On Changing the Narrative Around and Advancing Health for Black Women: An Interview with Natalie Burke

Our BlackHer Shero of the week is Natalie Burke, president and CEO of CommonHealth Action, whose mission is to develop people and organizations to produce health through equitable policies, programs, and practices. Natalie and I spoke about the need for power and authenticity, reframing the narrative around Black women’s health, and getting uncomfortable in order to create change. 

Tell us about your experience in the public health sector. How did you get involved in this work?

When I was 19 and in my sophomore year of college, I started to get phone calls related to my grandparents’ health, their healthcare, and their challenges with navigating the healthcare system. I’m a child of Jamaican immigrants, and my grandparents were having a really difficult time getting quality and culturally competent care. I began to think “how does health happen”? So, I built experiences and ultimately a career that allowed me to experience our healthcare system from different angles. From doing federal health policy analysis, to working at the National Association of County and City Health Officials, to working at an ambulatory care agency, and at NIH (National Institutes of Health), my career has enabled me to see health from different angles. 

As individuals, our health is not an accident, it’s a product of society. While part of our health is genetic (10-20%), about 40-50% is determined by the systems and institutions that create the context in which we live our lives. In 2004, I co-founded my current organization CommonHealth Action to develop people and organizations to produce health equity through equitable policy, program, and practice. Health equity is when all people have fair opportunities to achieve the best possible health. 

That’s great. Can you say more about what health equity means for Black women? 

Black women experience significant inequities across systems and institutions including housing, education, transportation, and employment. Our experiences of those systems, shape and create the conditions that determine whether we are put on a path of illness, disease, and early death, or health and well-being. For example, living in poverty creates a persistent type of toxic stress that takes a toll on a cellular level. It’s called allostatic load, and according to epigeneticists it actually causes genetic expression to change. While a Black woman might have a genetic predisposition to be hypertensive, that gene doesn’t have to be turned on. Toxic stress turns on chronic disease. Thus, if we want Black women to be healthy, we have to deal with  structural issues like pay equity. 

So much of what you just said is resonating with me as you talk about the intersections of racism and sexism, and the connections between economic security and health. When we think about the current pandemic, how should we be advancing health equity during this time?

We’re getting ready to go into a period of family gathering, and there’s going to be a burden on Black women to create closeness during this pandemic while creating realistic expectations about how to keep everybody safe. We’ve got to plan for and deal with the pandemic now. At the same time, we need to deal with the future and reimagine Black women’s health. 

Black women’s bodies are not broken. We are not inherently flawed. We were not born to be sick, injured, or die early. We need to create a new image and narrative about what healthy Black womanhood looks like. We have to shift power in organizations, communities, systems, institutions, and families so that Black women have the ability to determine our own health destinies. 

The issue that Black women face is not health disparities, it’s health inequities. Health disparities are merely differences in health status and health outcomes between groups. Health inequities are disparities that are preventable and avoidable, and are the manifestation of unjust policies, programs, and practices. Health equity is about understanding who a person, family, community, or population is and figuring out what’s necessary for them to get to their best possible health outcomes. 

You’re speaking a word, Natalie! Is there anything else you want Black women to know about your work? 

A lot of my work, particularly since March, has been about standing in this space of the pandemic and racial unrest. In this moment, organizations are hard-pressed to think about allyship and how to have conversations about racial inequity and all of the -isms,  particularly in the workplace. 9.9 times out of 10, when the CEO says that we have to do transformation around racial equity within the company, a Black woman is at the head of that work. To do that work with authenticity is tough stuff. It can bring a level of scrutiny that is consistent and intense.  It can create an allostatic load that makes people sick. 

In sister circles, I’ve been saying that it is so important to be honest. Being honest is authenticity, and authenticity is power. We have to find the strength, energy, and the affirmation to engage in a level of authenticity that’s going to make people incredibly uncomfortable. This is the work I do at my organization. We orchestrate constructive discomfort. Because in order for us to become more equitable, we have to be willing to embrace discomfort. No great change happens without discomfort. 

Let me ask you our miracle question. You go to sleep tonight and wake up tomorrow and it’s October 2021 and a miracle has occurred for Black women. What happened?

Black women have sight lines on new spaces and opportunities to engage, discernment to be strategic and make decisions, and power to create and define reality for ourselves and others. That would be the miracle. When Black women are able to fully engage our power, we will save this nation. Frankly, I think we are the ones that have kept America together for 400 years.



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