were systematically dismantled. The closing of public hospitals and the privatization of healthcare services shifted the focus from care and prevention to risk management and individualized responsibility. Often, Medicaid expansion is hailed as the gold standard option for addressing healthcare access and poor health outcomes among Black women, ignoring that only 26 percent of the US Black population is even considered low-income.⁴ What is too often ignored are the disparities among the other 74 percent, who have health insurance access and more promising socio-economic status, yet poorer health outcomes that can be explained by social and economic structures of difference disproportionately affecting their lived experiences.

Austerity measures have systematically withdrawn resources from Black communities. They act as a “spatial force” that degrades the social infrastructure of Black communities, reducing access to quality education, safe housing, and economic opportunities.⁵ These include cuts to the public sector, which results in disproportionate job loss and economic impact; disinvestment in public education, which results in school funding gaps, tuition hikes and unfair targeting of Historically Black Colleges and Universities (HBCUs); reductions in social safety nets, such as Supplemental Nutrition Assistance Program (SNAP), Medicaid and housing assistance; criminalization and fines, along with targeted racialized violence and unfair laws, and the carceral system; historical and ongoing disinvestment such as redlining and police brutality; and environmental health disparities further contributing to social determinants of health. These measures have left Black women at the mercy of an individualized, for-profit healthcare system. What was once a commitment to collective public health has now been replaced by a framework of risk management, which treats health as a personal responsibility rather than a public good. This shift in governance ignores the larger political economy that creates these inequities.

Stress, Sleep, and the Political Economy of Exhaustion

Chronic stress, sleep deprivation, and the toll of structural violence disproportionately affect Black women. Chronic stress is not just an emotional or psychological experience; it has tangible, deleterious effects on the body. It contributes to a range of physical health outcomes, including cardiovascular disease, diabetes, and sleep deprivation. Lack of sleep, in turn, worsens these conditions, creating a vicious cycle that is difficult to escape. Sleep deprivation is not merely a matter of individual behavior but is a structural outcome of long work hours, labor exploitation, and living conditions shaped by housing instability, environmental racism, and the pervasive presence of policing in Black communities. These factors directly impact the physical health of Black women.

The wellness and self-care paradigms that dominate popular discussions around health are inadequate to address the root causes of these issues. They often focus on individual lifestyle changes without challenging the structural and systemic factors that contribute to the stress and exhaustion that Black women experience. In contrast, a collective care model recognizes health as a community responsibility and addresses the social, political, and economic factors contributing to Black women’s health disparities. Historical circumstances of threat and survival in Black communities produced formalized and informal networks that embody such a collective care approach and continue to sustain these communities today. These models are often over-represented via civic care organizations and informal networks that were re-ignited and re-imagined during the COVID-19 pandemic. Their integral role in the histories, values and traditions of Black communities make them a useful tool for collective care delivery, but do not negate that Black communities pay for government services and receive unequal treatment and poor health outcomes, regardless of socioeconomic status.

Public Health Without the Public

Healthcare in the US is often conditioned on employment and most typically privatized. Further, non-governmental institutions are the largest purveyors of public health and this has led to a system where the most marginalized populations receive inadequate care. For Black women, this looks like a higher likelihood of dying from breast cancer compared to white women, despite white women being more likely to be diagnosed.⁶ Moreover, Black women in the United States face a disproportionately high and rising rate of homicide, or Black femicide, often driven by firearm violence, interpersonal violence and systemic racism.⁷ Reports from April 2026, documented numerous victims of intimate partner or familial violence, including Dr. Cerina Fairfax, Nancy Metayer Bowen, Pastor Tammy McCollum, Ashanti Allen, Victoria Alexander, Barbara Deer, Davonta Curtis, Teonia Stokes, Gladys Johnson, Daneshia Heller, Imani Dia Smith, and Myneika Scott.⁸

These women represented all socioeconomic statuses and geographical locations in the US Recent data indicates that Black women are murdered at rates roughly four times higher than white women, with rates resembling the Global South. The COVID-19 pandemic demonstrated such inequities with respect to healthcare access and disease, as Black women were often what was termed front line workers (e.g., healthcare, retail and hospitality, manufacturing and logistics, public safety, education), putting them at increased risk for contracting the virus. There are also several accounts of Black women complaining of persistent exhaustion, with this fatigue often signalling a serious disease or even fatal condition. For example, sixty-year old Wells Fargo employee Denise Prudhomme was so ignored at her job that when she entered work on a Friday in August 2024 and died in her cubicle from “sudden cardiac death in the setting of myocardial fibrosis”, she wasn’t found until Tuesday, four days later.⁹ Or, in the case of forty year old LaQuita Cole who worked 7 days a week at her Nashville restaurant, where she was owner and chef, and passed away in her sleep on April 25, 2025, after posting about extreme exhaustion, saying “Quita needs rest.”¹⁰ These are not isolated incidents, nor are they recent occurrences. Clearly, the contextual lives of Black women, Black families and Black communities shape the trajectory of their health.

In Louisiana’s “Cancer Alley”, an 85-mile industrial corridor along the Mississippi River, Black women are the primary leaders of a grassroots movement fighting what United Nations experts and the Environmental Protection Agency (EPA) define as environmental racism. Residing in predominantly Black communities often built on former plantation lands, these women face disproportionate health risks, including cancer rates significantly higher than the national average.¹¹

The discourse, data extraction and behavioral interventions typically prioritize individual responsibility for health, while failing to address the underlying systemic causes of poor health. The language becomes about Black women not exercising, resting, eating right, picking the right partner and choosing whatever behavior that is deemed to cause the health condition or issue. This discourse fails Black women, as it blames them for systemic issues they do not have control over. This move toward individualized health care ignores the collective structures that historically supported public health, such as religious, social and civic-based mutual aid based institutions; professional and philanthropic organizations and community-based and collaborative networks.

In place of universal care, we now see an emphasis on data extraction, behavioral interventions, and individualized responsibility. For Black women, this means being subjected to interventions that treat the symptoms of stress and health issues without addressing the socio-economic and racial conditions that exacerbate them. In this model, health is viewed not as a collective good but as a commodity. Those who can afford care receive it, while others are left to navigate a privatized, fragmented system. Behavioral interventions, such as wellness programs or lifestyle changes, are often framed as the solution, despite the fact that these strategies do little to address the root causes of health inequities.

The consequences of this shift are stark. Public health, which once aimed to protect the health of populations, has increasingly been replaced with a model that treats health as an individual concern, managed by private entities that profit from monitoring, surveilling, and managing individuals’ health behaviors. This new model reinforces existing inequalities, discarding those who are deemed unworthy of care and prioritizing profit over collective well-being.

Beyond Survival: Collective Care and Radical Futures

Despite the overwhelming challenges posed by racial capitalism and austerity, there are examples of resistance and transformation. Black feminist and womanist health practices have long prioritized collective care, or the practice of health that is not just about individual survival but about building collective capacities for well-being, over individual survival. These practices focus not just on health but on reclaiming the communal, political, and social dimensions of care. Joy, as envisioned by these movements, is not a lifestyle brand or a consumer product, but a collective capacity to heal and thrive together. And, like most grass roots-community based practices and programs, addressing the lived experiences of the most marginalized can benefit all, just like the Black Panther Party’s school based meal programs was adopted by the United States Department of Agriculture (USDA) to become the National School Lunch Program (NSLP) and School Breakfast Program (SBP).¹²

Another example of this collective care practice for holistic well–being is the Freedom Community Clinic (FCC), based in Oakland, CA. FCC is a “a community-based integrative health ecosystem that uplifts the wisdom of Ancestral Medicine with the strengths of Western medicine to provide revolutionary, community-centered Whole-Person Healing to the People. In all its offerings, FCC prioritizes healing for Black, Brown, Native, and immigrant communities.” Since its 2019 founding by Dr. Bernadette (Bernie) Lim, FCC has built on the rich legacies of Black, Asian and Hispanic/Latinx communities and ancestral wisdom to achieve Whole Person Healing.¹³ Since they began, FCC programming has reached nearly 10,000 people: they have established community and school-based healing clinics and partnerships; opened community healing centers, including a pharmacy/apothecary; and started an ancestral healing farm with bilingual community apprenticeship programs. FCC has convened nearly 200 healing clinics and events per year and raised over $4 million.

The future of public health lies in reclaiming the collective, in building care infrastructures that prioritize mutual aid and social well-being over profit and individualism. The way forward is with the collective and from the community. This future calls for a shift away from a system that commodifies health and toward a model that emphasizes communal well-being, collective support, and political activism as fundamental components of health. By grounding care in these practices, we can challenge the systems that perpetuate inequities and create healthier, more just futures for Black women and all marginalized communities.

From Case Study to Call to Action

The health of Black women in the US offers us a window into the future of public health under racial capitalism. It reveals the ways in which public health has been systematically undermined, reoriented away from collective care, and replaced with a model that prioritizes market logic and individualized responsibility.

To move forward, we must reject the notion that defending the status quo is sufficient. The health outcomes of Black women demand that we radically transform our approach to public health. This transformation requires not just addressing health disparities but also challenging the political and economic systems that perpetuate them. Black women’s health is not an isolated issue; it is a reflection of a broader systemic collapse. The time to act is now, and the solutions lie in collective care, structural transformation, and a radical reimagining of public health.

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Jameta Nicole Barlow (PhD, MPH) is a community health psychologist and associate professor at The George Washington University. A Charlottesville native, she utilizes Black Feminism and decolonizing methodologies to address structural health inequities affecting Black women and girls. With 25 years of transdisciplinary experience, Dr. Barlow is a yoga instructor, doula, and author of Writing Blackgirls’ and Women’s Health and Science. Her “writehealing™” curriculum integrates storytelling and restorative practices to foster intergenerational healing and wellness. @drjametanicoleabarlow

Notes

Sonya C. Faber et al., “The Weaponization of Medicine: Early Psychosis in the Black Community and the Need for Racially Informed Mental Healthcare,” Frontiers in Psychiatry 14, (February 8, 2023): 1098292, doi: 10.3389/fpsyt.2023.1098292; David Puder, “Episode 143: Overdiagnosis of Schizophrenia in Black Patients,” featuring Danielle Hairston and Chantel Fletcher, Psychiatry & Psychotherapy Podcast, podcast audio, filmed March 25, 2022, https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-143-overdiagnosis-of-schizophrenia-in-black-patients.
Valerie Wilson, “African Americans and Women Disproportionately Pay the Price for Austerity and Congressional Dysfunction,” Economic Policy Institute, September 30, 2015, https://www.epi.org/publication/african-americans-and-women-disproportionately-pay-the-price-for-austerity-and-congressional-dysfunction/; Robyn Marasco, “Classics Revisited: Cedric J. Robinson’s Black Marxism: The Making of the Black Radical Tradition and Beyond,” The University of Chicago Press Journals 57, no. 3 (May 2025): 437–445, https://www.journals.uchicago.edu/doi/10.1086/736053; Reed T. DeAngelis, “Racial Capitalism and Black-White Health Inequities in the United States: The Case of the 2008 Financial Crisis,” Journal of Health and Social Behavior 66 no. 2, (July 30 2025): 148-164, https://pmc.ncbi.nlm.nih.gov/articles/PMC11779970/; Sarah Lazare, “Capitalism Is Built on the Backs of Black Women,” In These Times, June 14, 2017, https://inthesetimes.com/article/capitalism-is-built-on-the-backs-of-black-women-domestic-workers.
Sheppard-Towner Maternity and Infancy Protection Act, Pub. L. No. 67-97, 42 Stat. 224 (1921).
Legal Services Corporation, “Section 2: Today’s Low-income America,” The Justice Gap Report, accessed May 4, 2026, https://justicegap.lsc.gov/resource/section-2-todays-low-income-america/.
Rose M. Brewer, “21st-Century Capitalism, Austerity, and Black Economic Dispossession,” Souls 14, no. 3-4 (2012): 227–39.
Clement G. Yedjou et al., “Health and Racial Disparity in Breast Cancer,” Advances in Experimental Medicine and Biology 1152 (January 3 2020): 31–49, https://pmc.ncbi.nlm.nih.gov/articles/PMC6941147/.
Jonathan Franklin, “What Recent Killings of Black Women Reveal About a Growing Crisis,” Capital B News, published April 27, 2026, https://capitalbnews.org/black-women-domestic-violence-crisis/#:~:text=The%20killing%20of%20Black%20women,the%20University%20of%20New%20Mexico.
Franklin, “Recent Killings of Black Women.”
Jordan Gartner, “Cause of Death Released for Wells Fargo Employee Found Dead at Desk 4 Days After Clocking In,” WSAZ News, published October 25, 2024, https://www.wsaz.com/2024/10/26/cause-death-released-wells-fargo-employee-found-dead-desk-4-days-after-clocking/.
“Quita Cole: Businesswoman Dies after Making Social Media Post Expressing Her Exhaustion,” MSN, accessed May 20, 2026, https://www.msn.com/en-xl/africa/kenya/quita-cole-businesswoman-dies-after-making-social-media-post-expressing-her-exhaustion/ar-AA1JTfTS.
Lisa Song and Lylla Younes, “EPA Calls Out Environmental Racism in Louisiana’s Cancer Alley,” ProPublica, published October 19, 2022, https://www.propublica.org/article/cancer-alley-louisiana-epa-environmental-racism.
Alondra Nelson, Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minne]sota Press, 2011), 70, 90.
Bernadette Lim and Monica Hahn, “Whole-Person Healing to the People: Culturally Affirming and Community-Based Approaches to Integrative Health Equity,” Global Advances in Integrative Medicine and Health 14 (July 4 2024).