Addressing Institutional Racism & Health Inequality: My Perspective

Diana Abwoye receiving an award for academic excellence in her Family Nurse Practitioner program. The author being inducted into the Sigma Theta Tau International Honor Society of Nursing in 2018.

By Diana Namumbejja Abwoye — August 18, 2020

Covid-19 has affected all aspects of our lives. It has exposed how much the United States is an unequal place for people of color. I will speak here from my own experience. It may not be a reflection of all people of color, but I hope it will help us get the conversation going.

I was born in Kampala, Uganda. The difference between me and other people of color born in the U.S. is that I made a choice as a young woman to immigrate from my home. I did so in an effort to support my family, and in a pursuit to find democracy, justice, education, and equity. Those born in the U.S. did not have this choice; their ancestors did not have a choice. I once lived in a country where almost everyone was black and the only thing we sorted by color was laundry, but here in the United States, I am constantly reminded of how much skin color matters.

For the longest time after I arrived, I didn’t pay much attention to racial differences. I held on to my sense of belonging to a culture I left behind. Today, as a mother of two Black girls, I am constantly worried about how I am going to raise them in this new place I call home. A place where I constantly have to worry about them fitting into a neighborhood, a school, a doctor’s office. I worry about raising my girls in a society that will stereotype them, limit their opportunities, challenge their confidence and make them feel like outsiders. I fear for my black husband and worry about his safety very often.

During my Family Nurse Practitioner training, I learned that African Americans have the highest risk for many chronic health conditions, including heart disease and diabetes, and that African American women are more likely to die during childbirth and from breast and ovarian cancers. The  textbooks we used documented this, but they didn’t explain why these people were at greater risk. Once, during a lecture, I asked why African Americans were at risk for a certain condition, but I didn’t get a response. Later, a classmate commended me for my question but also added, “Have you seen the stuff those people eat? It can clog your arteries.”

Following this conversation, I thought about the shallow, white-centered teaching about race and health disparities, and the necessity of educating students about cultures and lifestyles. I thought about why certain ethnicities make the choices they make and about how, far too often, they don’t have access to the resources they need. Many people don’t understand why people eat what they eat, why they can not afford organically grown foods or are sometimes unable to stay home and make a healthy home cooked meal for their family. In order for us to address health equity, we need to focus on solving the underlying social, economic and systemic racial structures that predispose these people to such lifestyle choices.

My work as a Covid-19 case investigator talking to people in the state of Massachusetts has made me think about where the United States is today. It is a reflection of the past, a past that was built with uneven distribution of resources, a past that was set to privilege only a few in the nation. This matters because after so many years we are still facing systemic racism, racial bias, uneven distribution of resources and social injustice. As I spoke to people with Covid-19, I could hear on the other end of the phone their frustration, their fear, and their exhaustion. While I worried about them going out of their homes and spreading the disease, they worried about getting enough food for their families, finding space to isolate, being evicted from their apartments, losing their jobs and/or getting  deported.

Amidst all this, George Floyd’s murder occurred, sparking protests around the world. Black people have called for equality for so long. How many lives should be lost before we put an end to it? My takeaway from all this is that we as a society need to continue having these conversations; it is long overdue for all white people to listen and take part in them. I challenge all of us to do what we can do about racial disparities and inequity. Ask yourself: how have I used my privilege to support those who are less privileged? How can I set the stage for a better world for the next generation?

Those of us who have children need to ask ourselves questions about how we are raising them. We need to set the stage now and raise our children to accept that it is okay for people to be different and it does not matter how they look; all that counts is the fact that they are human and deserve to be treated and regarded as humans.

I challenge white people to not just be our white allies but to be our white accomplices. White people need to use this moment to decide who they are and who they will continue to be in this world we are all sharing. I challenge organizations not to just post equal opportunity statements and protest signs for publicity, but to get these conversations started in their organizations and create suitable environments for a diverse workforce. Diversity does not come from hiring people of color; it comes through diverse mindsets, an inclusive culture and practice. Schools and colleges should focus on an equitable fundamental education that challenges the status quo of institutional racism and creates opportunities for those who are not privileged. Such environments call for continued conversations about whiteness among students and faculty, in addition to a safe space for them to express themselves.

Together we can change history and create a better nation for all our citizens.

Diana Namumbejja Abwoye is a family nurse practitioner and a member of the Board of Directors of Our Bodies Ourselves who translated and adapted “Our Bodies, Ourselves” into Luganda.

15 responses to “Addressing Institutional Racism & Health Inequality: My Perspective”

  1. Thank you dear, i eas thinking about how i need to lose weight with diet change and also realised that with my big family, healthy choices are not an option because of the cost. In Uganda proteins and vegetables are expensive so we eat lots of carbs thus rising obesity. You nailed it. Thanx Diana

    • What an amazing article Diana! Thank you being a voice and encouraging all of us to stand up and do our part! Thanks for sharing, I will be sharing forward!!

  2. Excellent Op Ed! The words “do you see what those people” resonates with me because I am one of “those people”. The question from this soon to be health care provider should be; Do we really know what African Americans eat, why do some eat unhealthy foods, and how can we help?

  3. Thank you Diana, you have eloquently addressed racism in this country. As a Kenyan woman, who also decided to come to the USA to better my self and my family, i soon realized that i was in a country where i had to fight for my rights at all levels. Racism is institutionalized and practiced subtly that you can miss it if you do not pay attention. I also realized that one has to fight it at all levels and stand up for yourself. Those born in this country do not have the The opportunity to live in environment where they are majority with an inbuilt self-esteem that is needed to fight racism, self-esteem is one of the qualities that racism strips away from the black community, yet self-esteem is very important in being able to stand for your rights. I can remember that when i came to this country,i went to the elementary school to apply for my children, the secretary told me that the school which was largely white was not taking any more students, i asked her to give that in writing and i would come to pick the letter personally the next day, two hours latter, she called me to let me know that the children were all set to attend the school. I was taking a nursing course, when one of the teachers profiled the black students, stated that foreign black students should know that she will work with us to ensure we succeed in the class, i reminded her that if we can think in three languages, and give her answers at the same rate as other students who spoke one language, then, we were able to handle the class work. Yes we worry about our black children, i worry when they drive expensive cars, will they be profiled? i drive through the black neighborhood and notice all the fast foods restaurant which are not in the white neighborhood. Addressing racism, requires talking about it, educating the white community to see it for what it is, restoring self-esteem on the black community, and policy change at all levels.

  4. Thank you my sister for addressing this issue. I am one of those people who made the choice to come here. This story resonates with me 100% and as a mother of a black boy everyday I imagine what many call the unimaginable “the George Floyd” scenario and many before him. As an Adult Geriatric Nurse Practioner my hope is that all health providers come to understand that when you tell someone to make life style changes to make sure they have the resources to support the health plan you are putting in place for them to follow. Not to label black patients as “non-compliant” when they have no resources to support the complaince..indeed covid-19 has not only revealed/exposed these inequalities but has blown them out for the world to see. Today over 100 million Americans have no health insurance and we know very well majority are people of color. During covid with a group of other Nurses I started to volunteer my NP services in a local immigrant community, many of them without insurance, many were discharged home after hospital stay recovering from covid without home services or family support to help them to fully recover from this virus which we all know it takes a lot of time and energy to get back to baseline…the sad stories are endless..these people are afraid to even collect free food because they know they may get deported..really have a lot to share but all I cans its a mess we have to work together to clean up.

  5. I wish we would have more conversations about white privilege.
    And what does this mean exactly?

    Have we come this far to not even have the understanding we need to communicate?

    We should all be there for each other, truly!

  6. Dear Ms. Abwoje,
    Thank you for your clear perspective on these issues of health and racism and how they are inextricably woven into the lives of Black and Brown people living in America.You are correct in pointing out that the COVID 19 pandemic has focused a spotlight on the inequalities in the determinants of health; education, living situation, economic status, nutritious food, access to health care and the other pillars that are the foundations of well-being for humankind. You have issued a call to action, now who will answer?

  7. I was in the classroom when you raised that question, and I didn’t know someone made that comment to you afterwards… in one moment appreciating your questioning and one may think caused them to think more critically. Then to fall into the sam tired stereotypical rhetoric that many students have after constantly hearing black people have high risk for certain chronic diseases compared to their white counterparts. I pray I see in my lifetime that professors stop halting the conversation at simply stating this info and rather dive into conversations about health inequities that are rooted in systemic racism.

    Thanks for sharing, Diana!

  8. This is an amazing read, and your prospective gives a clear description of a black parents struggle in this country. Invoking fear into children that are different is brought down by generations of white privilege inequality. It’s more important than ever to help our children understand and embrace their differences and be proud of themselves. Thank you Diana for this article, you are already making a difference my friend.

  9. Blacks are 5 times more likely to want and have an abortion than whites and they have a problem with racism, the lack of freedom, access, opportunity and fairness; so as a first step, would Diana Namumbejja Abwoye agree that ALL abortion restrictions for Black women and their un-born babies should be removed? In fact, would she even go so far as to defend and facilitate the abortion of many more Black babies and possibly support many more abortion facilities in Black communities, so there are no abortion deserts in those communities? The result will be fewer Blacks and correspondingly less poverty and less crime. What do you think?

    It appears that Diana Namumbejja Abwoye’s position is there should be no restrictions on abortion, right up until the day of delivery. Would you ask her to confirm that? Probably 95% of all pregnancies are the result of a woman personally, freely and privately choosing to have unprotected sex and thereby freely choosing to become pregnant. Is that not so? Is that not pro-choice? Now, how often in life are we totally free and able to undo our free, personal and private choices? If you choose to rob a bank, can you go back later and undo that choice and find it perfectly acceptable? How about choosing to take out a large loan? Can you freely choose, demand and be allowed to not pay it back? (well, maybe so in San Francisco). How many redos do you have after making your free, private, personal choices? Should free and private choices have any consequences? (perhaps not in San Francisco and Washington D.C.).

    In 90-95% of pregnancies, choosing to have an abortion has absolutely nothing to do with women’s health and healthcare. Some will argue there are mental health issues of being denied an abortion, but what about the mental health issues associated with having an abortion? Which mental health concerns are more frequent and severe?

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