Of course, cardiovascular issues don’t just affect Black women; according to the Centers for Disease Control and Prevention (CDC), heart disease has been the overall leading cause of death in the U.S. since 1950. This is the impetus for American Heart Month, which arrives every February to emphasize the importance of weight management, regular doctor check-ups, eating “healthy,” and consistent exercise for maintaining a healthy heart.
February also marks Black History Month, when we honor the struggles and the achievements of Black people. I find it interesting (and a little revealing) that these two observances happen at the same time every year, especially considering the high rates of cardiovascular issues in Black women.
As a Black dietitian who works in public health and has an inclusive approach with clients, I find that the focus on lifestyle changes for cardiovascular health overlooks the real issues that keep many people—Black women in particular—from enjoying better health. If we really want to save the lives of Black women, we also need to start taking into account the unique experiences of Black women that significantly contribute to their health detriments.
The unique health determinants of Black women
When we talk about health disparities—like why Black women have such high rates of heart-health issues—we need to be clear-eyed about the many different factors out of an individual’s direct control that impact their health. Healthy People 2030—an initiative from the U.S. Department of Health and Human Services (HHS)—defines a health disparity as “a particular type of health difference that is linked with social, economic, and/or environmental disadvantage.”
In other words, disparities stem from inequities, which are unequal accesses or distributions of resources according to their need.
When I was in school to become a registered dietitian, I remember learning about health disparities among various populations, and thinking that the magic solution was for people to make better health choices. Sure, we learned about food insecurity and food “deserts” impacting people’s access to nutritious food. But the solutions for these problems always seemed to come from a place of healthism2—the idea that one’s health was entirely on them to address and solve.
I’ve since learned that non-medical factors out of one’s control—like where you live and how much money you make—are just as important when impacting your health. This is particularly true with heart health. A study published last year in Mayo Clinic Proceedings looked at death certificate data from 1999 to 2018, focusing on people between the ages of 25 and 64 who died from heart-health issues. The researchers found that counties with higher levels of socioeconomic deprivation (using metrics that factor in things like housing quality, income, employment status, transportation access3, and more) had significantly higher premature deaths from cardiovascular causes4, particularly among Black people and women.
When I read that Black women suffer from the highest rates of stroke, I don’t wonder what these women are eating, or whether they should be exercising more. I think about the constant state of stress that many are in due to the systemic barriers they are faced with daily.
Clearly, the societal and social components of a person’s life are linked with their risk of heart disease and other cardiovascular problems. Yet when you read information about heart disease and stroke among Black women, very few public health sources mention those social determinants. (The American Heart Association, for example, just highlights the importance of eating less salt and sodium and not the societal or environmental factors that contribute to stroke or high blood pressure.)
But the systemic barriers Black women face prove that you can’t just eat your way to improved heart health. According to a 2023 report compiled by the National Women’s Law Center, 18.8 percent of Black women lived in poverty in 2021—second only to Native American women. Poverty can significantly impact health and health outcomes by limiting resources to necessities, such as food, clean water, shelter, and clothing, along with a lack of access to health care, education, and transportation. And research shows that the stresses and burdens of living in poverty are to blame for 60 percent of the increased risk of heart attacks and strokes5 among low-income Americans, according to a 2020 study published in JAMA Cardiology.
It must be stated that Black women are not a monolith when it comes to socioeconomic factors. But even taking one’s income out of the equation, Black women still face unique issues that impact their well-being. Take stress, another underestimated risk factor for heart issues. Constant exposure to stressful situations can cause long-term health risks including digestive issues, muscle tension and pain, heart diseases, heart attacks, high blood pressure, stroke, sleep problems, and more. Chronic stress also suppresses the body’s immune system, making it harder to recover from illnesses. Everyone experiences stress, but research shows that Black people (and other people of color) are more at risk of “weathering,” aka early health issues caused by the stress of constant exposure to racism and other forms of adversity.
None of these issues are solved simply by telling people to go to the doctor. In the United States, people of color face disparities7 not only in access to health care, but also the quality of care received and therefore, their health outcomes. Many Black people also mistrust the medical establishment due to centuries of mistreatment. From J. Marion Sims— known as “the father of gynecology”8—experimenting on enslaved women without anesthesia, to forced sterilizations of women of color in the 1950s and ’60s, to high-profile women like Serena Williams almost dying from a pulmonary embolism while giving birth because her doctors didn’t take her symptoms seriously, it’s not a surprise that many Black Americans, particularly women, choose to not seek medical attention.
So when I read that Black women suffer from the highest rates of stroke, I don’t wonder what these women are eating, or whether they should be exercising more. I think about the constant state of stress that many are in due to the systemic barriers they are faced with daily. I think about how many avoid seeking medical attention because they are so often dismissed and not taken seriously.
We cannot continue to tell people to eat better for heart health and seek medical advice more often to get things like blood pressure checked if there are significant barriers to these suggestions.
Addressing heart health in Black women requires looking at the root causes
Health disparities are preventable differences, and we need to remember this. Our society is inequitable by design—take governmental “red-lining” of predominantly Black neighborhoods, which impacted economic development and contributed to racial segregation—and thus solutions for those inequalities (and their effects on health) have to be bigger than just what one individual can do.
Yes, we can all partake in behaviors that will support our individual bodies. However, we cannot talk about health as if everyone in society has equal and equitable access to achieve the level of health that our society recognizes. Recommendations and solutions need to be tailored to specific populations’ unique experiences. When we talk about Black women having the highest risk of stroke, for example, we can’t just discuss the food that’s being eaten and leave it at that.
For a start, we should recognize how various socioeconomic factors, environmental factors, and forms of biases, might be at play. We can discuss risk factors such as type 2 diabetes, high cholesterol, and other conditions. We need to know that eating nutritiously and exercising needs to be on an individual level and integrate the social determinants of health (SDOH). Health is not only about what we eat and how we move.
As health-care providers, I also think we can do a lot to move the needle for our patients and improve these outcomes. To start, it’s critical that all providers address the patient in front of us, and not counsel based on stereotypes. We sometimes make the mistake of making assumptions before getting to know our clients and patients. How can we give dietary or lifestyle advice without actually asking the individual firsthand? I’ll never forget when I heard from a client that her doctor suggested she stop eating so much red meat, when she was a vegetarian. Demographics are not monoliths and everyone is an individual with unique experiences and lifestyles. Learn them.
We all have to start acknowledging that there is no one-size-fits-all solution to supporting heart health, particularly for Black women who are most at risk.
Second, medical professionals—and the profession more widely—must acknowledge any harm caused by bias and stereotypes within medical research and health care. We cannot ignore that biases in the field exist, and are harmful and deadly. We also need to realize that racism can take form in many different ways. It can look like not receiving adequate care at the moment in a healthcare setting, but it also looks like not having accessible health care in specific neighborhoods.
It’s also crucial that medical education promotes a greater understanding of the topic of SDOH and healthism. The determinants of health are not a new subject, yet many providers (and members of the public!) forget the role that it plays in someone’s overall health status. For example, why do we focus our attention on dietary guidelines when it comes to conditions and illnesses, when we know that someone’s zip code9 is one of the biggest determinants of health?
The health field still places most of the onus of health on the individual, using words like “noncompliant” when someone doesn’t seem to be taking the advice of their medical provider. This should be reinforced in the curriculum alongside learning about food and nutrients in relation to ailments.
I also urge all health-care providers to continue educating themselves on cultural differences. I’m not talking about learning about what’s written in a textbook, because so much of that information is biased and outdated. We should all commit to learning from activists who speak on social injustices and stigmas in any form. None of us know everything and it’s our job to learn, grow, and evolve in order to provide the best possible care for our patients.
Above all, we all have to start acknowledging that there is no one-size-fits-all solution to supporting heart health, particularly for Black women who are most at risk. We all have different bodies, minds, lifestyles, situations, and people influencing our lives.
As tempting as it is to believe, we can’t just eat our way to better heart health—at least, not without significant improvements to the structural issues that keep us from being well.
Well+Good articles reference scientific, reliable, recent, robust studies to back up the information we share. You can trust us along your wellness journey.
- Ebong, Imo, and Khadijah Breathett. “The Cardiovascular Disease Epidemic in African American Women: Recognizing and Tackling a Persistent Problem.” Journal of women’s health (2002) vol. 29,7 (2020): 891-893. doi:10.1089/jwh.2019.8125
- Crawford, R. “Healthism and the medicalization of everyday life.” International journal of health services : planning, administration, evaluation vol. 10,3 (1980): 365-88. doi:10.2190/3H2H-3XJN-3KAY-G9NY
- Butler, Danielle C et al. “Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery.” Health services research vol. 48,2 Pt 1 (2013): 539-59. doi:10.1111/j.1475-6773.2012.01449.x
- Bevan, Graham H et al. “Socioeconomic Deprivation and Premature Cardiovascular Mortality in the United States.” Mayo Clinic proceedings vol. 97,6 (2022): 1108-1113. doi:10.1016/j.mayocp.2022.01.018
- Hamad, Rita et al. “Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults.” JAMA cardiology vol. 5,8 (2020): 899-908. doi:10.1001/jamacardio.2020.1458
- Dhabhar, Firdaus S. “Effects of stress on immune function: the good, the bad, and the beautiful.” Immunologic research vol. 58,2-3 (2014): 193-210. doi:10.1007/s12026-014-8517-0
- Hall, William J et al. “Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.” American journal of public health vol. 105,12 (2015): e60-76. doi:10.2105/AJPH.2015.302903
- Wall, L L. “The medical ethics of Dr J Marion Sims: a fresh look at the historical record.” Journal of medical ethics vol. 32,6 (2006): 346-50. doi:10.1136/jme.2005.012559
- Graham, Garth N. “Why Your ZIP Code Matters More Than Your Genetic Code: Promoting Healthy Outcomes from Mother to Child.” Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine vol. 11 (2016): 396-7. doi:10.1089/bfm.2016.0113