For Black communities, the ability to stay physically and mentally healthy has long been undermined by racism, social exclusion, and economic inequality. These challenges are especially acute for Black women, who face additional layers of discrimination and exclusion based on their gender and on cultural stereotypes.

For almost three decades, the California Black Women’s Health Project, a statewide nonprofit, has dedicated itself to improving the physical, spiritual, mental, and emotional health of the state’s 1.2 million Black women and girls through education, policy, outreach, and advocacy. It has trained hundreds of Black women through customizable Advocate Training Programs, including its Sisters Mentally Mobilized initiative, to become mental health community advocates and to launch regional mental health–focused support groups called Sister Circles.

I spoke with the project’s chief executive officer, Sonya Young Aadam, about the organization’s work, the challenges to Black women’s health in California, and ideas for eliminating inequities.

Q: The California Black Women’s Health Project was established in 1992. What did the founders hope to accomplish?

A: Byllye Avery [a women’s health pioneer and activist] is the founder of the Black Women’s Health Project movement. In the ’80s and early ’90s, it was clear there were almost no voices of Black women at the table when it came to addressing Black women’s health. She circled the country, talking to Black women about their health needs. Ultimately, the National Black Women’s Health Project was formed, and California started a chapter. It began with a focus on self-care, community care, and support circles for Black women, and it developed into advocacy. We began to ask, what are we doing to address the systems that have historically neglected us? What policies would support better health for Black women?

Q: What drew you to California Black Women’s Health Project?

A: I grew up in South LA and then lived outside of California for a long time both for college and work, mostly in corporate finance, investment banking, and strategic planning. When I moved back home to South LA, I was shocked to find that so many community conditions had not changed. I began to think, “What does it take to improve a community’s health?” After a period of reflection and extensive volunteer service, I joined the Los Angeles Urban League, where we worked on a grant project with the California Black Women’s Health Project. I knew the organization had a great mission, and I was a strong believer in the work. I joined the organization as CEO nearly six years ago.

Q: Why is your organization needed today?

A: If you’re Black and female, you have lived experiences that put you at risk of suffering from weathering — chronic toxic stressors driven by historical systemic racism, sexism, and classism. We interface with systems of care that have traditionally left out our experiences, our voices, and our needs. If we don’t stand up for ourselves together, no one else will. Longstanding disparities in Black maternal and infant mortality make it necessary for California Black Women’s Health Project to exist so we can collaborate with critical interventions like those created by Karen Scott, MD, MPH, in the SACRED Birth Study [cofunded by CHCF, Tara Health Foundation, and the Grove Foundation]. The study will evaluate the quality of perinatal services, support, and care in hospital settings. Also, predisposing risk factors for anxiety and stress in Black women make it necessary for our organization to exist. And so, we launched our Sisters Mentally Mobilized Advocate Training Program as a pilot project to address mental health disparities statewide in underserved populations. With support from CHCF, we also are helping to provide emotional support and capacity building tools to Black birth workers who are supporting Black mothers and birthing people* during the COVID-19 pandemic.

We’ve trained more than 500 Black women to become effective health policy activists and advocates in mental health, maternal health, domestic violence, and reproductive justice.

—Sonya Young Aadam

Q: Black and Latinx people have been three times more likely to contract COVID-19 than white residents and nearly twice as likely to die from it. What societal and structural issues contribute to this?

A: Black Californians are disproportionately impacted by the same issues that contribute to health disparities in other areas, except they have intensified because of COVID-19. For example, in the first few months of the pandemic Black leaders, advocacy groups, and media watchers were complaining that Black health care professionals were not seen in media coverage speaking about the coronavirus. Black people still have a lack of trust in the health care system because of historical mistreatment, so we need to hear from professionals who look like us about how to keep ourselves safe. Also, Black people have been showing up at hospitals complaining of virus-related symptoms, but because they have preexisting conditions they are told, “Oh, you have a history of asthma, so that’s probably what it is. You can go home.” Four days later they show up at the hospital near death from COVID-19. We are more likely than white people to be sent home without proper treatment. On top of that, we have limited testing in the Black community, and when we seek testing, we are often turned away. The New York Times, USA Today, and Emergency Medicine News are among many organizations that have documented these kinds of incidents.

The societal and structural biases we see with the pandemic continue to come up with other health concerns, including mental health challenges. If we don’t “sound” crazy enough or if we show up as someone who is “dressed too well” or “speaks too well,” we are turned away and told we don’t need care. We hear this so frequently from Black women in our Sisters Mentally Mobilized Advocate Training Program, where women are referencing their own experiences or that of a close friend or relation. Unfortunately, I became all too aware of this type of bias while assisting a family member in navigating a mental health treatment center earlier this year. Bias in health systems shows up in so many ways that often leave us being either turned away without proper treatment or turned off from returning for treatment.

Q: How are the events of 2020 affecting the mental health of Black women and girls?

A: Sadly, we’re seeing elevated levels of depression, anxiety, and isolation. We are a very spiritual, connected, social group of people, and Black women are the caregivers of our communities. It is difficult to be in a pandemic where there is fear of even being outside, where we cannot even come together in our places of worship. In the general population, many people are still going out, they’re on the beaches, they’ve resumed some activities. People in our community must be more careful. We are more susceptible to contracting this virus and dying of it, largely due to historical disparities in health care, and this causes added pressure. We are preparing for what I’m calling “post-COVID-19-stress-disorder.” Our Sister Circles are so important to serve as “tend and befriend” protective spaces to support us in times of skyrocketing depression and anxiety.

Q: How do Sister Circles approach the problem?

A: The Sister Circle model of engagement is an evidence-based practice. It’s a space where Black women come together to heal, to deal, to share, and nurture our spirits. Our Sister Circles use music, imagery, poetry, videos, reading materials, and a myriad of Black cultural traditions and practices to uplift, support, and to provide a caring environment. We aim to reduce anxiety, stigma, and isolation. Sister Circles incorporate a learning component when coupled with the Advocate Training Program. Participants learn horizontal and vertical advocacy principles, policy practices, and how to navigate systems of care, write letters to legislators, speak in public hearings, and train others to build advocacy circles for other Black women in their communities.

We’ve trained more than 500 Black women to become effective health policy activists and advocates in mental health, maternal health, domestic violence, and reproductive justice. For Black women who are interested in careers in the health professions, we use this model to implement culturally centered policy advocacy, self-care skills, and social determinants of health training. Increasing diversity in these careers is an organizational strategy priority.

Q: How can advocates work in tandem with the public health system?

A: Before COVID-19, our trained advocates could go with people to their health care visits. Having an advocate in the room with a patient can create a situation of ease and help the health professional understand what the patient is trying to communicate. An advocate has sufficient knowledge to support and help you if you need to get more extensive care.

For example, we are part of a collaborative where we train Black hairstylists to recognize the signs and symptoms of anxiety and depression. In the Black community, your hairstylist is often a person you see every two weeks or once a month. That person can recognize when something might be amiss and encourage clients to see a therapist or find a support group. Integrating advocates into the public health system serves the system because the advocates serve Black women and communities and support better engagement in matters of community health.

Q: What do you want changed in California’s public health system, especially in mental health?

A: Community-defined, evidence-based practices (CDEPs) are the best thing that could happen to the mental health care system. These practices are culturally sensitive approaches to health care that are effectively targeted to specific communities. I advocate for county and state health care systems to incorporate these practices into the traditional system and not treat them as an outside special project worthy of little investment and attention. These practices are rooted in culture and the recognition that culture and health are intricately connected. As one example, the integration of culturally centered group care as a mental health prevention and early intervention practice has strong potential in clinical treatment settings. The Sister Circle model of engagement to address mental health stigma, isolation, depression, and anxiety in Black women is a CDEP that could help reduce disparities in the public mental health system.

We envision a healthier future when Black women are empowered to make choices in an environment where health equity and justice are community priorities — and where our labor is matched with adequate support, not with crumbs.

—Sonya Young Aadam

Q: Why did you call on Governor Gavin Newsom to declare racism a public health crisis?

A: California Black Women’s Health Project is part of a statewide coalition that issued a letter to the governor along with California Pan-Ethnic Health Network, Black Women for Wellness Action Project, Public Health Advocates, and Roots Community Health Center. It was signed by 156 organizations and 440 individuals. California state leaders have fallen behind the governments of Nevada and Wisconsin in declaring racism to be a public health crisis. An executive order from the governor would open doors and funding chests. While California does have budget challenges, there still are resources that could be invested to dismantle racist practices, but no one’s going to move without leadership. Clear action by Governor Newsom is key to real progress in California.

Q: What is your vision for the California Black Women’s Health Project?

A: In five years, I imagine we will still be fighting to decrease health disparities and to increase diversity in the health care professions and navigating those efforts from the outside. In 10 years, I’m hopeful we will see more community-defined, culturally grounded practices integrated into the health care system to improve care for Black Californians. I envision advances in equity and health justice for Black women, families, and communities. I envision the public, corporate, and philanthropic sectors will work harder to invest in and collaborate with Black female–led organizations that support and lift up our communities.

The work is created by us and for us because of the gaps and racial inequities in our health care. We are working hard to pick up the pieces of our lives devastated by generations of structural racism and systemic barriers. We envision a healthier future when Black women are empowered to make choices in an environment where health equity and justice are community priorities — and where our labor is matched with adequate support, not with crumbs.

* The use of the term “birthing people” recognizes that not all people who become pregnant and give birth identify as a woman or a mother.

Claudia Boyd-Barrett

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others. Read More

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