chapter one: everything i thought was wrong
1. Although the United States: Irene Papanicolas et al., “Health Care Spending in the United States and Other High-Income Countries,” Journal of the American Medical Association, March 13, 2018, 1024–39, jamanetwork.com.
2. spends more on health care: Organisation for Economic Co-operation and Development, “Health Spending,” accessed June 2021, data.oecd.org.
3. The United States has the highest rate: Organisation for Economic Co-operation and Development, “Infant Mortality Rates,” accessed June 2021, data.oecd.org.
4. lowest life expectancy: Organisation for Economic Co-operation and Development, “Life Expectancy at Birth,” accessed June 2021, data.oecd.org.
5. The health outcomes of Black Americans: Steven H. Woolf and Laudan Aron, eds., U.S. Health in International Perspective: Shorter Lives, Poorer Health (Washington, D.C.: National Academies Press, 2013).
6. At every stage of life: Centers for Disease Control and Prevention, “Impact of Racism on Our Nation’s Health,” April 8, 2021, www.cdc.gov.
7. Black babies are more than twice: Centers for Disease Control and Prevention, “Infant Mortality,” Sept. 10, 2020, www.cdc.gov.
8. Black life expectancy: Centers for Disease Control and Prevention, “Health, United States, 2019—Data Finder,” March 2, 2021, www.cdc.gov.
9. African Americans have elevated death rates: Timothy J. Cunningham et al., “Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans—United States, 1999–2015,” Morbidity and Mortality Weekly Report, May 5, 2017, www.cdc.gov.
10. In a phrase: Arline T. Geronimus et al., “Weathering, Drugs, and Whack-a-Mole: Fundamental and Proximate Causes of Widening Educational Inequity in U.S. Life Expectancy by Sex and Race, 1990–2015,” Journal of Health and Social Behavior 60, no. 2 (2019): 222–39.
11. Even when income, education: Anne Case and Angus Deaton, “Life Expectancy in Adulthood Is Falling for Those Without a BA Degree, but as Educational Gaps Have Widened, Racial Gaps Have Narrowed,” Proceedings of the National Academy of Sciences of the United States of America, March 16, 2021, www.pnas.org.
12. College-educated Black mothers: Samantha Artiga et al., “Racial Disparities in Maternal and Infant Health: An Overview,” Kaiser Family Foundation, Nov. 10, 2020, www.kff.org.
13. The mission, instilled in everyone: Essence, “About,” accessed June 2021, www.essence.com.
14. the Heckler Report: Margaret M. Heckler, Report of the Secretary’s Task Force on Black and Minority Health, vol. 1, Executive Summary (Washington, D.C.: U.S. Department of Health and Human Services, 1985). In the Heckler Report, the Black-white health disparity was widest, but overall Blacks also fared worse than the other so-called minority groups—Hispanic, Asian/Pacific Islanders, and Native Americans. In fact, as an aggregate, Asian/Pacific Islanders were healthier and lived longer than all racial/ethnic groups, including whites. Still, the authors of the report noted “data deficiencies,” including inadequate sample sizes for minorities other than Blacks, that made it difficult to create an accurate picture.
15. “Progress depends more on education”: Marlene Cimons, “Need for Education, Behavior Changes Cited: Minorities Suffer from Health Gap,” Los Angeles Times, Oct. 17, 1985, www.latimes.com.
16. “implication, of course, is that”: Edith Irby Jones, “Closing the Health Status Gap for Blacks and Other Minorities,” Journal of the National Medical Association 78, no. 6 (1986).
17. By the time I was: Ryan Marx, “Chicago Homicide Data Since 1957,” Chicago Tribune, March 2, 2016, www.chicagotribune.com.
18. nearly a third of all Black residents: U.S. Department of Commerce, Employment Profiles of Selected Low-Income Areas, Chicago, Ill.—Summary, PHC (3)-16 (Washington, D.C.: U.S. Government Printing Office, 1972).
19. In the 1970s, the overall Black population: Neil J. Smelser et al., eds., America Becoming: Racial Trends and Their Consequences (Washington, D.C.: National Academy Press, 2001), 1:52.
20. co-written a groundbreaking article: Colin McCord and Harold P. Freeman, “Excess Mortality in Harlem,” New England Journal of Medicine, Jan. 18, 1990, 173–77, www.nejm.org.
21. he had founded: Harold P. Freeman Patient Navigation Institute, hpfreemanpni.org.
22. In the Black community: Philip D. Curtin, “The Slavery Hypothesis for Hypertension Among African Americans: The Historical Evidence,” American Journal of Public Health 82, no. 12 (Dec. 1992): 1681–86, ajph.aphapublications.org.
23. hypertension researcher Clarence Grim: Rozalynn S. Frazier, “ ‘African Gene Theory’ Is a Myth, and It’s Harming Black Men’s Heart Health,” Men’s Health, Jan. 24, 2021, www.menshealth.com.
24. This theory was so widespread: Osagie K. Obasogie, “Oprah’s Unhealthy Mistake,” Los Angeles Times, May 17, 2007, www.latimes.com.
25. “In people who have this gene”: American Heart Association, “High Blood Pressure and African Americans,” Oct. 31, 2016, www.heart.org.
26. the California Black Women’s Health Project: Earlise C. Ward et al., “African American Women’s Beliefs, Coping Behaviors, and Barriers to Seeking Mental Health Services,” Qualitative Health Research 19, no. 11 (Nov. 2009): 1589–601.
27. “i found god in myself”: Ntozake Shange, For Colored Girls Who Have Considered Suicide When the Rainbow Is Enuf (New York: Scribner, 2010), 87.
28. By then, research had mounted: Arline T. Geronimus, “The Weathering Hypothesis and the Health of African American Women and Infants: Evidence and Speculations,” Ethnicity and Disease 2, no. 3 (Summer 1992): 207–21.
29. When the story, “The Hidden Toll”: Linda Villarosa, “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” New York Times Magazine, April 11, 2018, www.nytimes.com. Print version titled “The Hidden Toll: Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.”
30. “We are the ones”: Leandris C. Liburd, “ ‘I’m Sick and Tired of Being Sick and Tired’ (Fannie Lou Hamer, 1964)—Why We Work to Create Pathways to Health Equity,” Centers for Disease Control, Conversations in Equity, April 30, 2015, blogs.cdc.gov.
31. “ ‘our people, our problem’ ”: Black AIDS Institute, accessed June 2021, blackaids.org.
chapter two: the dangerous myth that black bodies are different
1. The lawsuit Relf v. Weinberger: Southern Poverty Law Center, “Relf v. Weinberger,” www.splcenter.org.
2. In his autobiography: J. Marion Sims, The Story of My Life (New York: D. Appleton, 1884), 236–37.
3. Almost a century later: Tuskegee University, “About the USPHS Syphilis Study,” accessed June 2021, www.tuskegee.edu.
4. Recruitment flyers read: MaconHistory, “Tuskegee Syphilis Study,” accessed June 2021, maconhistory.weebly.com. Author visited Tuskegee Center for Bioethics, where an original pamphlet was displayed.
5. “a notoriously syphilis-soaked race”: James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (1981; New York: Free Press, 1993), 16.
6. Late in the era: Rebecca Skloot, The Immortal Life of Henrietta Lacks (New York: Crown, 2010).
7. In 1951, Lacks visited: Johns Hopkins Medicine, “The Legacy of Henrietta Lacks,” accessed June 2021, www.hopkinsmedicine.org.
8. More than seventy years after: Amy Dockser Marcus, “Henrietta Lacks and Her Remarkable Cells Will Finally See Some Payback,” Wall Street Journal, Aug. 1, 2020, www.wsj.com.
9. In 1973, Congress held hearings: Centers for Disease Control and Prevention, “The Tuskegee Timeline,” accessed April 22, 2021, www.cdc.gov.
10. In 1997, when issuing a formal apology: White House Office of the Press Secretary, “Apology for Study Done in Tuskegee,” May 16, 1997, clintonwhitehouse4.archives.gov.
11. In 2018, a statue celebrating: William Neuman, “City Orders Sims Statue Removed from Central Park,” New York Times, April 16, 2018, www.nytimes.com; Esha Ray and Denis Slattery, “Protesters Demand Removal of Central Park Statue of 19th Century Doctor Who Experimented on Slave Women,” New York Daily News, Aug. 20, 2017, www.nydailynews.com.
12. “I can show you”: Relf sisters, interview by author, Montgomery, Ala., Dec. 17, 2018.
13. “I was waiting to see”: Bly, interview by author, Montgomery, Ala., Feb. 29, 2020.
14. As she continued meeting: B. Drummond Ayres Jr., “Racism, Ethics, and Rights at Issue in Sterilization Case,” New York Times, July 2, 1973, www.nytimes.com.
15. In 1910, 90 percent of all African Americans: “The Great Migration,” History.com, Jan. 26, 2021, www.history.com.
16. Of those remaining in the South: Isabel Wilkerson, “The Long-Lasting Legacy of the Great Migration,” Smithsonian Magazine, Sept. 2016, www.smithsonianmag.com; James N. Gregory, “The Second Great Migration: A Historical Overview,” in African American Urban History Since World War II, ed. Kenneth L. Kusmer and Joe W. Trotter (Chicago: University of Chicago Press, 2009).
17. In Alabama specifically, census data: “Alabama’s Population: 1800 to the Modern Era,” AL.com, Dec. 28, 2019, www.al.com.
18. “I have amputated the legs”: Benjamin Moseley, A Treatise on Tropical Diseases: And on the Climate of the West-Indies (London: G. G. and J. Robinson, 1795), 475.
19. “They have less hair”: Thomas Jefferson, Notes on the State of Virginia (London, 1785).
20. In his widely read paper: Samuel Cartwright, “Report on the Diseases and Physical Peculiarities of the Negro Race,” New Orleans Medical and Surgical Journal, May 1851.
21. Brown, who eventually managed to escape: John Brown, Slave Life in Georgia: A Narrative of the Life, Sufferings, and Escape of John Brown, a Fugitive Slave, Now in England, ed. L. A. Chamerovzow (London, 1855).
22. Cartwright was a professor: Lucius M. Lampton, “Samuel Adolphus Cartwright,” Mississippi Encyclopedia (Jackson: Center for the Study of Southern Culture, University of Mississippi, 2017), mississippiencyclopedia.org.
23. specialized in illness and physiology: “Samuel Cartwright, Health and Physiology Committee of the Louisiana Medical Association,” Mississippi Encyclopedia, 181.
24. The two attorneys had recently founded: Southern Poverty Law Center, “Our History,” www.splcenter.org.
25. In July 1973, they filed: Law School Case Brief, Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974), www.lexisnexis.com.
26. Just before the official filing: B. Drummond Ayres Jr., “Racism, Ethics, and Rights at Issue in Sterilization Case,” New York Times, July 2, 1973, www.nytimes.com.
27. In a July 2, 1973, New York Times story: Ibid.
28. A Times article a few days later: B. Drummond Ayres Jr., “Sterilizing the Poor: Exploring Motives and Methods,” New York Times, July 8, 1973, www.nytimes.com.
29. During the open hearing: Bill Kovach, “Sterilization Consent Not Given, Father Tells Kennedy’s Panel,” New York Times, July 11, 1973, www.nytimes.com.
30. At the Family Planning Clinic: Donna Franklin, “Beyond the Tuskegee Apology,” Washington Post, May 29, 1997, www.washingtonpost.com.
31. Nial Ruth Cox: Edward Hudson, “Suit Seeks to Void Sterilization Law,” New York Times, July 13, 1973, www.nytimes.com.
32. filed a suit: Nial Ruth Cox, Appellant, v. A. M. Stanton, M.D., et al., Appellees, No. 74-2218, U.S. Court of Appeals, Fourth Circuit, argued April 11, 1975 (decided Oct. 6, 1975), law.resource.org.
33. A governmental caseworker: Ria Tabacco Mar, “The Forgotten Time Ruth Bader Ginsburg Fought Against Forced Sterilization,” Washington Post, Sept. 19, 2020, www.washingtonpost.com.
34. In North Carolina: “The Governor’s Task Force to Determine the Method of Compensation for Victims of North Carolina’s Eugenics Board,” Jan. 27, 2012.
35. Like North Carolina, thirty-one other states: Lisa Ko, “Unwanted Sterilization and Eugenics Programs in the United States,” Independent Lens, PBS, Jan. 29, 2016, www.pbs.org.
36. In California, more than 17,000: Nicole L. Novak et al., “Disproportionate Sterilization of Latinos Under California’s Eugenic Sterilization Program, 1920–1945,” American Journal of Public Health 108 (2018): 611–13, ajph.aphapublications.org.
37. In 1976, a study: National Library of Medicine, “1976: Government Admits Unauthorized Sterilization of Indian Women,” www.nlm.nih.gov.
38. The same year, HEW reported: Eugenics Archive, “Puerto Rico,” eugenicsarchive.ca.
39. Eventually, because of the Relfs’ case: Southern Poverty Law Center, “Relf v. Weinberger.”
40. they recruited Melvin Belli: Ayres, “Sterilizing the Poor, Exploring Motives and Methods.”
41. Belli, nicknamed King of Torts: Richard Severo, “Melvin Belli Dies at 88; Flamboyant Lawyer Relished His Role as King of Torts,” New York Times, July 11, 1996, www.nytimes.com.
42. To validate his theory: Lundy Braun, Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics (Minneapolis: University of Minnesota Press, 2002). Dr. Braun’s theory is summarized in Lundy Braun, “Race, Ethnicity, and Lung Function: A Brief History,” Canadian Journal of Respiratory Therapy 51, no. 4 (Autumn 2015): 99–101.
43. A 2013 review of studies: Ronald Wyatt, “Pain and Ethnicity,” Virtual Mentor 15, no. 5 (2013): 449–54.
44. As recently as 2016: Kelly M. Hoffman et al., “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites,” Proceedings of the National Academy of Sciences of the United States of America 113, no. 16 (2016): 4296–301, www.pnas.org.
45. Center for Investigative Reporting: Corey G. Johnson, “Female Inmates Sterilized in California Prisons Without Approval,” Reveal, July 7, 2013, revealnews.org.
46. In 2017, Judge Sam Benningfield: “White County Inmates Given Reduced Jail Time if They Get Vasectomy,” News Channel 5, Nashville, July 19, 2017, www.newschannel5.com.
47. In the fall of 2020: Caitlin Dickerson, Seth Freed Wessler, and Miriam Jordan, “Immigrants Say They Were Pressured into Unneeded Surgeries,” New York Times, Sept. 29, 2020, www.nytimes.com.
48. “I felt sorry for them”: Levin, phone interview by author, March 3, 2020.
49. In 2013, North Carolina: WFMY staff, “August 22, 1974: NC Woman’s ‘Forcibly Sterilized’ Case Was Dismissed,” WFMY News 2, Aug. 22, 2016, www.wfmynews2.com.
50. Virginia followed in 2015: Gary Robertson, “Virginia Lawmakers OK Payout to Forced Sterilization Survivors,” Reuters, Feb. 26, 2015, www.reuters.com.
51. Though California apologized to the victims: Carl Ingram, “State Issues Apology for Policy of Sterilization,” Los Angeles Times, March 12, 2003, www.latimes.com.
52. Their mother died in 1980: Minnie Relf obituary, Montgomery Advertiser, June 21, 1980, www.newspapers.com; Legacy.com, “Lonnie Relf,” May 31, 2009, www.legacy.com.
chapter three: unequal treatment
1. New York Times Magazine cover story: Linda Villarosa, “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” New York Times Magazine, April 11, 2018, www.nytimes.com.
2. One Saturday afternoon: Center for Reproductive Rights, reproductiverights.org.
3. Her organization had recently collaborated: SisterSong, www.sistersong.net; Black Mamas Matter Alliance, blackmamasmatter.org.
4. “Did you know that a Black woman”: Richard V. Reeves and Dayna Bowen Matthew, “6 Charts Showing the Race Gaps Within the American Middle Class,” Brookings Institution, Oct. 21, 2016, www.brookings.edu.
5. At the Decolonizing Birth Conference: Decolonizing Birth Conference, www.decolonizingbirthconference.com.
6. By the end of the day: Birthmark Doulas, www.birthmarkdoulas.com.
7. This piece, part of Lost Mothers: Nina Martin and Renee Montagne, “The Last Person You Would Expect to Die in Childbirth,” ProPublica and NPR, May 12, 2017, www.propublica.org; Nina Martin, Emma Cillekens, and Allessandra Freitas, “Lost Mothers,” ProPublica, July 17, 2017, www.propublica.org.
8. In fact, as I was reporting: Corrine A. Riddell et al., “Trends in Differences in US Mortality Rates Between Black and White Infants,” JAMA Pediatrics 71, no. 9 (Sept. 2017): 911–13, jamanetwork.com.
9. What’s more, my friend: Dána-Ain Davis, Reproductive Injustice: Racism, Pregnancy, and Premature Birth (New York: New York University Press, 2019).
10. pointed me to statistics: Michael Haines, “Fertility and Mortality in the United States,” Economic History Association, accessed June 17, 2021, eh.net.
11. Why is the current Black-white disparity: Reeves and Matthew, “6 Charts Showing the Race Gaps Within the American Middle Class.”
12. studies out of Columbia University: Columbia University, Columbia Public Health, “Respectful Maternity Care,” updated May 24, 2021, www.publichealth.columbia.edu.
13. Tanzania—where problems in pregnancy: World Health Organization, “Trends,” accessed June 17, 2021, https://data.unicef.org/resources/trends-maternal-mortality-2000-2017/.
14. “There is something structural”: Freedman, interview by author, Columbia University Mailman School of Public Health, Nov. 15, 2017.
15. “We don’t do that here”: Sang Hee Won (Lynn Freedman’s colleague), phone interview by author, Feb. 28, 2017.
16. Landrum lived in Broadmoor: Greg B. Smith, “Neighborhood Effort Keeps Community Alive After Hurricane Katrina,” New York Daily News, Aug. 22, 2015, www.nydailynews.com.
17. “Is she okay?”: Landrum, interview by author, New Orleans, Nov. 2, 2017.
18. Rarely has an article: Kevin A. Schulman et al., “The Effect of Race and Sex on Physicians’ Recommendation for Cardiac Catheterization,” New England Journal of Medicine, Feb. 25, 1999, 618–26, www.nejm.org.
19. chose this topic for a reason: Centers for Disease Control and Prevention, “Facts About Hypertension,” accessed Sept. 8, 2020, www.cdc.gov; Centers for Disease Control and Prevention, “Racial and Ethics Disparity in Heart Disease,” Health, United States Spotlight, April 2019, www.cdc.gov.
20. majority of them white men: Avram Goldstein, “Race, Sex Disparity Found in Heart Care,” Washington Post, Feb. 25, 1999, www.washingtonpost.com.
21. “How your doctor treats”: Sally Satel, “The Indoctrinologists Are Coming,” Atlantic Monthly, Jan. 2001.
22. “Last night we told you”: Abigail Thernstrom and Stephan Thernstrom, eds., Beyond the Color Line: New Perspectives on Race and Ethnicity in America (Stanford, Calif.: Hoover Institution Press, 2001), 133.
23. “as close to a definition”: Editorial, “Institutionalized Racism in Health Care,” Lancet 9155 (1994): 765.
24. “serves to fuel anger”: Lisa M. Schwartz, “Misunderstandings About the Effects of Race and Sex on Physicians’ Referrals for Cardiac Catherization,” New England Journal of Medicine, July 22, 1999, 279–83, www.nejm.org.
25. Even as the controversy: Henry J. Kaiser Family Foundation, “Race, Ethnicity, and Medical Care: A Survey of Public Perceptions and Experiences,” Oct. 1999, www.kff.org.
26. In 2000, Clinton signed legislation: National Institutes of Health, “National Institute on Minority Health and Health Disparities,” NIH Almanac, accessed Dec. 4, 2020, www.nih.gov.
27. “When he was growing up”: Schulman, Zoom interview by author, Aug. 4, 2020.
28. The Listening to Mothers: Listening to Mothers III Pregnancy and Birth, “Report of the Third National U.S. Survey of Women’s Childbearing Experiences,” May 2013, www.nationalpartnership.org.
29. National Academy of Sciences: National Academy of Sciences, “Mission,” accessed June 18, 2021, www.nasonline.org.
30. Unequal Treatment: Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academies Press, 2003). The report was released in March 2002 and published in 2003.
31. A mention of Dr. Kevin Schulman’s: Thomas E. Perez, “The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status,” in Smedley, Stith, and Nelson, Unequal Treatment.
32. “To the extent that doctors”: “Subtle Racism in Medicine,” New York Times, March 22, 2002, www.nytimes.com.
33. Two weeks after the publication: Luis Ferré-Sadurní, “New York to Expand Use of Doulas to Reduce Childbirth Deaths,” New York Times, April 22, 2018, www.nytimes.com.
34. Inspired by the story: Grace Douglas, “Award-Winning Journalist to Discuss the American Infant Mortality Crisis,” News @ ODU, Old Dominion University, Jan. 21, 2020, www.odu.edu.
35. Merck announced: “Merck Announces ‘Safer Childbirth Cities’ Initiative, Issues Call to Action to Reverse the Rise in U.S. Maternal Deaths,” Merck press release, Oct. 1, 2018, www.merck.com.
36. Most exciting for me: Louisiana Department of Health, Bureau of Family Health, “Louisiana Perinatal Quality Collaborative (LaPQC),” accessed June 18, 2021, ldh.la.gov.
37. In January 2018: Rob Haskell, “Serena Williams on Motherhood, Marriage, and Making Her Comeback,” Vogue, Jan. 10, 2018, www.vogue.com.
chapter four: something about being black is bad for your body and your baby
1. Their experiences support the findings: Richard David and James Collins Jr., “Disparities in Infant Mortality: What’s Genetics Got to Do with It?,” American Journal of Public Health 97, no. 7 (July 2007): 1191–97, ajph.aphapublications.org.
2. “Something about growing up”: “Disparities in Infant Mortality Not Related to Race, Study Finds,” Science Daily, July 31, 2007, www.sciencedaily.com.
3. Our country, the richest in the world: “Preterm Births Cost U.S. $26 Billion a Year; Multidisciplinary Research Effort Needed to Prevent Early Births,” National Academies of Sciences Engineering Medicine, July 13, 2006, www.nationalacademies.org.
4. In general, in the United States: World Bank, “The Current Health Expenditure (% of GDP),” data.worldbank.org.
5. America spends nearly $11,000: World Bank, “Current Health Expenditure Per Capita (Current US$),” data.worldbank.org.
6. However, when the research pair: James Collins Jr. and Richard David, “The Differential Effect of Traditional Risk Factors on Infant Birthweight Among Blacks and Whites in Chicago,” American Journal of Public Health 80, no. 6 (June 1990), ajph.aphapublications.org.
7. To test their theory: Richard J. David and James Collins Jr., “Differing Birth Weight Among Infants of U.S.-Born Blacks, African-Born Blacks, and U.S.-Born Whites,” New England Journal of Medicine, Oct. 23, 1997, 1209–14, www.nejm.org.
8. For this study: James Collins Jr., Shou-Yien Wu, and Richard J. David, “Differing Intergenerational Birth Weights Among the Descendants of US-Born and Foreign-Born Whites and African Americans in Illinois,” American Journal of Epidemiology 155, no. 3 (2002): 210–16.
9. Finally, in 2007, Drs. David and Collins: David and Collins, “Disparities in Infant Mortality.”
10. It contained what is now considered: Kenneth C. Schoendorf et al., “Mortality Among Infants of Black as Compared with White College-Educated Parents,” New England Journal of Medicine, June 4, 1992, 1522–26, www.nejm.org.
11. A team of female researchers: Boston University Sloane Epidemiology Center, “Black Women’s Health Study,” accessed June 21, 2021, www.bu.edu.
12. They were interested in looking: Nurses’ Health Study, “The Nurses’ Health Study and Nurses’ Health Study II Are Among the Largest Investigations into the Risk Factors for Major Chronic Diseases in Women,” accessed June 21, 2021, nurseshealthstudy.org.
13. The next day I googled him: David R. Williams, “Miles to Go Before We Sleep: Racial Inequities in Health,” Journal of Health and Social Behavior 53, no. 3 (Sept. 2012): 279–95.
14. In 2011, writing: Ronald Howell, “Before Their Time,” Yale Alumni Magazine, May/June 2011, yalealumnimagazine.com.
15. “If you were a woman”: Miller, phone interviews by author, Nov. 18 and Dec. 11, 2020.
16. about 2.6 percent of physicians are Black women: Association of American Medical Colleges, “Diversity in Medicine, Facts and Figures 2019,” www.aamc.org.
17. Geronimus, who coined the term: Arline T. Geronimus, “The Weathering Hypothesis and the Health of African American Women and Infants: Evidence and Speculations,” Ethnicity and Disease 2, no. 3 (Summer 1992): 207–21.
18. Inspired by the book: Carol B. Stack, All Our Kin: Strategies for Survival in a Black Community (New York: Basic Books, 1997).
19. That year, in the journal: Arline T. Geronimus, “On Teenage Childbearing and Neonatal Mortality in the United States,” Population and Development Review 13, no. 2 (June 1987): 245–79.
20. Karen Pittman, a Black sociologist: Tamar Lewin, “Studies Cause Confusion on Impact of Teen-Age Pregnancy,” New York Times, March 7, 1990, www.nytimes.com.
21. Geronimus persisted: Geronimus, “Weathering Hypothesis and the Health of African American Women and Infants.”
22. concept of John Henryism: S. A. James et al., “John Henryism and Blood Pressure Differences Among Black Men,” Journal of Behavioral Medicine 6, no. 3 (Sept. 1983): 259–78.
23. For her 2006 study: Arline T. Geronimus et al., “ ‘Weathering’ and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States,” American Journal of Public Health 96, no. 5 (2006): 826–33, ajph.aphapublications.org.
24. “Breaking Point”: U-Meleni Mhlaba-Adebo, Soul Psalms (Berkeley, Calif.: She Writes Press, 2016).
25. “By then, I was starting to understand”: Mhlaba-Adebo, interview by author, Boston, Sept. 30, 2020.
26. “Have You Ever”: U-Meleni Mhlaba-Adebo, “Have You Ever,” Nov. 24, 2020, YouTube, www.youtube.com.
27. “Poem for Jabu”: Mhlaba-Adebo, Soul Psalms, 65.
28. “Her body is a weapon”: U-Meleni Mhlaba-Adebo, “Her Body Is a Weapon,” u-meleni.com.
chapter five: where you live matters
1. Danielle Bailey grew up: Danielle Bailey-Lash and Caroline Armijo, interviews by author, March 14, 2019.
2. a town of about fifteen hundred: U.S. Census Bureau, “Walnut Cove Town, North Carolina,” www.census.gov.
3. Though a sign encourages fishing: A. Dennis Lemly, “Symptoms and Implications of Selenium Toxicity in Fish: The Belews Lake Case Example,” Aquatic Toxicology 57 (2002): 39–49, www.fs.usda.gov.
4. In 2014, the danger became: Department of Environment and Natural Resources, “DENR Response to Duke Energy Coal Ash Spill,” May 12, 2014, https://deq.nc.gov/media/1781/download.
5. Because the pond was unlined: Earthjustice, “Mapping the Coal Ash Contamination,” Oct. 6, 2020, earthjustice.org.
6. Englewood High School, which: Illinois High School Glory Days, “Chicago Englewood High School ‘Eagles,’ ” www.illinoishsglorydays.com.
7. about twenty-four thousand residents: Chicago Metropolitan Agency for Planning, “Englewood,” June 2021, www.cmap.illinois.gov.
8. We later learned that Chicago has the country’s: “Large Life Expectancy Gaps in U.S. Cities Linked to Racial & Ethnic Segregation by Neighborhood,” NYU Langone Health News Hub, June 5, 2019, nyulangone.org.
9. A wide-ranging report: NAACP, “Fumes Across the Fence-Line: The Health Impacts of Air Pollution from Oil & Gas Facilities on African American Communities,” Nov. 2017, naacp.org.
10. A study conducted by the EPA’s: Ihab Mikati et al., “Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status,” American Journal of Public Health, March 7, 2018, 480–85, ajph.aphapublications.org.
11. Ironically, another study: Christopher W. Tessum et al., “Inequity in Consumption of Goods and Services Adds to Racial–Ethnic Disparities in Air Pollution Exposure,” Proceedings of the National Academy of Sciences of the United States of America 116, no. 13 (March 2019): 6001–6, www.pnas.org.
12. In December 2017: Mark D. Risser and Michael F. Wehner, “Attributable Human-Induced Changes in the Likelihood and Magnitude of the Observed Extreme Precipitation During Hurricane Harvey,” Geophysical Research Letters 44, no. 24 (Dec. 2017): 12457–64, agupubs.onlinelibrary.wiley.com.
13. A 2017 survey: Megan L. McKenna et al., “Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama,” American Journal of Tropical Medicine and Hygiene 97, no. 5 (2017): 1623–28, www.ajtmh.org; article corrected in American Journal of Tropical Medicine and Hygiene 98, no. 3 (March 2018): 936.
14. In 2017, a United Nations official: Connor Sheets, “UN Poverty Official Touring Alabama’s Black Belt: ‘I Haven’t Seen This’ in the First World,” AL.com, Dec. 8, 2017, updated March 7, 2019, www.al.com.
Catherine Coleman Flowers, a MacArthur genius, wrote a book called Waste: One Woman’s Fight Against America’s Dirty Secret about Lowndes County, where she was born and raised.
15. “Call Tony and have him”: Sandra Thomas, interview by author, Walnut Grove, N.C., Feb. 22, 2020.
16. Though cancer is an unpredictable: American Association of Neurological Surgeons, “Glioblastoma Multiforme,” accessed June 28, 2021, www.aans.org.
17. Eventually, she discovered: Earthjustice, “Coal Ash Contaminates Our Lives,” accessed June 28, 2021, earthjustice.org.
18. Seventy percent of coal ash ponds: Statement, Lisa Evans to U.S. Commission on Civil Rights, “Coal Ash Pollution and Impacts on Minority and Low-Income Communities,” Jan. 22, 2016, www.dropbox.com/s/g1ubwsnu4lye4v9/Evans%20USCCR%20statement%20010816.pdf?dl=0.
19. North Carolina had more than one hundred: Lisa Sorg, “Do You Live near a Coal Ash Disposal Site?,” NC Policy Watch, Sept. 4, 2018, www.ncpolicywatch.com.
20. Two years later, the state would admit: Michael Biesecker, “NC Toxicologists: Water near Duke’s Dump Not Safe to Drink,” Associated Press, Aug. 2, 2016, apnews.com.
21. This event, which received: Catherine E. Shoichet, “Spill Spews Tons of Coal Ash into North Carolina River,” CNN, Feb. 9, 2014, www.cnn.com.
22. In 1896, when African Americans: Frederick L. Hoffman, Race Traits and Tendencies of the American Negro (New York: Macmillan, 1896).
23. Du Bois and his team: W. E. B. Du Bois and Isabel Eaton, The Philadelphia Negro: A Social Study (Philadelphia: Ginn, 1899; Philadelphia: University of Pennsylvania Press, 1996).
24. In a later work: W. E. Burghardt Du Bois, “The Health and Physique of the Negro American,” American Journal of Public Health 93, no. 2 (Feb. 2003): 272–76. Journal article is excerpted from Du Bois, The Health and Physique of the Negro American (Atlanta: Atlanta University Press, 1906).
25. Even educated, affluent Blacks: Lewis Mumford Center for Comparative Urban and Regional Research University at Albany, “Separate and Unequal: The Neighborhood Gap for Blacks and Hispanics in Metropolitan America,” Oct. 13, 2002, mumford.albany.edu.
26. Only 44 percent of Black Americans: Dana Anderson, “Minneapolis, Milwaukee & Salt Lake City Have the Lowest Black Homeownership Rates in the U.S., with Just One-Quarter of Black Families Owning Their Home,” Redfin News, June 29, 2020, updated Oct. 19, 2020, www.redfin.com.
27. compared with about 65 percent: Census.gov, “Quarterly Residential Vacancies and Homeownership, First Quarter 2021,” Release Number CB21-56, April 27, 2021, www.census.gov.
28. Homeownership, a pillar of the so-called American dream: Troy McMullen, “The ‘Heartbreaking’ Decrease in Black Homeownership,” Washington Post, Feb. 28, 2019, www.washingtonpost.com.
29. This contributes to a wealth gap: Neil Bhutta et al., “Disparities in Wealth by Race and Ethnicity in the 2019 Survey of Consumer Finances,” Feds Notes, Sept. 28, 2020, www.federalreserve.gov.
30. Many areas where the streets: Richard Rothstein, The Color of Law (New York: Liveright, 2018).
31. A 2020 study: National Community Reinvestment Coalition, “Redlining and Neighborhood Health,” accessed June 29, 2021, ncrc.org.
32. According to the 2019 report: Samuel DuBois Cook Center on Social Equity, “The Plunder of Black Wealth in Chicago: New Findings on the Lasting Toll of Predatory Housing Contracts,” May 2019, socialequity.duke.edu.
33. In 1978, Robert Bullard: Author interviews, phone June 21, 2018, and at the Climate Reality Leadership Corps Training, Atlanta, March 16, 2019.
34. The suit charged: Robert D. Bullard, “The Mountains of Houston: Environmental Justice and the Politics of Garbage” (2014), ricedesignalliance.org.
35. In his 1990 book: Robert D. Bullard, Dumping in Dixie: Race, Class, and Environmental Quality (Boulder, Colo.: Westview Press, 1990).
36. As Bullard was writing: Matt Reimann, “The EPA Chose This County for a Toxic Dump Because Its Residents Were ‘Few, Black, and Poor,’ ” Timeline, April 3, 2017, timeline.com.
37. The study, Toxic Wastes: Commission for Racial Justice, United Church of Christ, Toxic Wastes and Race in the United States (1987), nrc.gov.
38. In 2007, the UCC revisited: Robert Bullard et al., Toxic Wastes and Race at Twenty, 1987–2007, United Church of Christ Justice and Witness Ministries, March 2007, www.nrdc.org.
39. In time for Black History Month: United Church of Christ, “Breath to the People”: Sacred Air and Toxic Pollution, Feb. 2020, www.ucc.org.
40. In 1992, the EPA created: U.S. Environmental Protection Agency, “Environmental Justice Fact Sheet,” April 1996, www.epa.gov.
41. The new office hired: Ali, interview by author at the Climate Reality Leadership Corps Training, Atlanta, March 16, 2019.
42. In 1994, the newly elected president: U.S. Environmental Protection Agency, “Laws and Regulations, Summary of Executive Order 12898—Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations,” Feb. 16, 1994, www.epa.gov.
43. Then, in 2017, Donald Trump: Juliet Eilperin and Brady Dennis, “White House Eyes Plan to Cut EPA Staff by One-Fifth, Eliminating Key Programs,” Washington Post, March 1, 2017, www.washingtonpost.com.
44. The proposal also called for: Brady Dennis, “EPA Environmental Justice Leader Resigns, amid White House Plans to Dismantle Program,” Washington Post, March 9, 2017, www.washingtonpost.com.
45. His three-page, single-spaced: Mustafa Santiago Ali resignation letter, March 8, 2017, www.documentcloud.org/documents/3514958-Final-Resignation-Letter-for-Administrator.html.
46. A year and a half later: Coral Davenport, Lisa Friedman, and Maggie Haberman, “E.P.A. Chief Scott Pruitt Resigns Under a Cloud of Ethics Scandals,” New York Times, July 5, 2018, www.nytimes.com.
47. Before Pruitt was pushed out: Ihab Mikati et al., “Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status,” American Journal of Public Health, March 7, 2018, 480–85, ajph.aphapublications.org.
48. The campaign outline states: Poor People’s Campaign, “Our Demands,” accessed June 29, 2021, www.poorpeoplescampaign.org.
49. The week after the North Carolina: Lisa Friedman, “Cost of New E.P.A. Coal Rules: Up to 1,400 New Deaths a Year,” New York Times, Aug. 21, 2018, www.nytimes.com.
50. On that day, which was: “Danielle Bailey-Lash Comments 2018 Event,” YouTube, www.youtube.com.
51. “If the coal ash”: Amanda Dodson, “Al Gore Stops in Stokes County,” Stokes News, Aug. 15, 2018, www.thestokesnews.com.
52. On Thursday, March 14: Climate Reality Project, “Three Great Moments from Our Atlanta Training,” April 6, 2019, www.climaterealityproject.org.
53. on April 1, the North Carolina: North Carolina Environmental Quality, “DEQ Orders Duke Energy to Excavate Coal Ash at Six Remaining Sites,” press release, April 1, 2019, deq.nc.gov.
54. The good news was short-lived: Lisa Sorg, “Duke Energy to DEQ: See you in court,” The Pulse, NC Policy Watch, April 12, 2019, www.pulse.ncpolicywatch.org.
55. That means that though some notable Black: Charlotte Alter, Suyin Haynes, and Justin Worland, “Time 2019 Person of the Year, Greta Thunberg,” Time, Dec. 23/Dec. 30, 2019, time.com.
56. In March 1990, more than a hundred: Southwest Organizing Project, Letter, March 16, 1990, www.ejnet.org.
57. The weekend event in 1991: Environmental Justice/Environmental Racism 17-point platform adopted at the First National People of Color Environmental Leadership Summit, Oct. 24–27, 1991, www.ejnet.org.
58. Bullard, one of the organizers: Deep South Center for Environmental Justice, “HBCU Climate Change Consortium,” accessed June 30, 2021, www.dscej.org.
59. A 2018 survey: Dorceta E. Taylor, “Diversity in Environmental Organizations Reporting and Transparency Report No. 1,” Jan. 2018, www.researchgate.net.
60. A 2019 report: Green 2.0, “Leaking Talent,” accessed June 30, 2021, diversegreen.org.
61. The company reached a settlement: Duke Energy Carolinas, LLC, and Duke Energy Progress, LLC, v. North Carolina Department of Environmental Quality, settlement agreement, Dec. 31, 2019, www.southernenvironment.org.
62. Caroline thinks about her friend: Caroline Armijo, interviews by author, Stokes County, N.C., Feb. 21–23, 2020.
63. In 2018, inspired by Danielle: Lilies Project, Addressing Coal Ash Through Arts & Parks, accessed June 30, 2021, theliliesproject.org.
chapter six: strong, loud, and angry: the invisibility of black emotional pain
1. On a hectic day: Audrey Brianne, Zoom interview by author, March 20, 2021.
2. A 2018 national survey: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, “2018 National Survey on Drug Use and Health: African Americans,” www.samhsa.gov.
3. The proliferation of high-profile: Jacob Bor et al., “Police Killings and Their Spillover Effects on the Mental Health of Black Americans: A Population Based, Quasi-experimental Study,” Lancet 392 (2018): 302–10, www.thelancet.com.
4. Instead, they are much more likely: V. A. Hiday et al., “Criminal Victimization of Persons with Severe Mental Illness,” Psychiatric Services 50 (Jan. 1999): 62–68.
5. A 2012 report: E. Fuller Torrey et al., “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals, 2005–2010,” Treatment Advocacy Center, July 19, 2012, www.treatmentadvocacycenter.org.
6. In Zora Neale Hurston’s: Zora Neale Hurston, Their Eyes Were Watching God (New York: HarperCollins, 2021).
7. A 2009 study found: “Black Girls Are 50 Percent More Likely to Be Bulimic Than White Girls,” Science Daily, March 25, 2009, www.sciencedaily.com.
8. A 2020 review of thirty-eight previous: Rachel W. Goode et al., “Binge Eating and Binge-Eating Disorder in Black Women: A Systematic Review,” International Journal of Eating Disorders 53, no. 4 (April 2020): 491–507, onlinelibrary.wiley.com.
9. despite research that points to: Yunyu Xiao et al., “Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991–2019,” JAMA Newtork Open 4, no. 6 (June 2021), www.jamanetwork.com.
10. McClain had first gained: Leanita McClain, “The Middle-Class Black’s Burden,” Newsweek, Oct. 13, 1980, 12.
11. Her early poetry: Leanita McClain, A Foot in Each World: Essays and Articles (Evanston, Ill.: Northwestern University Press, 1986).
12. a very popular book: Terrie M. Williams, Black Pain: It Just Looks Like We’re Not Hurting: Real Talk for When There’s Nowhere to Go but Up (New York: Scribner, 2009).
13. Millions of African Americans: Mental Health America, “Black and African American Communities and Mental Health,” accessed July 2, 2021, www.mhanational.org; National Institute of Mental Health, “Mental Health Information, Statistics,” accessed July 2, 2021, www.nimh.nih.gov.
14. about 84 percent of the psychology: “Psychology’s Workforce Is Becoming More Diverse,” Monitor on Psychology 51, no. 8 (2020): 19, www.apa.org.
15. This includes Black people: Black Women’s Health Imperative, “Postpartum Depression While Black,” April 20, 2018, bwhi.org.
16. Mistreatment of African Americans: Alexander Thomas and Samuel Sillen, Racism and Psychiatry (New York: Carol, 1993).
17. A 1968 article: Walter Bromberg and Franck Simon, “The ‘Protest’ Psychosis: A Special Type of Reactive Psychosis,” Archives of General Psychiatry 19, no. 2 (1968): 155–60, jamanetwork.com.
18. Black men are still four times: “African Americans More Likely to Be Misdiagnosed with Schizophrenia, Study Finds,” Science Daily, March 21, 2019, www.sciencedaily.com.
19. Instead, according to a 2019 study: Michael A. Lindsey et al., “Trends of Suicidal Behaviors Among High School Students in the United States, 1991–2017,” Pediatrics 144, no. 5 (Nov. 2019), pediatrics.aappublications.org.
20. Over Labor Day weekend: Gloria McMullen, interviews with author, Middletown, Conn., Aug. 10 and 22, 2020.
21. Forty percent of adults: Carolyn Zezima, “Incarcerated with Mental Illness: How to Reduce the Number of People with Mental Health Issues in Prison,” Psycom, Aug. 12, 2020, www.psycom.net.
22. Individuals with severe mental illnesses: Doris A. Fuller et al., “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters,” Treatment Advocacy Center, Office of Research and Public Affairs, Dec. 2015, www.treatmentadvocacycenter.org.
23. Jails and prisons hold more people: E. Fuller Torrey et al., “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States,” Treatment Advocacy Center, May 2010, www.treatmentadvocacycenter.org.
24. By all accounts, including databases: Washington Post staff, “Fatal Force,” Washington Post, updated July 2, 2021, www.washingtonpost.com; Guardian staff, “The Counted, People Killed by Police in the US,” Guardian, accessed July 2, 2021, www.theguardian.com.
25. one in four fatal encounters: Fuller et al., “Overlooked in the Undercounted.”
26. According to Mapping Police Violence: Mapping Police Violence, accessed July 3, 2021, mappingpoliceviolence.org.
27. “We would hear him”: Karen McMullen, interview by author, Brooklyn, July 27, 2020.
28. Bipolar disorder, a brain condition: “Bipolar Disorder (Manic Depressive Illness),” Mental Illness Policy Organization, accessed July 3, 2021, mentalillnesspolicy.org.
29. Black people are not diagnosed properly: Kaja R. Johnson and Sheri L. Johnson, “Inadequate Treatment of Black Americans with Bipolar Disorder,” Psychiatric Services 65, no. 2 (Feb. 2014): 255–58, ps.psychiatryonline.org.
30. While Black adults in the United States: Human Rights Watch, “US: Disastrous Toll of Criminalizing Drug Use,” Oct. 12, 2016, www.hrw.org; Tess Borden et al., Every 25 Seconds: The Human Toll of Criminalizing Drug Use in the United States, Human Rights Watch and American Civil Liberties Union, Oct. 2016, www.hrw.org.
31. In 1971, President Nixon: Equal Justice Initiative, “Nixon Adviser Admits War on Drugs Was Designed to Criminalize Black People,” March 25, 2016, eji.org.
32. The kicker: Josh Rovner, “Racial Disparities in Youth Incarceration Persist,” Sentencing Project, Feb. 3, 2021, www.sentencingproject.org.
33. In 1986, the Anti–Drug Abuse Act: American Civil Liberties Union, “Cracks in the System: 20 Years of the Unjust Federal Crack Cocaine Law,” Oct. 2006, www.aclu.org.
34. Decades after the fact: Dan Baum, “Legalize It All,” Harper’s Magazine, April 2016, harpers.org.
35. 2010 Fair Sentencing Act: American Civil Liberties Union, “Fair Sentencing Act,” accessed July 3, 2021, www.aclu.org.
36. In fact, a 2017 analysis: Julie Netherland and Helena B. Hansen, “The War on Drugs That Wasn’t: Wasted Whiteness, ‘Dirty Doctors,’ and Race in Media Coverage of Prescription Opioid Use,” Culture Medicine and Psychology 40, no. 4 (Dec. 2016): 664–86; Yardena Schwartz, “Painkiller Use Breeds New Face of Heroin Addiction,” NBC News, June 19, 2012, www.nbcnews.com.
37. Federal spending also reveals: Shannon Mullen et al., “Crack vs. Heroin,” Asbury Park Press, Dec. 2, 2019, updated June 17, 2020, www.app.com.
38. According to the police report: McMullen Boston PD initial report, requested on Dec. 2, 2011; Commonwealth of Massachusetts Plymouth County Office of the District Attorney, “Investigation Concluded,” Feb. 28, 2011.
39. Conducted an investigation: Commonwealth of Massachusetts Plymouth County Office of the District Attorney, “Investigation Concluded,” Feb. 28, 2011.
40. It took eight years: “The Schroeder Brothers Memorial Medal, the Department Medal of Honor, the Boston Police Relief Association Memorial Award,” Blackstonian, Jan. 4, 2013, blackstonian.org.
chapter seven: discrimination and ill-treatment can harm every body
1. Charlene Marshall: Erin Beck, “Banned from Attending White Colleges in 1950s, Former Delegate to Receive Honorary Degree,” Charleston Gazette-Mail, May 15, 2015, www.wvgazettemail.com.
2. Ashley and Jason turn: Ashley and Jason (last names withheld), interview by author, Morgantown, W.Va., Oct. 26, 2020.
3. The other options that the Bartlett House: Bartlett Housing Solutions, “Our Programs,” accessed July 26, 2021, www.bartletthousingsolutions.org.
4. Many of the Bartlett House clients: Department of Numbers, “Morgantown, West Virginia Unemployment,” www.deptofnumbers.com.
5. But the census points to: U.S. Census Bureau, “Quick Facts Morgantown City, West Virginia,” July 1, 2019, www.census.gov.
6. That means that most: West Virginia Division of Labor, “Minimum Wage & Maximum Hours,” accessed July 26, 2021, labor.wv.gov.
7. The local government’s annual: “FY 2020 Annual Action Plan—Substantial Amendment, City of Morgantown, WV,” Nov. 18, 2020, 61, www.morgantownwv.gov.
8. About a block up: West Virginia University, “WVU Facts,” accessed July 26, 2021, www.wvu.edu.
9. That question sent me: U.S. Census Bureau. “Quick Facts West Virginia,” July 1, 2019, www.census.gov.
10. West Virginia is part of Appalachia: Appalachian Regional Commission, “About the Appalachian Region,” accessed July 26, 2021, www.arc.gov.
11. It has among the country’s highest: Kaiser Family Foundation, “Poverty Rate by Race/Ethnicity” (2019), www.kff.org; John Deskins, “Human Capital in West Virginia,” West Virginia Executive, March 4, 2020, www.wvexecutive.com.
12. Mining jobs peaked: Ken Ward Jr., “The Coal Industry Extracted a Steep Price from West Virginia. Now Natural Gas Is Leading the State Down the Same Path,” ProPublica, April 27, 2018, www.propublica.org.
13. Ironically, one of the poorest states: Giacomo Tognini, “Not Just Trump and Bloomberg: Here Are the Billionaire Politicians of the Decade,” Forbes, Dec. 26, 2019, www.forbes.com.
14. Along with Donald Trump: Tim Loh, “Governor Says Trump Interested in His Plan to Prop Up Coal Mining,” Bloomberg, Aug. 9, 2017, www.bloomberg.com.
15. The state had the lowest life expectancy: Elizabeth Arias et al., “U.S. State Life Tables, 2018,” National Vital Statistics Reports 70, no. 1 (March 2021), www.cdc.gov.
16. Racial health disparities: Louise Norris, “West Virginia and the ACA’s Medicaid Expansion,” healthinsurance.org, Oct. 16, 2020, www.healthinsurance.org; Jennifer Welsh, “Race and Life Expectancy in All 50 States,” Live Science, March 5, 2012, www.livescience.com.
17. Still, it is worth examining: Steven H. Woolf and Heidi Schoomaker, “Life Expectancy and Mortality Rates in the United States, 1959–2017,” Journal of the American Medical Association, Nov. 26, 2019, 1996–2016.
18. This, even though West Virginia expanded: Norris, “West Virginia and the ACA’s Medicaid Expansion.”
19. The obesity rate: West Virginia Department of Health and Human Resources, Bureau for Public Health, “Fast Facts” (2018), dhhr.wv.gov.
20. These health problems: Anne Case and Angus Deaton, “Mortality and Morbidity in the 21st Century,” Brookings Papers on Economic Activity (Spring 2017), www.brookings.edu.
21. His 2016 best seller: J. D. Vance, Hillbilly Elegy (New York: HarperCollins, 2016).
22. what W. E. B. Du Bois described: W. E. B. Du Bois and Isabel Eaton, The Philadelphia Negro: A Social Study (Philadelphia: Ginn, 1899; Philadelphia: University of Pennsylvania Press, 1996).
23. “I need a haircut”: Scott (last name withheld), interview by author, Morgantown, W.Va., Oct. 27, 2020.
24. Several years ago, Nicole Novak: Novak, interview by author, Iowa City, Iowa, Dec. 18, 2019.
25. The study, published in 2017: Nicole Novak et al., “Change in Birth Outcomes Among Infants Born to Latina Mothers After a Major Immigration Raid,” International Journal of Epidemiology 46, no. 3 (June 2017): 839–49.
26. Caitlin Sussman, the Friendship House’s: Caitlin Sussman, interview by author, Morgantown, W.Va., Oct. 26, 2020.
27. Nearly every U.S. media outlet: Anne Case and Angus Deaton, “Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Sciences of the United States of America 112, no. 49 (2015): 15078–83, pnas.org.
28. Between 1997, just after Purdue Pharma: Neil Davey, “Congress Must Do More to Address the U.S. Opioid Epidemic,” Center for American Progress, Aug. 25, 2016, www.americanprogress.org.
29. But in 2007, the government cracked down: Barry Meier, “In Guilty Plea, OxyContin Maker to Pay $600 Million,” New York Times, May 10, 2007, www.nytimes.com.
30. The vast majority of heroin users: “Prescription Opioids and Heroin Research Report, Prescription Opioid Use Is a Risk Factor for Heroin Use,” National Institute on Drug Abuse, Oct. 1, 2015, www.drugabuse.gov.
31. Though Purdue Pharma pleaded: Meier, “In Guilty Plea, OxyContin Maker to Pay $600 Million.”
32. Geronimus, while acknowledging: Arline Geronimus, interview by author, New York, Dec. 7, 2019.
33. Many are the Americans: Anne Case and Angus Deaton, Deaths of Despair and the Future of Capitalism (Princeton, N.J.: Princeton University Press, 2020), 38.
34. “This is where I’m going to put you”: Dani Ludwig, interview by author, Morgantown, W.Va., Oct. 26, 2020.
35. He moved into Diamond Village: Daniel (last name withheld), interview by author, Morgantown, W.Va., Oct. 26, 2020.
36. “I know you’re wondering”: Paula (last name withheld), interview by author, Morgantown, W.Va., Oct. 26, 2020.
37. A thick paperback: Elizabeth Lesser, Broken Open: How Difficult Times Can Help Us Grow (New York: Ballantine Books, 2020).
38. On October 27, 2020: Morgantown Police Department, “Morgantown Police Respond to Drug Overdose,” Oct. 2020, morgantownwv.gov.
39. A month later: Joe Buchanan, “City of Morgantown Clears Diamond Village Homeless Encampment,” WDTV, Dec. 1, 2020, www.wdtv.com.
40. Between 2007 and 2012: Eric Eyre, “Drug Firms Poured 780M Painkillers into WV amid Rise of Overdoses,” Charleston Gazette-Mail, Dec. 17, 2016, updated Dec. 27, 2017, www.wvgazettemail.com.
41. This led to an outbreak: Gregg S. Gonsalves and Forrest W. Crawford, “Dynamics of the HIV Outbreak and Response in Scott County, Indiana, 2011–2015: A Modeling Study,” Lancet HIV 5, no. 10 (Oct. 2018): e569—e577.
42. In 2015, worried officials: Sean T. Allen et al., “Understanding the Public Health Consequences of Suspending a Rural Syringe Services Program: A Qualitative Study of the Experiences of People Who Inject Drugs,” Harm Reduction Journal 16, no. 33 (2019), harmreductionjournal.biomedcentral.com.
43. Several decades of research: Centers for Disease Control and Prevention, “Summary of Information on the Safety and Effectiveness of Syringe Services Programs (SSPs),” accessed May 23, 2019, www.cdc.gov.
44. At its peak, nearly five hundred: Josh Katz, “Why a City at the Center of the Opioid Crisis Gave Up a Tool to Fight It,” New York Times, April 27, 2018, www.nytimes.com.
45. “mini-mall for junkies and drug dealers”: Ibid.
46. The group was considering: Leslie Rubin, “EXCLUSIVE: Charleston Police Launch Investigation into Off-the-Radar Needle Distribution,” WCHS, Oct. 22, 2020, wchstv.com.
chapter eight: putting the care back in health care: solutions
1. By the time the story ran: Linda Villarosa and Joan Roberts, “Nobody’s Safe,” Essence, June 1987.
2. In November 1996: Andrew Sullivan, “When Plagues End,” New York Times Magazine, Nov. 10, 1996, www.nytimes.com.
3. A month later: Newsweek staff, “The End of Aids?,” Newsweek, Dec. 1, 1996, www.newsweek.com.
4. HIV had been framed: Centers for Disease Control and Prevention, “U.S. HIV and AIDS Cases Reported Through December 1996,” HIV/AIDS Surveillance Report 8, no. 2 (Dec. 1996), www.cdc.gov.
5. The first, “AIDS Fears Grow”: Linda Villarosa, “AIDS Fears Grow for Black Women,” New York Times, April 5, 2004, www.nytimes.com.
6. The second, “Patients with H.I.V.”: Linda Villarosa, “Patients with H.I.V. Seen as Separated by a Racial Divide,” New York Times, Aug. 7, 2004, www.nytimes.com.
7. In 2016, now nearly thirty years: Centers for Disease Control and Prevention, “Lifetime Risk of HIV Diagnosis, Half of Black Gay Men and a Quarter of Latino Men Projected to Be Diagnosed Within Their Lifetime,” NCHHSTP Newsroom, Feb. 23, 2016, www.cdc.gov.
8. Ground zero was Jackson: Eli Samuel Rosenberg et al., “Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex with Men in US States, Metropolitan Statistical Areas, and Counties, 2012–2013,” Journal of Medical Internet Research 2, no. 1 (2016), publichealth.jmir.org.
9. The story, which ran on the cover: Linda Villarosa, “America’s Hidden H.I.V. Epidemic,” New York Times Magazine, June 6, 2017, www.nytimes.com.
10. In 1991, I wrote a story: Linda Villarosa, “Showdown at Sunrise,” Essence, July 1991.
11. Nearly thirty years later: Linda Villarosa, “Pollution Is Killing Black Americans. This Community Fought Back,” New York Times Magazine, July 28, 2020, www.nytimes.com.
12. Also in 1991, I wrote: Linda Villarosa, “Emergency: The Crisis in Our Health Care,” Essence, Sept. 1991.
13. In 2016, while working: Cedric Sturdevant, interviews by author, Jackson, Miss., Oct. 4–9, 2016.
14. As I was working on the final draft: Sturdevant, phone interview by author, Jan. 26, 2017.
15. “Sometimes I wonder about that”: Sturdevant, interview by author, Greenville, Miss., March 2, 2020.
16. An article published: Shreya Kangovi et al., “Evidence-Based Community Health Worker Program Addresses Unmet Social Needs and Generates Positive Return on Investment,” Health Affairs 39, no. 2 (Feb. 2020), www.healthaffairs.org.
17. In 2010, the Affordable Care Act: MHP Salud, “History of Community Health Workers (CHWs) in America,” accessed July 14, 2021, mhpsalud.org.
18. But our country of 331 million: U.S. Bureau of Labor Statistics, “Occupational Employment and Wages, May 2020: 21-1094 Community Health Workers,” www.bls.gov.
19. countries like Ethiopia: USAID, “HRH2030 Assessment of Ethiopia’s Health Extension Program Builds Evidence for Substantial Social Returns on HRH Investments,” March 31, 2020, hrh2030program.org.
20. HEWs like Roba: World Bank, “Physicians (per 1000 People),” accessed July 14, 2021, data.worldbank.org.
21. “I never want someone”: Aster Roba, interview by author, Ethiopia, Aug. 25, 2010.
22. The maternal mortality ratio: United Nations Population Fund, “Executive Summary, Trends in Maternal Mortality, 2000 to 2017,” www.unfpa.org.
23. A 2020 report estimated: USAID, “HRH 2030 Assessment of Ethiopia’s Health Extension Program,” March 31, 2020, hrh2030program.org.
24. Additionally, a study that looked: Yibeltal Assefa et al., “Community Health Extension Program of Ethiopia, 2003–2018: Successes and Challenges Toward Universal Coverage for Primary Healthcare Services,” Globalization and Health 15, no. 24 (2019), globalizationandhealth.biomedcentral.com.
25. Research from the World Health Organization: Zulfiqar A. Bhutta et al., “Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems,” Global Health Workforce Alliance, World Health Organization, accessed July 14, 2021, www.who.int.
26. The CHW concept: MHP Salud, “History of Community Health Workers (CHWs) in America.”
27. A compilation of case studies: Henry B. Perry, “Health for the People: National Community Health Worker Programs from Afghanistan to Zimbabwe,” Maternal and Child Survival Program, USAID, April 2020, pdf.usaid.gov.
28. A 2016 study published: Katy B. Kozhimannil et al., “Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery,” Birth 1, no. 10 (Jan. 2016).
29. Louisiana has one of the highest rates: Centers for Disease Control and Prevention, “Infant Mortality Rates by State,” accessed March 12, 2021, www.cdc.gov; Kaiser Family Foundation, “Infant Mortality Rate by Race/Ethnicity” (2018), www.kff.org.
30. highest rates of maternal mortality: Centers for Disease Control and Prevention, “Maternal Mortality by State, 2018,” www.cdc.gov; Jia Benno et al., “Louisiana Pregnancy-Associated Mortality Review 2017 Report,” Louisiana Department of Health (2020), ldh.la.gov.
31. Touro, a community hospital: Ryan Marx et al., “Touro Infirmary,” USA Today (2019), www.usatoday.com.
32. In 2020, the American Medical Association: American Medical Association, “New AMA Policy Recognizes Racism as a Public Health Threat,” Nov. 16, 2020, www.ama-assn.org.
33. an epidemiological review of research: Michael R. Kramer and Carol R. Hogue, “What Causes Racial Disparities in Very Preterm Birth? A Biosocial Perspective,” Epidemiologic Reviews 31 (2009): 84–98.
34. “No one believes you”: Carol Hogue, interview by author, Atlanta, Jan. 26, 2018.
35. One of the studies highlighted: Marion E. Gornick et al., “Effects of Race and Income on Mortality and Use of Services Among Medicare Beneficiaries,” New England Journal of Medicine, Sept. 12, 1996, 791–99, www.nejm.org.
36. A 2020 study showed: Brad N. Greenwood et al., “Physician–Patient Racial Concordance and Disparities in Birthing Mortality for Newborns,” Proceedings of the National Academy of Sciences of the United States of America, July 16, 2020.
37. In a widely circulated editorial: Mary T. Bassett, “#BlackLivesMatter—a Challenge to the Medical and Public Health Communities,” New England Journal of Medicine, March 19, 2015, 1085–87, www.nejm.org.
38. Beginning in 2016: NYC Health, “Race to Justice,” accessed July 14, 2021, www1.nyc.gov.
39. In that state, the rate of maternal deaths: California Maternal Quality Care Collaborative, “CA-PAMR (Maternal Mortality Review),” accessed July 14, 2021, www.cmqcc.org.
40. However, Black women did not benefit: California Maternal Quality Care Collaborative, “Birth Equity,” accessed July 14, 2021, www.cmqcc.org.
41. she co-sponsored SB-464: California Legislative Information, “SB-464 California Dignity in Pregnancy and Childbirth Act (2019–2020),” leginfo.legislature.ca.gov.
42. In August 2018: Louisiana Department of Health, “Reducing Maternal Morbidity Initiative—Interim Report,” accessed July 14, 2021, ldh.la.gov.
43. In the end, after twenty-one months: Louisiana Department of Health, “Reducing Maternal Morbidity Initiative—Final Report,” updated May 25, 2021, ldh.la.gov.
44. The agency used the Undoing Racism model: Undoing Racism, People’s Institute for Survival and Beyond, “How Can We Undo Racism,” accessed July 14, 2021, pisab.org.
45. Even as the country grows more diverse: Association of American Medical Colleges, “Diversity in Medicine: Facts and Figures 2019,” accessed July 14, 2021, www.aamc.org.
46. The much-cited 2016 University of Virginia study: Kelly M. Hoffman et al., “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites,” Proceedings of the National Academy of Sciences of the United States of America 113, no. 16 (2016): 4296–301, www.pnas.org.
47. Madeleine DeGrange: Madeleine DeGrange, Zoom interview by author, Sept. 21, 2020.
48. On a national level: White Coats for Black Lives, “How Does Your Medical School Add Up” (2021), whitecoats4blacklives.org.
49. In 2019, the group published: White Coats for Black Lives, “Racial Justice Report Card 2018,” whitecoats4blacklives.org.
50. On the West Coast: Institute for Healing and Justice, accessed July 14, 2021, www.instituteforhealingandjustice.org.
51. In response, the multiracial student group: Noor Chadha et al., “Towards the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice,” Institute for Healing and Justice in Medicine (2020), www.instituteforhealingandjustice.org.
52. In August 2020, a study: Darshali A. Vyas et al., “Hidden in Plain Sight—Reconsidering the Use of Race Correction in Clinical Algorithms,” New England Journal of Medicine, Aug. 27, 2020, 874–82, www.nejm.org.
53. The Institute for Healing: Allison Inserro, “Flawed Racial Assumptions in eGFR Have Care Implications in CKD,” American Journal of Managed Care, Oct. 25, 2020, www.ajmc.com.
54. In 2020, Naomi Nkinsi: Patricia Kullberg, “How Racism Gets Baked into Medical Decisions,” Science for the People, Dec. 21, 2020, magazine.scienceforthepeople.org.
55. In September 2019, Stanley Goldfarb, MD: Stanley Goldfarb, “Take Two Aspirin and Call Me by My Pronouns,” Wall Street Journal, Sept. 12, 2019, www.wsj.com.
56. Three days later, the Journal’s: Editorial Board, “Corrupting Medical Education: The Reaction to Dr. Goldfarb’s Op-Ed Proves His Point,” Wall Street Journal, Sept. 15, 2019, www.wsj.com.
57. the Journal published another essay: Stanley Goldfarb, “Med School Needs an Overhaul,” Wall Street Journal, April 13, 2020, www.wsj.com.
58. In March 2021, during a podcast: Apoorva Mandavilli, “Editor of JAMA Leaves After Outcry over Colleague’s Remarks on Racism,” New York Times, June 1, 2021, www.nytimes.com.
afterword
1. We would not be the first: Mary T. Bassett, “#BlackLivesMatter—a Challenge to the Medical and Public Health Communities,” New England Journal of Medicine, March 19, 2015, 1085–87, www.nejm.org.
2. These talks, called “Something Inside”: Hilary Beard, “Something Inside: Tools to Thrive: We Gonna Be Alright,” Facebook, April 3, 2020, https://www.facebook.com/hilarybeardauthor/videos/1037482676638919.
3. I was also reading notes: “The Spirit of 1848,” Fall 1994; revised: Nov. 2000, Nov. 2001, March 2005, www.spiritof1848.org.
4. But the picture was becoming clear: Reis Thebault, Andrew Ba Tran, and Vanessa Williams, “The Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate,” Washington Post, April 7, 2020, www.washingtonpost.com.
5. “There are so many stupid”: Idris Elba (@idriselba), Twitter, March 16, 2020, 2:18 p.m., twitter.com/idriselba/status/1239617034901524481?lang=en.
6. On March 27: Senators Kamala D. Harris, Elizabeth Warren, and Cory A. Booker and Representatives Ayanna Pressley and Robin L. Kelly to Secretary Alex M. Azar II, March 27, 2020, www.warren.senate.gov.
7. Shortly after, the American Medical Association: American Medical Association, “Top Physician Orgs Urge COVID-19 Mortality Data by Race, Ethnicity,” April 8, 2020, www.ama-assn.org.
8. The NAACP, Dr. Crear-Perry: We Must Count, “Disaggregate Covid-19 Data by Race, Genders, Socioeconomic Status,” April 3, 2020, https://coronavirus.jhu.edu/data/racial-data-transparency.
9. While African Americans were 32 percent: Thebault, Tran, and Williams, “Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate.”
10. “Baby, if you aren’t feeling good”: Nicole Charles, interview by author, New Orleans, April 7, 2020.
11. That day the Louisiana Department of Health: Chris McCrory, “COVID-19 Timeline: See How Fast Things Have Changed in Louisiana,” WWL, March 22, 2020, www.wwltv.com.
12. At a news conference: “Louisiana Governor Edwards Coronavirus News Conference,” C-SPAN, March 19, 2020, www.c-span.org.
13. guidelines the City of New Orleans: McCrory, “COVID-19 Timeline.”
14. Dr. Maybank’s op-ed ran: Aletha Maybank, “The Pandemic’s Missing Data,” New York Times, April 7, 2020, www.nytimes.com.
15. CDC released the first chunk: Shikha Garg et al., “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019—COVID-NET, 14 States, March 1–30, 2020,” Morbidity and Mortality Weekly Report, April 17, 2020, 458–64, www.cdc.gov.
16. Data from the Louisiana: Sheba Turk, “Racial Disparities in Louisiana’s COVID-19 Death Rate Reflect Systemic Problems,” WWL, April 7, 2020, www.wwltv.com.
17. “The coronavirus is very much under control”: Kathryn Watson, “A Timeline of What Trump Has Said on Coronavirus,” CBS News, April 3, 2020, www.cbsnews.com.
18. the president reiterated: Ibid.
19. The next day, an official: Megan Thielking and Helen Branswell, “CDC Expects ‘Community Spread’ of Coronavirus, as Top Official Warns Disruptions Could Be ‘Severe,’ ” Stat News, Feb. 25, 2020, www.statnews.com.
20. “within a couple of days”: Watson, “Timeline of What Trump Has Said on Coronavirus.”
21. On March 9, the day: McCrory, “COVID-19 Timeline.”
22. Trump compared the virus: Watson, “Timeline of What Trump Has Said on Coronavirus.”
23. “The Fake News Media”: Rebecca Klar, “Trump: ‘Fake News Media,’ Democrats Working to ‘Inflame the CoronaVirus Situation,’ ” Hill, March 9, 2020, thehill.com.
24. Trump erroneously suggested: “President Trump claims injecting people with disinfectant could treat coronavirus,” YouTube, April 24, 2020, www.youtube.com.
25. My story ran: Linda Villarosa, “ ‘A Terrible Price’: The Deadly Racial Disparities of Covid-19 in America,” New York Times Magazine, May 3, 2020, updated Nov. 18, 2020, www.nytimes.com.
26. African Americans were more likely: Richard A. Oppel Jr. et al., “The Fullest Look Yet at the Racial Inequity of Coronavirus,” New York Times, July 5, 2020, www.nytimes.com. The rates for Latinx and Native Americans were also elevated, especially as the pandemic progressed.
27. This pileup of deaths: Elizabeth Arias et al., “Provisional Life Expectancy Estimates for January Through June, 2020,” Centers for Disease Control and Prevention, National Vital Statistics Systems, Report 010, Feb. 2021, www.cdc.gov.
28. An analysis of CDC data: Tiffany N. Ford, Sarah Reber, and Richard V. Reeves, “Race Gaps in COVID-19 Deaths Are Even Bigger Than They Appear,” Brookings Institution, June 16, 2020, www.brookings.edu.
29. In an April radio interview: James Doubek, “Louisiana Sen. Cassidy Addresses Racial Disparities in Coronavirus Deaths,” NPR, April 7, 2020, www.npr.org.
30. An article in The Lancet: Manish Pareek et al., “Ethnicity and COVID-19: An Urgent Public Health Research Priority,” Lancet, April 21, 2020, www.thelancet.com.
31. Dr. Anthony Fauci: “COVID-19 Vaccine: Dr. Fauci Gets Why Black People Are Wary After Tuskegee Experiment,” BET News, July 29, 2020, www.bet.com.
32. “communities of color…to step up”: “White House Coronavirus News Conference,” YouTube, April 10, 2020, www.youtube.com.
33. I watched a video: Jonathan Tilove, “Chanting ‘Let Us Work!,’ ‘Fire Fauci!,’ Protesters at Capitol Decry Virus Restrictions,” Statesman, April 18, 2020, www.statesman.com.
34. Studies showed that white communities: Diana S. Grigsby-Toussaint et al., “Disparities in the Distribution of COVID-19 Testing Sites in Black and Latino Areas in New York City,” Preventive Medicine 147 (June 2021); Anuja Vaidya, “Most Rural US Counties Are in COVID-19 ‘Testing Deserts,’ Analysis Finds,” Becker’s Hospital Review, June 23, 2020, www.beckershospitalreview.com.
35. As COVID rose: Nina Feldman, “The Black Doctors Working to Make Coronavirus Testing More Equitable,” NPR, Oct. 1, 2020, www.npr.org.
36. A paper released: X. Wu et al., “Air Pollution and COVID-19 Mortality in the United States: Strengths and Limitations of an Ecological Regression Analysis,” Science Advances 6, no. 45 (Nov. 2020).
37. With a nod toward: Centers for Disease Control and Prevention, “CDC COVID-19 Response Health Equity Strategy,” updated Aug. 21, 2020, www.cdc.gov.
38. A study published: Michael W. Sjoding et al., “Racial Bias in Pulse Oximetry Measurement,” New England Journal of Medicine, Dec. 17, 2020, 2477–78, www.nejm.org.
39. On December 4, she posted a video: Susan Moore, Facebook, Dec. 4, 2020, www.facebook.com/susan.moore.33671748/posts/3459157600869878.
40. Dr. Moore died two weeks later: John Eligon, “Black Doctor Dies of Covid-19 After Complaining of Racist Treatment,” New York Times, Dec. 23, 2020, updated Dec. 25, 2020, www.nytimes.com.
41. An earlier statement: Dennis M. Murphy, “Directly Addressing the Issue of Racial Equity in Our Facilities,” Indiana University Health, Dec. 24, 2020, iuhealth.org.
42. In Washington, D.C., 40 percent: Abby Goodnough and Jan Hoffman, “The Wealthy Are Taking an Outsize Share of Vaccines Meant for Poorer Neighborhoods,” New York Times, Feb. 2, 2021, www.nytimes.com.
43. In December 2020, a poll: Liz Hamel et al., “KFF COVID-19 Vaccine Monitor: December 2020,” Kaiser Family Foundation, Dec. 15, 2020, www.kff.org.
44. As with other medical studies: Samantha Artiga et al., “Racial Diversity Within COVID-19 Vaccine Clinical Trials: Key Questions and Answers,” Kaiser Family Foundation, Jan. 26, 2021, www.kff.org.
45. Data compiled by the CDC: Centers for Disease Control and Prevention, “Overdose Deaths Accelerating During COVID-19,” Dec. 17, 2020, www.cdc.gov.
46. “the most concerning in the United States”: John Raby, “CDC: West Virginia HIV Wave Could Be ‘Tip of the Iceberg,’ ” Associated Press, March 17, 2021, apnews.com.
47. in April 2021 he signed a bill: Cuneyt Dil, “West Virginia Lawmakers Approve Needle Exchange Regulations,” Associated Press, April 10, 2021, apnews.com.
48. Nearly half of Black respondents: Yaphet Getachew et al., “Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States,” Commonwealth Fund, Sept. 10, 2020, www.commonwealthfund.org.
49. Nancy Krieger was interviewed: Isaac Chotiner, “The Interwoven Threads of Inequality and Health,” New Yorker, April 14, 2020, www.newyorker.com.
50. In response to the ill-treatment: Aletha Maybank et al., “Say Her Name: Dr. Susan Moore,” Washington Post, Dec. 26, 2020, www.washingtonpost.com.
51. Breonna Taylor, the Black medical worker: “Justice Denied: An Overview of the Grand Jury Proceedings in the Breonna Taylor Case,” NAACP Legal Defense Fund, Oct. 27, 2020, www.naacpldf.org.
52. During the pandemic, California moved ahead: California Legislative Information, “AB-241 Implicit Bias: Continuing Education: Requirements (2019–2020), October 10, 2019,” leginfo.legislature.ca.gov.
53. His essay on Black Americans: Clyde W. Yancy, “COVID-19 and African Americans,” Journal of the American Medical Association 323, no. 19 (2020): 1891–92, jamanetwork.com.
54. “COVID-19 has taken off the Band-Aid”: Clyde Yancy, interview by author, Chicago, April 18, 2020.