Representation Matters

In his talk, Eddie Carson talked about the oppression of African American women, its historical origins as well as its contemporary manifestations. In particular, he introduced the wearing hypothesis—first proposed by the Michigan scientist Arline Geronimus in 1992, it suggests that socioeconomic disadvantages had a significant impact on the health of African American women.

This notion shouldn’t be surprising. If we examine the life expectancies by each demographic, one finds African American transwomen with the lowest average length of life; it is hence imperative that we analyze social injustices and structural discriminations through the lens of intersectionality. It is interesting that Carson brought up historical context, as the perception and mistreatment of African American women in history directly correlate to their experiences today.

While African American women are, as the wearing hypothesis states, suffering from significantly worse health conditions vis-à-vis other demographics because of their socioeconomic environment and background, the health care system in the U.S. continues to reinforce, rather than mitigating, that oppression. Because of the absence of a universally affordable health care system, impoverished Americans are less likely to be insured or bear the expense of costly medical treatments. An illness may be the last straw for low-income families, and African American women often fall into that group due to existing and historical systematic oppressions.

But that oppression is not merely financial. As Carson said in his talk, African American women are often the target of discrimination in hospitals and doctor’s offices, where African Americans are underrepresented in general. While there currently are training programs against implicit bias in the health care industry, there is a need for more representation. Yet in the same time, the health care sector is special because it has a very high entry threshold: It is much more difficult to become a doctor for someone who comes from a destitute background than most other professions. From entering a college to graduating medical school, implicit racial biases are present against African American women at almost every step. For that reason, we can’t just look at representation in the health care industry alone, but the system we live in as a whole.

This is particularly important in the midst of a global pandemic. One thing I’ve been thinking about lately, after Covid-19 broke out in both of my countries, is that the health of our society is determined by the least common denominator—that if someone around you is sick and can’t afford to visit a clinic, you are as vulnerable as everybody else, often regardless of how rich you are and what private health care plan you are on.