American Scientist

SICKENING: Anti-Black Racism and Health Disparities in the United States. Anne Pollock. 202 pp. University of Minnesota Press, 2021. Paper, $21.95.

For an overview of the book, see the review by Flora Taylor.

In Sickening, Anne Pollock invites readers to consider the varied and interconnected effects of racism on the health and well-being of Black people in the United States—effects that she skillfully reveals in her analyses of six 21st-century events. Pollock’s focus on recent events in these six case studies is an important contribution to conversations about health equity; she finds in them examples of racism affecting health outcomes, not just as a result of events that happened in the far past but also through interactions occurring in the present.

Pollock explains in the introduction to the book that in order to fully understand the impact of each of the events she describes, readers will need to keep in mind that race is a social construct, and that anyone who is visually perceived to be Black is at risk of being ignored or mistreated in the same ways that the individuals in her case studies were. Furthermore, in the United States, people who are labeled Black may have immigrated from various parts of the world such as Haiti or Ethiopia, and they may live or have been raised in a rural area or a city, in or outside the South. That is to say, they come from different communities, each of which has its own health behaviors and cultural practices. However, cultural differences of this sort are often not considered in health care due to implicit racial bias on the part of health care providers.

In the concluding chapter of Sickening, Pollock outlines for readers a guide for carrying out their own analyses of events involving social injustices. It consists of a four-step template. As I describe each step in the template, I will also illustrate the step with some examples from Pollock’s analysis of the book’s sixth case study, which is titled “Reproductive Injustice: Serena Williams’s Birth Story.”

Step one: Choose an event and look at it across scales. At the micro scale, identify something that has happened to a specific person at a particular time. On September 1, 2017, Serena Williams gave birth to her daughter Olympia by emergency Cesarean section after labor had been induced. The following day she began to have difficulty breathing. Because she had a history of blood clots, she immediately recognized that she had a pulmonary embolism and asked for heparin and a CT scan with a contrast agent. But she faced challenges in getting health care providers to listen to her and take her health concerns seriously.

At the meso scale, look at the immediate context of the event—the type of neighborhood, city, region, or social sphere in which it took place, for instance, and who was present. Williams is a famous professional tennis player—a celebrity. Nevertheless, in this specific situation, her requests to be treated for pulmonary embolism were initially disregarded despite her fame. Additionally, as Pollock mentions, over the course of her career, Williams’s body has been represented harshly, and she has experienced both “hypervisibility and dehumanization.” Media coverage has specifically focused on Williams’s body. Her superior strength has led some to question not just her femininity but her status as female; her raw aggression on the court has been seen as masculine. Her physique and clothing choices on the court have been commented on extensively, but her birthing experience was not given the same level of attention.

At the macro scale, look at the broader social and historical context of the event—trends in history and society, such as segregation. Tell a bigger story by examining how structural racism contributed to the event. Writing about her 2017 childbirth experience on Facebook, Williams noted that, according to the U.S. Centers for Disease Control, Black women are at least three times more likely to die during pregnancy or childbirth than white women are. Pollock explains that the inequities in childbirth experiences derive in part from a history of Black women being treated as fodder for health care experiments. The founder of gynecology, Marion Sims, performed many surgeries on enslaved women without anesthesia and under risky conditions. Instead of treating these women as patients in need of care and relief, he treated them as research subjects for the medical advancements that made him famous. He exploited and contributed to the myth that Black women have a high tolerance for pain, a myth that continues to influence how Black women are treated by health care providers today.

Step two. Do background reading. Read closely. Pay attention to what media accounts assume and how they shape the story; seek out accounts by activists and advocates; look at the writing of academics and experts, being sure to include work by Black scholars. Serena Williams’s own voice is at the center of this case study. She publicly shared her childbirth experience both on social media and in a magazine interview, advocating for reproductive justice and bringing attention to health disparities in pregnancy outcomes. Pollock notes that many stakeholders are proposing solutions and urging actions to end reproductive injustices. Many nonprofit organizations are working to achieve better prenatal and maternal care for women of color. For example, to encourage more action on the issue, the SisterSong Women of Color Reproductive Justice Collective has created the following definition of reproductive justice: “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Better care is clearly needed, because African Americans have the highest infant mortality rate of any racial or ethnic group in the United States, as quantitative data from National Vital Statistics Reports have consistently indicated.

Step three. Add layers of analysis. Look at the role of infrastructure and technology, the economic context, the intersection of race with class, gender, age, disability, sexuality, and power; ask yourself whose knowledge is valued and who does, or does not, have power. Concern yourself not only with the who, what, when, and where of the event but also with why, and ask how the event is significant. This kind of framework is important when examining racism because it can help identify solutions and interventions for underserved communities. For example, in the Serena Williams case Pollock talks about taking an “upstream approach” to medical distrust by shifting the focus away from patients’ distrust of providers, and toward provider mistrust of patients. Providers should be encouraged to look for racism in their medical practice and to obtain training that will help them recognize implicit bias. In addition, many programs and initiatives have advocated the funding of mobile health clinics and certified labor doulas in order to increase both medical access and social support for underserved women. Reducing the health care costs associated with complicated pregnancies is important, particularly for families with limited resources. Some states have supported legislation, such as a Medicaid expansion bill, that would provide more women with health insurance coverage; however, more action is needed. Pollock also includes in her analysis of the Williams case a discussion of risk factors such as education level and socioeconomic status, noting that for Black women, disparities remain constant across varying levels of education. She explains that what happened to Serena Williams despite her more privileged class status happens to many Black women in the United States. Health care infrastructure should therefore be centered on strategies for achieving equity in access to care and quality of care provided. Also, solutions should be based on evidence that includes data from qualitative research carried out by communities of color.

Step four. Write your account. Tell the story with compassion and orient it toward justice, keeping in mind the humanity of the people involved. Cite Black women (see citeblackwomencollective.org). Then repeat all four steps as often as necessary. In the Serena Williams case study, Pollock organizes voices, history, scales, and research into an easy-to-follow narrative that tells others why the event is significant, and she suggests actions they can take to fight racism in health care. Many of the details she includes, such as the treatment and care received in health care facilities, are likely to resonate with Black women readers. Pollock centers Williams’s story while making it clear how routine it is for Black women to have experiences of the same sort. She cites highly respected experts within the Black community, such as epidemiologist Camara Jones, who is a prominent social justice advocate. Citing Black women and acknowledging their efforts in the analysis is appropriate and helps gain the trust of communities of color.

Each step in Pollock’s template serves as an important foundation for an analysis that will promote change without perpetuating further harm to communities of color. Each step will help you look beyond the statistics and think critically about the impact of racism. I highly recommend using her template to analyze other events that are disproportionately affecting Black Americans—for instance, the COVID-19 pandemic, recent incidents of police brutality, and the recent mass shooting in a grocery store in Buffalo, New York, where most of the shoppers were Black people.

Systemic and structural racism are so deeply embedded in our society that the resulting disparities for Black Americans are often overlooked. As Pollock states, “unequal exposure to risk and the unjust denial of care are . . . profoundly routine.” The challenge is getting people to acknowledge these facts. Sickening is a great book for opening minds, encouraging action, and inspiring advocacy for justice.