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Black Lives Matter: A Message and Resources for Midwives

2020; Wiley; Volume: 65; Issue: 4 Linguagem: Inglês

10.1111/jmwh.13155

1542-2011

Michelle L. Drew, Pamela Reis,

Food Security and Health in Diverse Populations

Journal of Midwifery & Women's HealthVolume 65, Issue 4 p. 451-458 EditorialFree Access Black Lives Matter: A Message and Resources for Midwives Michelle L. Drew CNM, FNP-C, DNP, MPH, Michelle L. Drew CNM, FNP-C, DNP, MPH Chair, American College of Nurse-Midwives Black Midwives Caucus for Reproductive Justice and Birth EquityExecutive Director, Ubuntu Black Family Wellness CollectiveSearch for more papers by this authorPamela Reis CNM, NNP-BC, PhD, Pamela Reis CNM, NNP-BC, PhD Associate EditorSearch for more papers by this author Michelle L. Drew CNM, FNP-C, DNP, MPH, Michelle L. Drew CNM, FNP-C, DNP, MPH Chair, American College of Nurse-Midwives Black Midwives Caucus for Reproductive Justice and Birth EquityExecutive Director, Ubuntu Black Family Wellness CollectiveSearch for more papers by this authorPamela Reis CNM, NNP-BC, PhD, Pamela Reis CNM, NNP-BC, PhD Associate EditorSearch for more papers by this author First published: 02 August 2020 https://doi.org/10.1111/jmwh.13155Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat A very powerful piece titled Your Black Colleagues May Look Like They're Okay—Chances Are They're Not by Danielle Cadet was recently published online.1 In this publication the author talked about the tale of 2 quarantines—one experienced by people of means and the other experienced by the marginalized and disadvantaged. She explained how COVID-19, coupled with daily micro- and macroaggressions such as those experienced by Christian Cooper in New York City's Central Park,2 has wreaked havoc on the physical and emotional health of people of color. This editorial features an adaptation of the essay, "A Message to Midwives," that was written by Dr. Michelle Drew, Chair of the American College of Nurse-Midwives (ACNM) Black Midwives Caucus for Reproductive Justice and Birth Equity, on behalf of the Caucus (ACNM Connect Town Hall, June 2, 2020). In her composition, written after the tragic murder of George Floyd in Minneapolis, Minnesota, Dr. Drew poignantly speaks to Black birth workers and white allies about the enduring pain and angst of being Black in America, and she explains why we, as Black midwives, are not okay. The editorial reflects the authors' sentiments and reflections as midwives of color when it was completed on June 27, 2020; therefore, the perpetually evolving landscape of racism and race relations in the United States may not be fully captured in this publication. Please read and use the appendix that accompanies this editorial. The appendix is a collection of racism, antiracism, and racial equity resources for clinicians and educators, recommended by midwives of color. The contributors hope these resources will promote meaningful dialogue and action against racism, white supremacy, and the oppression of people of color. A MESSAGE TO MIDWIVES To Black Midwives: In Solidarity "Mama!" That was the last word George Floyd uttered before he died, as a police officer with a long history of brutality choked the life out of him with a knee on his neck in broad daylight and in full view of citizens, while none of his fellow officers intervened. In fact, those fellow officers were just as complicit in Mr. Floyd's death through actions that further impeded his ability to breathe. "Mama," he said … this haunts us. We watched the footage, we sat silent and in tears in front of our televisions. We felt like a small part of us died on that cold street with him. When he cried for his mother, we heard our own children calling out for us when they are in distress. As Black parents, we grieve for another Black mother who is facing a prospect that far too many Black mothers do—outliving their child and being forced to bury part of themselves. We worry about our own children, bringing on full-blown anxiety disorders, albeit mostly undiagnosed. We shudder to think what Mr. Floyd's mother must have gone through seeing the murder of her son play out on national television. We know that all of us live with a burrowing pit in our souls born out of fear and angst, and even more so now, when the children of our bodies and hearts are out of our sights. Whether they are small children or grown adults, we never quite reconcile that they may not return home to us. How can we sit comfortably when we are afraid that a routine traffic stop or playing in a park with a toy gun can be enough for law enforcement to decide that we or our children have forfeited our right to life? We question what kind of world we have brought our children into. How do we convince our babies to feel safe in a country that now, more than ever, consistently leaves no doubt that it hates us for nothing other than our Blackness? George Floyd was a son, father, partner, and a brother: all these roles experienced in desolation. Those of us who aren't parents feel hurt as siblings of Black men, as children of Black men, as partners of Black men, and as lovers of Black men. We ponder if we ever want to be parents if being the parent of a Black child means living in a chronic state of fear. This is the experience of weathering that we share with our foremothers. As Black health care providers serving Black communities, we feel the burning pain of white supremacy directed at us, but also at the families we serve and the babies we've welcomed into the world. We are fearful for the future for our young people as they grow and come of age, when we know that today a young Black man has a better chance of going to prison than graduating from college.3 We worry for the mothers we care for. We look at all that impedes their ability to thrive, but in real time we reconcile how to help them simply survive birthing their babies. What does the future hold as these babies grow? Will they be future nurses, physicians, or skilled tradespersons? Or will they be killed by someone who views them as a threat for just existing? We ask these questions in a nation designed to keep us spiritually terrorized, although we already know the answers. As members of the Black community, we are angry, tired, and just plain fed up. We know that the public uprising across America isn't just about George Floyd, may he rest in eternal peace and power; it is a conflagration culminating from 152 years of state-sanctioned violence designed to terrorize our people into submission and to reinforce the culture of slavery and Jim Crow. That, on top of 246 years of kidnappings, enslavement, and murders in the name of nation and economy. We cannot hold our distress and outcries in any longer. James Baldwin was right when he proclaimed, "To be a Negro in this country and to be relatively conscious is to be in a rage almost all the time."4 As Black people, how do we live safely in a society where white supremacy says we don't belong? How can we be safe when at any moment police can be weaponized against us? How do we move freely within our relative ecosystems, when any white person with a cell phone can call 911 and say they feel threatened by us, thereby subjecting us to arrest, battery, or murder? What can we do, when as Traci Blackmon points out, we can never be unarmed when our Blackness is the weapon that society fears most?5 As Black birth workers, we want you to know that as always, we stand with you and beside you as you press on in the hard work of caring for your community. A community that knows and trusts you. A community that needs you to be strong and compassionate during a devastating pandemic and civil unrest. We share your exhaustion. We are not okay. As we struggle with anger and grief, we are also afraid. It hurts so much to know that after centuries of state-sanctioned aggression and white supremacy, we are still despised in the country that we and our ancestors literally built with our blood, sweat, and tears. We know that we are not safe, and that safety is one of the most basic needs that must be present in order to thrive. Yet safety is refused to us second after second, minute after minute, day after day, week after week, month after month, and year after year. We join you in collective mourning and determination that now, more than ever, we will hold those in power accountable for their actions and inaction. We refuse to accept any more pain. We join you in resistance, and we will not be silent in the presence of state-endorsed terrorism turned toward us in our communities. We give ourselves permission to desire to see every symbol of our oppression burn. We give ourselves permission to grieve. We reject the assertions of those who condemn the political uprisings happening across the country. We know that the protestors aren't criminals or thugs as they have been labeled. They are freedom fighters. They are our neighbors, children, siblings, and friends. They are us. America is in crisis, and as Dr. Martin Luther King Jr said, "Riots are the language of the unheard."6 We demand to be listened to. We decry the militarization of the police force against our community and echo the sentiments so eloquently stated by Dr. Georges Benjamin, past Executive Director of the American Public Health Association (APHA), and the membership of APHA at large when they issued a resolution declaring police violence a public health crisis that must be urgently addressed.7 We stand firm with Dr. Benjamin again, as he reiterated following the murder of George Floyd that the time for action is now.8 We commit, now more than ever, to grassroots change in our communities to dismantle the structural determinants of health that put Black mothers and babies at risk. Let us hold each other close. We will work together in our homes, our communities, and our nation to bring about the change that is essential for us not just to survive, but to thrive. Stay in contact. Do not be afraid to reach out to one another and say, "I need you." And when called, let's be prepared to answer. To White Midwives: Be Antiracist To our white allies: even as we thank you for your empathy, we call on you to reflect on the words of activist Angela Davis, who is widely quoted as saying, "In a racist society, it is not enough to be non-racist, we must be anti-racist." We exhort predominantly white organizations we affiliate with, such as places of employment, professional societies, social clubs, and places of worship, to examine themselves and determine the culture that has been curated. We demand more than token lip service of empathy and outrage. Individual initiatives created to solve the problem of diversity and inclusion should not be viewed as bright lights. Literature across disciplines demonstrates that diversity and inclusion programs are at best ineffective, and at worst more harmful to the marginalized people they are supposed to serve, unless every member of the organization is invested in change.9-11 As allies, we implore you to acknowledge the white supremacy integrated into your lives, language, and organizational structures and commit to actively destroying it once and for all to create truly safe, inclusive spaces that welcome everyone. Use your power to demand that we are treated with basic human dignity. There is no neutral ground. There are no innocent bystanders. Are you prepared to be like Viola Liuzzo, Andrew Goodman, Michael Schwerner, James Reeb, Jonathan Daniels, Jim Letherer, Anne Braden, Peter Norman, Juliette Morgan, and William Moore? Those are a few of the brave white people who fought for the civil rights of Black Americans a half century ago. Are you prepared to march with us, vote with us, be arrested with us, and die with us to advance the cause of justice? If not, we respectfully ask that you silence your voice until you are. To All Midwives: Black Lives Matter We mourn for every Black man, woman, and child who was killed by police in the past year and beyond. We stand beside the families of those victims of police violence saying we will not be silent. Not today, not tomorrow, not ever. George Floyd, your life mattered. Tony McDade, Ahmaud Arbery, Breonna Taylor, Yassin Mohamed, Finan Berhe, Sean Reed, Steven Taylor, Ariane McCree, Miles Hall, Darius Tarver, Atatiana Jefferson, William Green, Tamir Rice, Botham Jean, E.J. Bradford, Michael Brown, Michael Dean, James Johnson, Antwon Rose, Stephon Clark, Samuel David Mallard, De'Von Bailey, Christopher Whitfield, Anthony Hill, Eric Logan, JaQuavion Slaton, Ryan Twyman, Brandon Webber, Jimmy Atchison, Robert Lawrence White, you are forever etched into our memories as victims of police violence, and your lives mattered. Charleena Lyles, pregnant mother of four when you were shot by Seattle Police in front of your children, your life mattered. Black Lives Matter. Appendix: Racism, Antiracism, and Racial Equity Resources This appendix is a brief compilation of select racism, antiracism, and racial equity resources recommended by midwives of color. Each resource notes the midwife who recommended it. This list is not intended to be exhaustive; a wealth of information can be found through many additional sources. REFERENCES 1Cadet D. Your Black colleagues may look like they're okay—chances are they're not. Refinery29. May 28, 2020. Accessed June 24, 2020. https://www.refinery29.com/en-us/2020/05/9841376/black-trauma-george-floyd-dear-white-peopleGoogle Scholar 2Nir SM. The bird watcher, that incident and his feelings on the woman's fate. New York Times. May 27, 2020. Accessed June 24, 2020. https://www.nytimes.com/2020/05/27/nyregion/amy-cooper-christian-central-park-video.htmlGoogle Scholar 3Toldson IA, Morton J. Editor's comment: A million reasons there're more black men in college than in prison; eight hundred thousand reasons there's more work to be done. J Negro Educ. 2011; 80(1): 1- 4. Google Scholar 4Baldwin J, Capouya E, Hansberry L, Hentoff N, Hughes L, Kazin A. The Negro in American culture. CrossCurrents. 1961; 11(3): 205- 224. Google Scholar 5Blackmon T. Plenary panel on racism. Lecture presented at: World Meeting of Popular Movements; February 16, 2017; Modesto, CA. Google Scholar 6King MLK Jr. The other America. Lecture presented at: Gross Pointe High School; March 14, 1968; Gross Pointe, MI. Google Scholar 7 American Public Health Association. Addressing Law Enforcement Violence as a Public Health Issue. Policy no. 201811. Washington, DC: American Public Health Association; November 13, 2018. Accessed June 24, 2020. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violenceGoogle Scholar 8Benjamin G. Racism is an ongoing public health crisis that needs our attention now. News release. American Public Health Association. May 29, 2020. Accessed June 24, 2020. https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/racism-is-a-public-health-crisisGoogle Scholar 9Newkirk P. Diversity, Inc.: The Failed Promise of a Billion-Dollar Business. New York, NY: Bold Type Books; 2019. Google Scholar 10Krentz M, Dean J, Garcia-Alonso J, Taplett F, Tsusaka M, Vaughn E. Fixing the flawed approach to diversity. Boston Consulting Group website. January 17, 2019. Accessed June 2, 2020. https://www.bcg.com/publications/2019/fixing-the-flawed-approach-to-diversity.aspx. Google Scholar 11Dobbin F, Kalev A. Why diversity programs fail. Harv Bus Rev. 2016; 94(7/8): 52- 60. PubMedWeb of Science®Google Scholar BOOKS Anderson C. White Rage: The Unspoken Truth of Our Racial Divide. New York: Bloomsbury; 2017 White Rage: The Unspoken Truth of Our Racial Divide is about the insidious process of white dominance and supremacy in the United States for the sole purpose of suppressing the progress of Black people. Anderson talks about white backlash, born out of structural racism, as a way for white Americans to suppress the progress of Black people, using their privileged role as white citizens. The author describes reactionary trends in US history aimed at Black suppression, such as Jim Crow laws and voting laws that serve to disenfranchise Black voters. (Recommended by Pandora T. Hardtman, CNM, RM, DNP) Brown D, Keith V, eds. In and Out of Our Right Minds: The Mental Health of African American Women. New York: Columbia University Press; 2003 African American women are at increased risk for poor mental health because of social determinants of health that disproportionately affect them, such as poverty, unemployment, racism, and reduced access to quality health care. Yet African American women are viewed, for the most part, as resilient in the face of adversity. In and Out of Our Right Minds: The Mental Health of African American Women is a collection of works by several authors that examines the mental health of African American women in the context of race, gender, class, and social status. (Recommended by Nichole Wardlaw, CNM, MSN) Byrd WM, Clayton LA. An American Health Dilemma: Race, Medicine, and Health Care in the United States, 1900-2000. New York: Routledge; 2002 This is the sequel to a book written by the same authors that focused on the health care of African Americans prior to 1900. In this volume, the authors continue their discourse about the impact of racism in the health care of African Americans in the context of the early 20th century, including the impact of World War II, the Civil Rights era, medical experimentation and eugenics, the Black health care crisis of the 1980s and 1990s, and what health care reform looks like in the context of racism and health disparities. (Recommended by Nichole Wardlaw, CNM, MSN) Collins PH. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. 2nd ed. New York: Routledge; 2000 African American women have developed a rich intellectual tradition within the realm of Black feminist ideology. Black Feminist Thought is an analysis of the work of prominent Black feminist thinkers such as Angela Davis, bell hooks, Alice Walker, and Audre Lorde. This book is the first to provide an overview and synthesis of Black feminist thought. (Recommended by Pandora T. Hardtman, CNM, RM, DNP) Cooper B. Eloquent Rage: A Black Feminist Discovers Her Superpower. New York: Picador; 2018 Brittany Cooper is professor of Women's and Gender Studies and Africana Studies at Rutgers University. Her work has appeared in many popular media sources. In Eloquent Rage Cooper describes how Black women's anger, which has been traditionally portrayed as destructive and revolting, can be channeled into a powerful and positive force for change. She also explores the differences between white feminists and Black feminists in this book, affirming that feminism is not a one-concept-fits-all phenomenon. (Recommended by Pandora T. Hardtman, CNM, RM, DNP) Darity WA Jr, Mullen AK. From Here to Equality: Reparations for Black Americans in the Twenty-First Century. Chapel Hill, NC: University of North Carolina Press; 2020 From Here to Equality: Reparations for Black Americans in the Twenty-First Century helps the reader understand underlying racism and discrimination within the US economy, especially from a historical perspective. (Recommended by Maria Valentin-Welch, CNM, DNP, MPH, CDP) DiAngelo R. White Fragility: Why It's So Hard for White People to Talk About Racism. Boston, MA: Beacon Press; 2018 White Fragility takes a hard look at systemic racism and white supremacy in the United States and helps white people develop awareness around these issues to become antiracists and better allies for people of color. (Recommended by Maria Valentin-Welch, CNM, DNP, MPH, CDP) Eberhardt JL. Biased: Uncovering the Hidden Prejudice That Shapes What We See, Think, and Do. New York: Penguin Books; 2019 In Biased, Dr. Jennifer Eberhardt helps readers understand unconscious bias from a physical, biological, and research point of view, drawing on her 15 years of working experience with police departments to understand unconscious bias. (Recommended by Maria Valentin-Welch, CNM, DNP, MPH, CDP) Kendi IX. Stamped from the Beginning: The Definitive History of Racist Ideas in America. New York: Bold Type Books; 2016 Stamped from the Beginning: The Definitive History of Racist Ideas in America is a must-read for everyone committed to antiracism work. Kendi's thorough and comprehensive account of the insidious development of anti-Black racist ideology takes the reader from the origins of racist ideas predating the establishment of the United States to the Civil Rights and post–Civil Rights eras. Kendi exposes the fact that racism did not develop solely out of ignorance and hatred but instead was promulgated and defended by some of the most brilliant scholars in the history of the United States. This award-winning book is an essential primer in antiracism scholarship. (Recommended by Pamela Reis, CNM, NNP-BC, PhD) Lorde A. Sister Outsider: Essays and Speeches. Trumansburg, NY: Crossing Press; 1984 This is an essential text in intersectional feminist theory by the Black poet, activist, and scholar Audre Lorde. It is a collection of essays that reflect on the intersections of racism, gendered oppression, and the challenges and blind spots that white feminism reinforce. This is just one of her many works. (Recommended by Paulomi Mimi Niles, CNM, LM, PhD, MPH) Metzl JM. Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland. New York: Basic Books; 2019 In Dying of Whiteness, a physician explores the politics and policies of the Donald Trump era and reveals how a system of white power and privilege that further expanded under Trump's administration has served to disadvantage the very individuals the system intended to protect—lower- and middle-class white individuals living in the US heartland. Metzl travels through the heartland states of Missouri, Tennessee, and Kansas interviewing white citizens of these states about policies related to health care, gun control, unemployment, social services, and others. He discovers the shocking costs of Trump-era policies to this population, such as rising gun suicides, increasing dropout rates, greater unemployment, and premature death. (Recommended by Pamela Reis, CNM, NNP-BC, PhD) Morrison T. The Origin of Others. Cambridge, MA: Harvard University Press; 2017 The Origin of Others is derived from Toni Morrison's Harvard lecture series "The Literature of Belonging." In this book, Morrison reflects on how literature, history, and politics have affected US culture regarding race. She talks about the concept of othering to reflect the experience of people of color as left out or excluded from experiences based on race. (Recommended by Pandora T. Hardtman, CNM, RM, DNP) Rothstein R. The Color of Law: A Forgotten History of How Our Government Segregated America. New York: Liveright Publishing Corporation; 2017 The Color of Law details the adverse consequences of government-sponsored and -mandated housing segregation based on race. Housing segregation led to Black and Indigenous children of color being trapped in segregated, poor-performing schools. Lack of a quality education precluded their access to higher education and quality employment, prevented them from escaping substandard housing, and exposed them to environmental aerosolized toxins, the criminal justice system, and mass incarceration. The impact of these social forces on Black and Indigenous women of color is weathering expressed in maternal morbidity and mortality and racial health disparities. (Recommended by Patricia O. Loftman, CNM, LM, MS) Silliman J, Fried MG, Ross L, Gutiérrez ER. Undivided Rights: Women of Color Organize for Reproductive Justice. Boston, MA: South End Press; 2004 The 4 authors of Undivided Rights: Women of Color Organizing for Reproductive Justice are leaders in the reproductive justice movement. They use historical research, case studies, and personal interviews to document the experiences of African American, Latinx, Native American, and Asian people in the struggle for reproductive rights. Issues such as racism, immigration, genocide, and activism in the fight for reproductive justice are discussed. (Recommended by Pandora T. Hardtman, CNM, RM, DNP) Verschelden C. Bandwidth Recovery: Helping Students Reclaim Cognitive Resources Lost to Poverty, Racism, and Social Marginalization. Sterling, VA: Stylus Publishing; 2017 This book addresses the notion that many students of color who pursue higher education enter their programs with reduced mental capacity or cognitive resources because of persistent worry about the familiar effects of racism. Poverty, stereotype threat, racial health disparities, and lack of a sense of belonging often consume students' intellect, making it difficult for them to concentrate on the course material. Verschelden offers strategies and interventions that rebuild bandwidth to help students succeed in college and reach their full potential for success. (Recommended by Felina Ortiz, CNM, DNP) Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Doubleday; 2006 In Medical Apartheid, Harriet A. Washington documents the shocking history of medical experimentation on Black Americans since the middle of the 18th century. The book is presented in 3 parts. The first part of the book documents the beginning of the troubling tradition of medical experimentation from slavery to the Tuskegee studies of untreated syphilis in Black men. Part 2 focuses on eugenics and reproductive coercion aimed at the Black community and the continued atrocities in medical experimentation, this time involving radiation and experimentation on Black prisoners. Part 3 tackles contemporary concerns such as the double-edged sword of DNA technology, the impact of infectious diseases on the Black community, and bioterrorism aimed at Black people. (Recommended by Nichole Wardlaw, CNM, MSN) JOURNAL ARTICLES Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453-1463 Racism is the power to control the distribution of resources and differential access to goods, services, and opportunities of society that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources. There is an assumption that people who enter the health professions, including midwifery, enter with good intentions and the desire to acquire information and skills to render excellent health care. However, rendering excellent health care also includes an understanding of the impact of racism on health outcomes. (Recommended by Patricia O. Loftman, CNM, LM, MS) Effland KJ, Hays K, Ortiz FM, Blanco BA. Incorporating an equity agenda into health professions education and training to build a more representative workforce. J Midwifery Womens Health. 2020;65(1):149-159 This article provides an Equity Agenda Guideline for health education programs, especially those focused on midwifery education, for utilization of equitable goals and processes in recruitment, retention, and graduation. In response to atrocious health care disparities in communities at the margins and a racially homogenous workforce, especially in midwifery, the authors offer both a vision and a systems approach roadmap that promote a diverse workforce. The 8-section guideline and conceptual framework highlight tools and examples that build a climate for belonging. The related website, www.equitymidwifery.org, offers extensive resources for transformation to an equity-focused learning environment that students, staff, and faculty of color are more likely to see themselves contributing to. (Recommended by Felina Ortiz, CNM, DNP) Geronimus AT, James SA, Destin M, et al. Jedi public health: co-creating an identity-safe culture to promote health equity. SSM Popul Health. 2016;2:105-116 Although racism is easy to identify when it takes the form of individual discriminatory actions, these acts are symptoms of a much larger problem. Too often, we fail to address the pervasive racism embedded in our society's scaffolding because it is difficult to detect and eradicate. The Jedi Public Health Framework sheds light on how systemic racism insidiously affects health and health care. The authors discuss racism as a dynamic situational problem that surrounds us. It is in the environment where we live and seek health care and creates distorted prisms through which identities are misconstrued. As we strive for health equity, we must change what the authors call the "surround" of our society and health care system. (Recommended by Lauren A. Arrington, CNM, DNP) Jones CP. Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health. 2000;90(8):1212-1215 Dr. Camara Jones is an expert on racism and its impact on health. In this seminal work she outlines the differences between institutional, personally mediated, and internalized racism. Through her allegory she makes plain the ways in which racist acts and structures improve the health of some and degrade the health of others. Her article is essential reading for anyone seeking to understand a