Vox: All Posts by Julia Cravenhttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2023-06-26T07:00:00-04:00https://www.vox.com/authors/julia-craven/rss2023-06-26T07:00:00-04:002023-06-26T07:00:00-04:00What wellness means for Black women
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<p>Capitalism, white supremacy, and yoga pants: An interview with DeJa Love, CEO of the Black Women’s Wellness Agency. </p> <p id="zIsQ1P">My relationship with wellness is more complicated than running into a guy I ghosted at an office party. I began my journey in 2017 as a lot of people do: dressed in Lululemon and sipping green juice on my way to a yoga class. (I had chosen <a href="https://www.shondaland.com/live/body/a30243253/getting-down-at-trap-yoga/">trap classes</a> because I was much more comfortable hearing “Mouth Full of Golds” during child’s pose than risking <a href="https://www.buzzfeednews.com/article/aishamirza/until-white-women-ruined-it">stepping on a white woman’s yoga mat</a>.) Soon, wellness became a capitalistic pursuit I held near. I loved grabbing a blue spirulina smoothie while out on a run — but only dressed in head-to-toe Nike gear. Lulu was for the gym and yoga. I became obsessed with rings, namely, closing the ones on my Apple Watch. </p>
<p id="x84a2r">By 2020, after spending thousands of dollars on this journey without seeing any measurable improvement in my mental health — <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716594/">which people do experience from wellness efforts</a> — I began to interrogate why I expected this effort to cure my anxiety and depression. I was sidelined by the coronavirus pandemic and, like many others, began to question what actually mattered to me. Still, I did yoga, strength trained, cycled, and meditated at home to keep myself mentally afloat during the pandemic and during the antiracism protests over the murder of George Floyd, an immensely triggering moment for Black folks. Having a routine was helpful until it wasn’t. </p>
<p id="M5EM26">By 2022, I was experiencing weekly panic attacks that slowly increased to I-don’t-know-how-many-days a week. I wasn’t sleeping or moving much farther than from my bed to the couch. When I was eating, I wasn’t choosing nutritious foods. I’d run out of motivation to care for myself — and all of it felt like it shouldn’t be happening to <em>me</em> because <em>I</em> should be tougher. </p>
<p id="xtlCNK">Mainstream wellness was, to lean further into cliches, a Band-Aid on a bullet wound. I was actively pursuing better mental and physical health, a key piece of a wellness journey, but I wasn’t taking the time to establish what felt good to me. I was trying to fit into the trendiness of wellness, and I desperately wanted the freedom it proclaimed I could have if I bought enough stuff. Nowadays, I define wellness as, “Doing what feels good and aligns with what I believe I need in this moment.”</p>
<p id="jycKxv">My burnout story is a quintessential narrative among Black women. Many of us have been raised to be “strong” despite the systemic factors that make such an ideal impossible to uphold. The Strong Black Woman trope demands that we swallow our pain for the greater good of others, and it comes with <a href="https://journals.sagepub.com/doi/full/10.1177/0361684319883198">grave psychological consequences</a>. It can make us more susceptible to depression, anxiety, and feelings of isolation. For some Black women, we rarely forgive ourselves for our mistakes and relentlessly seek to meet others’ expectations. This is more harrowing when we consider that <a href="https://www.apa.org/topics/stress/body">stress</a> compounds. Besides causing headaches, chest pain, fatigue, and stomach issues, heightened stress levels can make sleeping impossible. Your breathing can quicken. You could develop high blood pressure, a weakened immune system, anxiety, depression, Type 2 diabetes, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/">memory loss</a> — adverse health outcomes that Black people are more likely to experience. </p>
<p id="dQ56GX">The systemic conditions that prevent Black women from being able to take proper care of ourselves is one of our nation’s most significant health injustices. And to add insult to our spiritual injury, wellness practices, which can be a useful tool to fight poor mental health, are presented to us through a Eurocentric, capitalist lens, encouraging us to spend money many of us don’t have on products we don’t need to care for ourselves. </p>
<p id="k9G59V">I discussed these conditions and the role wellness plays in navigating them with DeJa Love, the CEO of the <a href="https://www.thebwwa.com/">Black Women’s Wellness Agency</a>. Love’s agency supports Black women who are stressed, burnt out, and overwhelmed by connecting them to Black women wellness providers. This could be a yoga teacher, meditation or life coach, personal trainer, or any non-clinical wellness service that helps manage stress. </p>
<p id="93gxcw">“We have to go deeper because the world in which we’re living in, it’s not sustainable for us to keep at this pace,” Love says. “I really view this as a fierce urgency, as life or death. When Black birthing persons are dying at three times the rates of white folks, that’s a crisis. We are dying, across the board, at higher rates. This is why it’s so important.” </p>
<p id="dKJy54">This interview has been condensed and lightly edited for clarity. </p>
<p id="AsmVTQ"><strong>Explain your personal approach to wellness. Is it more spiritual? Or is it more political? </strong></p>
<p id="sxyMqe">For Black women, our wellness is infinite. That it is not a $200 yoga mat or yoga pants. Since, especially in the mainstream context of the United States — which is incredibly racist with white supremacist undertones — wellness is generally capitalistic. It’s about the doing, and the purchasing. </p>
<p id="WBiaV7">Infinite wellness is knowing that maybe wellness for me in one moment is sitting in silence, sensory deprivation, not on social, not logged in, but sitting, connecting to breath, connecting to the divine spirit that guides us, whatever folks identify with. In the context of America, wellness is rest. It’s challenging a toxic grind culture that tells us we need to constantly produce, that we’re not enough, that we’re not doing enough. I’m guided by Tricia Hersey and her work. She leads <a href="https://thenapministry.com/">The Nap Ministry</a>, and her book <a href="https://bookshop.org/p/books/rest-is-resistance-a-manifesto-tricia-hersey/18255493?ean=9780316365215"><em>Rest Is Resistance</em></a> has really shifted my paradigm and informs a lot of what I view as wellness.</p>
<p id="qTxjFA"><strong>What are some of those white supremacist undertones to wellness? </strong></p>
<p id="Gbe8FS">It’s really this notion of, “I have to do something. I have to purchase something. I have to buy something. I have to keep performing.” And that can look like, “I need to buy the expensive mask. I need to buy expensive face serums. I need to go to the gym classes.” It’s still a perpetuation of grind culture and hyper-productivity. Whereas the Black Woman’s Wellness Agency and I challenge that and say, “Black women, you are enough by just being!” It seems so simple, but the brilliance is in the simplicity of being — not doing. Wellness is shifting our minds away from what we have been indoctrinated with, such as: “I have to be a certain weight, I have to look a certain way, I have to have this.” No. We have to be on the path of unlearning.</p>
<p id="KYdcOE">Those are some of the undertones. It’s about this aesthetic, and that’s what we get. But wellness is not an aesthetic. Wellness is being connected to our breath, our bodies, and calming the mental fluctuations that happen constantly. </p>
<p id="NHH6K9">This multibillion-dollar wellness industry that says you have to drink this or take this supplement or be in this intricate yoga posture just creates more work. </p>
<p id="Ue6hnf"><strong>Why isn’t wellness binary for Black women? I was looking on your website, and I saw that. I think I know what that means, but I’m very, very intrigued.</strong></p>
<p id="QeixJx">It’s not binary because we, as Black women, are so robust. We have had to be. We’ve had to be the heads of households, to be cooks and cleaners, to raise children and make sure the finances are handled — we’re constantly wearing so many hats. Our healing and our wellness are not going to be boxed in. It can’t be, because we have to do so much. </p>
<p id="05DK57">Black women are the largest demographic of advanced degree holders and business owners post-2020. We’re doing so much, and that’s why we’re proponents of wellness being whatever it is you need. </p>
<p id="GBFufx">If wellness is saying, “I’m just really tired, and I don’t need to push through,” then that’s wellness. If wellness is saying, “My family is expecting me to do something, and I say I can’t do that because I need to uphold my boundaries, and I can’t keep pouring from this empty cup,” then that’s wellness. That’s the journey that I’m still on. We’re all still on it. </p>
<p id="3XfAeE">It has to be full-spectrum and incredibly inclusive. It has to counter the mainstream approach to wellness — the skinny white woman in Lululemon doing an intricate yoga posture. That is not true wellness; that is a capitalistic approach that we have been fed, and we have to keep pushing back because that image may not serve us. Now, we are not a monolith, so maybe that image serves some Black women. I know for many, though, that it does not.</p>
<p id="Efr4K6"><strong>One thing that I think most Black women can all relate to is the pressure to fit into these spaces, whether it’s work or a yoga studio, where you’re the only Black person there, and people are looking at you crazy. So when we reclaim and reframe wellness — meaning we stop looking at it through this billion-dollar lens — how do we reconnect with our power? </strong></p>
<p id="3CrTaH">It’s multifaceted. It will take many different approaches. One of them is going for a walk and doing a walking meditation, not having your AirPods in, just listening to the sounds of nature so you can get out of your head and connect with the many thoughts that are going to come into your mind. I don’t want to demonize social media. It’s an amazing tool that connects us, but part of reclaiming is having healthy sabbaticals from social [media]. </p>
<p id="ipCwnc">I’m also a proponent of therapy. Therapy helps us be introspective. </p>
<p id="UDgyDa">Another thing that has helped me is being able to be free. Business ownership has allowed me to feel free. I’ve had an 18-year career in many business sectors, and within all of those sectors, you become indoctrinated, and your truth gets stifled by the dominant group. And even those who look like me can fall into assimilation and respectability. I speak unapologetically, and many people do not connect, and that’s fine. I’ve had to make peace with the fact that I may not get all the business contracts, or I may not gross the revenue that I want. But I can sleep at night knowing that I am speaking for Black women, that I am challenging inequities, the status quo, and a society that perpetuates it.</p>
<p id="poLgvq"><strong>You pointed out that when Black women really start taking care of ourselves, prioritizing our needs, and start centering our well-being, we lose people. It’s always been very interesting to me that when a Black woman starts thinking about her well-being versus how she can be in service to everyone else, people start dropping off. </strong></p>
<p id="eHsmUe">Earlier today, when I was on my walk, I was thinking about when we’re on journeys of evolution. I don’t want to be the same DeJa I was three years ago, a year ago. I want to be evolving, and learning, and there are folks that will not be there on that journey … it’s hard sometimes. It’s always the folks you don’t expect, the people who were always there. And that just hurts harder. Part of that evolution is releasing that attachment. And the folks that connect to me will find me. I will build a new community. </p>
<p id="eAtvTW"><strong>It’s like my granny used to say, “Everybody can’t come.” Speaking of her — a Black woman who absolutely prioritized her well-being after raising three generations of her family — how does wellness help Black women thrive?</strong></p>
<p id="FfApgM">It helps us because we are able to get reconnected with self. When I’m putting on my public health hat, our life expectancy is reduced in this white supremacist, very racist society. From medical racism in health care, housing, education, transportation — every facet that we intersect with has a huge impact on our outcome. Every facet of being in this country challenges us. Wellness helps us get back to our center when all of these forces that create the inequities we live in challenge us.</p>
<p id="oi3J8O">Sometimes we will question ourselves. We forget the confidence, the power, the self-esteem, the self-efficacy because we have been metaphorically beaten down by all of these systems.</p>
<p id="smPLDD">We even have to combat the complicity of folks in our own communities and other white-adjacent folks of color. I know that’s a provocative notion. Black people and other folks of color can uphold white supremacy because we’re all stewed in the same society. So people get surprised, for instance, that a Black physician can perpetuate harm to their Black patients. They have been trained in racist medical schools, so they can perpetuate what they have been taught. That’s why wellness is so important. Wellness is whatever a Black woman needs. We know what we need for our healing, to feel grounded, to feel at peace, to feel centered. That is crucial as we navigate this society that we operate in.</p>
<p id="QXswtl"><strong>How does taking care of ourselves challenge hustle culture? Sometimes this strikes me as a conundrum. We’re trying to get out of this capitalistic dynamic of wellness, but we live in a capitalistic society, and we have to survive. And sometimes, for certain wellness practices, you have to buy something. It feels very sticky sometimes to see taking care of yourself as a challenge to capitalism when we live in a society where it’s so deeply entrenched.</strong></p>
<p id="JQM6pU">It’s so important because grind culture is insidious. We are not even aware of the hold that grind culture has on us. That’s why stepping back transforms. </p>
<p id="lec0z0">Again, I’m not immune from it. That’s why I’m so intentional with my unlearning, even as a business owner, challenging myself to not just push through. I’ll say: “DeJa, you’ve been up for how many hours? You’ve been in how many back-to-back meetings? Go out, take a walk, do a guided meditation, go do some yoga, just do something!” </p>
<p id="KXH6YK">I want to see a world where all Black women, and I use that term inclusively, are well. Where we’re not burnt out, where we’re not overwhelmed, where we’re not stressed, where employers don’t undervalue our contribution — they’re not even paying us the full dollar! We’re getting what? Sixty-seven cents on the dollar? And working twice as hard to prove ourselves. That is the encapsulation of grind culture and being unwell. </p>
<p id="Fy81EW"><em>Julia Craven is a writer covering anything she thinks is cool. She’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em><strong>Make It Make Sense</strong></em></a><em>, a wellness newsletter.</em></p>
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https://www.vox.com/even-better/23771329/black-women-wellness-collective-deja-love-burnoutJulia Craven2022-12-30T06:00:00-05:002022-12-30T06:00:00-05:00The medical system has failed Black Americans for centuries. Could reparations be the answer?
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<p>The growing, and sometimes conflicted, calls for cash payments to achieve parity and better health outcomes, explained. </p> <p id="c3vWH5"><em>This story was produced in partnership with </em><a href="https://capitalbnews.org/"><em><strong>Capital B</strong></em></a><em>.</em></p>
<p id="Hp5ugJ">In 1972, two social workers set Debra Blackmon’s sterilization in motion. </p>
<p id="PPEYQw">The primary diagnosis in <a href="https://www.npr.org/sections/health-shots/2014/10/31/360355784/payments-start-for-n-c-eugenics-victims-but-many-wont-qualify">her medical records read</a>: <em>mental retardation severe</em>. Soon, Blackmon would undergo a total abdominal hysterectomy, a procedure, sanctioned by the local government, to remove her uterus and cervix.</p>
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<p id="r0O1hx">She was 14.</p>
<p id="60yeBE">Since 1929, the state of North Carolina <a href="https://www.npr.org/2011/12/28/144375339/a-brutal-chapter-in-north-carolinas-eugenics-past">had been signing off on forced sterilization</a> for those they deemed unfit to have children. Through its eugenics programs, the state sterilized more than 7,600 people, under the notion that halting reproduction by “mentally defective” people would benefit society. </p>
<p id="8OQUZj">While white people made up the majority of sterilizations prior to the 1960s, Black women were disproportionately targeted for the state-sanctioned surgeries in the later years of the program.</p>
<p id="Lb6XDr">“It was heart-wrenching,” says Bob Bollinger, the attorney who represented Blackmon and a handful of others with similar stories in separate legal cases against the state.</p>
<p id="RgEQVH">Although 30 states have had sterilization laws on the books, North Carolina’s program — which ran until 1974 — was one of the largest and most aggressive. Its victims were also the first to receive compensation, in an unprecedented reparations effort. </p>
<p id="Cjy40l">In 2013, state lawmakers set aside <a href="https://www.msnbc.com/all/eugenic-sterilization-victims-belated-justice-msna358381">$10 million for one-time payments</a> to the 1,500 to 2,000 victims they estimated were still alive. The compensatory funds covered those who had been sterilized through the state eugenics board’s formal process, but left out many who had been involuntarily sterilized by local welfare departments that had bypassed the state board. Until they came forward seeking reparations, the legislature was likely unaware such individuals existed. </p>
<p id="jZZofn">Blackmon was among them. She’d never receive payment under the statute.</p>
<p id="x5UtM8">“We lost all the cases because of how the law was written,” says Bollinger. North Carolina’s reparations program was successful as far as it went, he said. “It just didn’t go far enough.”</p>
<p id="iH1A10">The effort was one of the most well-known examples of reparations paid to Black Americans as an attempt to right an egregious wrongdoing in health care — part of a growing movement calling for direct monetary payments, free health care, and increased accountability for how the medical system treats Black patients. While the larger reparations movement calls for restitution for centuries of unpaid forced labor and post-emancipation exclusion from wealth-building activities, health care reparations would specifically address past and present harms caused to Black people by the medical establishment. </p>
<p id="aRxx0m">It’s estimated that around <a href="https://www.nytimes.com/interactive/2020/08/11/opinion/us-coronavirus-black-mortality.html">8.8 million Black Americans died prematurely</a> between 1900 and 2015 because of the racial health gap. One <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798135">recent study</a> found that household wealth was directly correlated to health outcomes. Advocates for a multi-pronged reparations package focused on monetary and political restitution for this harm say that such reparations would boost the health of Black communities. </p>
<p id="YQstGl">But academics and public health experts have long disagreed on whether financial reparations alone are an approach that can adequately rectify centuries of ill treatment that has resulted in dismal health outcomes for Black Americans. Will they solve the health inequities ingrained in a system designed to perpetuate harm?</p>
<p id="4zUudU">Blackmon’s story illustrates just how complex finding victims and appropriately compensating them can be. </p>
<h3 id="pL9Ubr">How history propelled racial disparities in health outcomes<strong> </strong>
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<p id="pTG6nU">Substantial evidence exists that enslavement negatively affected all aspects of Black life and laid the foundation for the health disparities Black Americans experience today. During enslavement, race was biologicalized, bolstering the belief that Black people were inferior. The enslaved were subjected to substandard housing conditions, poor sanitation, and food scarcity because of it. Combined with a lack of access to clean water and clothing, it placed them at a higher risk for respiratory diseases their immune systems had never before encountered and barred them from doing many of the things that make someone healthy, such as accessing adequate medical care. (Though they had <a href="https://www.monticello.org/sites/library/exhibits/lucymarks/medical/slavemedicine.html">their ways</a>.) Much of what we know about modern medicine began on the plantation and set the tone for the poor health currently experienced by Black Americans. </p>
<p id="phi6eh">Enslavers went to great lengths to prevent physicians from treating enslaved Africans’ ailments, frequently accusing them of “malingering.” It’s not as if the doctors were helpful, however. Typically, their purpose was to get an enslaved person back to work. And if the required medical “care” was more intensive, it was often incredibly harmful to the enslaved. </p>
<p id="4b63FM">“There were scientists and eugenicists who … thought about Black people as an entirely different species,” says Avik Chatterjee, an assistant professor at the Boston University School of Medicine. </p>
<p id="opWEnz">The way that doctors and scientists thought and wrote about race was one of the many tools used to justify enslavement’s continuation. “It’s not just that people in medicine and people in science were a part of a system, but they helped create the system that allowed for enslavement and oppression,” says Chatterjee. </p>
<p id="BlQMcF">Current misbeliefs that Black patients are more difficult, have thicker skin that is less prone to pain, or make up symptoms were cultivated during enslavement. Today, much of modern medicine <a href="https://capitalbnews.org/health-equity-explainer/">does not protect Black Americans</a>, who are at least three times as likely as white people to die from pregnancy-related causes, face disproportionate rates of chronic diseases, and often bear the most severe outcomes of infectious disease outbreaks. Black patients are underprescribed pain medication, excluded from experimental drug trials that could help manage an illness and provide fuller data for Black health outcomes, denied lifesaving medical procedures, or encouraged to undergo more harmful ones. Being Black is still a medical categorization via race adjustments, which allow medical providers to make clinical decisions based on a patient’s race. (A well-known instance of this is eGFR measurements, a medical formula that helps determine the health of the kidneys, for which <a href="https://slate.com/technology/2021/06/kidney-transplant-dialysis-race-adjustment.html">there is a higher bar for Black patients</a> — a practice that frequently prevents them from receiving treatment, such as transplants, that can enhance or save their lives.) Currently, the <a href="https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-health-status-outcomes-and-behaviors/">life expectancy</a> for Black Americans is 71.8 years versus 77.6 years for white Americans. </p>
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<p id="W2j6jg">Poor outcomes among Black Americans are also compounded by inequities that seep into their environment and community, such as a lack of access to affordable housing and healthy foods, exposure to violence or toxic waste, and the unavailability of open-air green spaces. These factors, often referred to as social determinants of health, affect people’s well-being. And they are often tainted by a history of racist social, economic, and housing policies. </p>
<p id="gSI0hj">These wrongs were never adequately addressed, leaving the playing field inequitable. That truth is the crux of the health care reparations movement. </p>
<h3 id="OiiTwO">Behind the call for reparations</h3>
<p id="Au2ZIT">Health care reparations became a substantial academic topic in the early 2000s. As Vernellia R. Randall, a law professor at the University of Dayton, <a href="https://academic.udayton.edu/health/01status/status07.htm">wrote</a>, a reparations package capable of eradicating the “Black health deficit” would entail a medley of transformative systemic changes focused on fixing the underlying causes of these disparities. They included, but weren’t limited to, universal health care, repairing environmental racism, providing a living wage, and encouraging cultural competence among physicians. </p>
<p id="ktwOfr">While other systemic factors would ideally be included in a health care reparations package, the general push for reparations is a separate endeavor, addressing economic, political, and housing discrimination resulting from enslavement. </p>
<p id="YumyFI">The effort to redress the harms to sterilization victims in North Carolina is a prime example of health reparations. In the case of that state’s reparations program, however, some of those who were directly affected were able to be located, but the program still missed people whose sterilization wasn’t approved by the state board — people like Blackmon. The same issue could befall any program searching for the descendants of specific harms in medicine, says Chatterjee. Many would exclude Black Americans whose ancestors were used as test subjects for medical experiments without anesthesia and <a href="https://www.rvu.edu/wp-content/uploads/2021/02/A-perspective-on-J.-Marion-Sims-and-antiBlack-racism-in-OBGYN-JMIG-Feb.-2021.pdf">maimed by doctors like James Marion Sims</a> or who died from smallpox in the early 20th century because of <a href="https://news.harvard.edu/gazette/story/2019/10/ramifications-of-slavery-persist-in-health-care-inequality/">the barriers to quality care post-emancipation</a>. It would also leave out Black patients currently dealing with the ramifications of the pseudoscience established during enslavement — such as doctors believing that they have “naturally” <a href="https://www.statnews.com/2020/09/15/lung-function-algorithms-health-disparities-black-people/">lower lung capacity</a>. </p>
<p id="eFCkFU">Growing evidence like this is bolstering the movement in favor of broader health care reparations. “Medical Reparations build on the longstanding call for slavery reparations by focusing on the specific debts owed to Black people in healthcare settings,” reads a report from the Repair Project, an initiative designed to address anti-Black racism in science and medicine. “It is a response to the health effects of racism writ large as legacies of slavery that persist today and that call for repair.”</p>
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<p id="wGjWUS">But the notion has not come without criticism. </p>
<p id="1kmeE1">“The US health care system needs a lot of work. It’s broken. It needs fixing,” said Darrell Gaskin, director of the Hopkins Center for Health Disparities Solutions. “Why try to put on a Band-Aid if all your pipes are leaking?”</p>
<p id="Tmkhwq">Gaskin supports compensation for patients who are victims of violence, like those who endured North Carolina’s forced sterilization program and the Tuskegee experiment. “I put that in the same category as if you went to a doctor, they made an egregious error, and you sued them for malpractice,” he says. </p>
<p id="IJdijt">But reparations, he argues, are a patch on a system that is inherently broken. On his list of potential solutions for health inequities, “a check is at the very end.”</p>
<p id="HUEqzi">It’s the health care structure that must be rebuilt, Gaskin says. Paychecks are “not necessarily fixing the system so that it stops injuring people.”</p>
<h3 id="mvuNlX">Why some believe payouts aren’t enough</h3>
<p id="k1Mkjt">Gaskin isn’t alone in his reasoning. While many experts believe payouts should be included in a reparations package, since they would provide people with <a href="https://www.salon.com/2020/01/15/the-wealthy-get-10-more-years-of-good-health-study-finds/">the quality of medical access that wealth brings</a>, there is a strong agreement that cash won’t provoke the systemic changes necessary to improve Black Americans’ well-being. </p>
<p id="qvzaT3">“We see that [wealth] doesn’t necessarily alleviate health inequities because, particularly in maternal outcomes, we see that <a href="https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth">Black women with graduate-level degrees</a> and <a href="https://www.cnn.com/2018/08/06/health/beyonce-vogue-pregnancy-complication-bn/index.html">astronomical amounts of wealth</a> still have poorer health outcomes than white women who haven’t graduated high school,” says Brittney Francis, a social epidemiologist at Harvard’s FXB Center for Health and Human Rights.</p>
<p id="1WgGDV">“It’s also a matter of revamping our educational system,” she adds. “It’s no good paying [people] money if you still are going to go see a doctor who’s educated in a system that uses a textbook saying that Black folks feel less pain.” </p>
<p id="3p2ztB">A solid reparations package, according to Francis, would also be multi-pronged and implement several key institutional changes. An educational component would better educate current and aspiring clinicians on their biases while eradicating anti-Blackness from the material they’re taught. It would also include plans to improve <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365659/">the health literacy of Black Americans</a>. And since “it’s estimated that” <a href="https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/">only 10 to 20 percent</a> of what determines health occurs in a clinical setting, such a package should include policies that bolster the infrastructure affecting other determinants of health. </p>
<p id="L2i3uC">Even though cash payments would allow a family that relies on public transit to buy a car, for example, they wouldn’t shorten the drive to the grocery store if that family lived in a community where disinvestment has left residents with <a href="https://slate.com/business/2021/04/dc-food-desert-grocery-black-residents-car-apartheid.html">no access to fresh foods</a>. It wouldn’t stop local governments from making <a href="https://www.propublica.org/article/how-black-communities-become-sacrifice-zones-for-industrial-air-pollution">zoning decisions</a> that allow Black communities to become saturated with environmental pollutants. Money won’t encourage cities to build <a href="https://www.nytimes.com/2022/10/05/health/diabetes-prevention-diet.html">more walkable communities</a> or improve the air quality in neighborhoods bisected by highways — and it won’t stop that same political devastation from happening again. If history serves as a predictor, should Black Americans use the funds to move into better-resourced, wealthier areas, the white residents would <a href="https://www.apa.org/news/press/releases/2021/10/white-flight-segregation">likely flee</a> — taking <a href="https://www.brookings.edu/essay/homeownership-racial-segregation-and-policies-for-racial-wealth-equity/">the resources that prevent underinvestment</a> with them. </p>
<p id="JwaMgM">“I don’t think that folks would actually be able to reap the benefits that we think they’ll be able to see,” Francis says of reparations payments on their own. “A lot of it will be maneuvering through the same systems, just with more money.” </p>
<h3 id="hOgJZd">What health reparations look like in action and what’s next </h3>
<p id="C1DuJd">In the 1970s, as North Carolina was ending its forced sterilization program, the federal government <a href="https://www.npr.org/2022/06/11/1104386467/tuskegee-syphilis-study-milbank-memorial-fund-apology">reached a $10 million settlement</a> with the surviving victims of the Tuskegee experiment <a href="https://www.nytimes.com/1997/05/12/us/families-emerge-as-silent-victims-of-tuskegee-syphilis-experiment.html">and the families</a> of those who died. As a part of that nonconsensual medical experimentation, nearly 400 Black men were intentionally denied syphilis treatment beginning in the 1930s. </p>
<p id="zPdR1s">The settlement, which came a year after the experiment ended, included monetary compensation and lifelong health care for participants and their immediate families. </p>
<p id="O2aYu3">Despite the government’s reparations effort, the experiment remains among the most infamous in American history, scarring Black patients, who have been left skeptical of the same medical system that abused their grandparents and <a href="https://capitalbnews.org/black-women-pain/">continues to dismiss them</a>. The trauma passed down generations partially explains why Black communities remain hesitant to engage in clinical research, where they are underrepresented, and why they’re wary of medical care in general. </p>
<p id="VBY75u">“You have to heal,” says Monica Ponder, an assistant professor of health communication and culture at Howard University. “You have to restore trust in the population when it comes to people feeling safe in their bodies and in communal spaces.” Although she applauds the efforts to right historic atrocities, she says she continues to see Black Americans hurt by the health care system today. </p>
<p id="9j3qqy">“Why is it always about <a href="https://www.nature.com/articles/d41586-020-02494-z">Henrietta Lacks</a> or Tuskegee when harm happens almost every day?” Ponder wonders. “Why does it have to get to that point?”</p>
<p id="z1ZIrY">What constitutes harm needs to be redefined, she said. “Violence happens often in the health care system.” </p>
<p id="8Wo5iM">How reparations in health should look, in Ponder’s eye, depends on how they will be defined. She describes the movement as being at a critical point, bursting with new avenues and opportunities to explore. In her mind, reparations should have been paid already as a means to bridge the gap between the bondage of slavery and equitable health outcomes. </p>
<p id="hWp52a">Some of those potential solutions include adding layers of accountability for doctors and hospitals by ensuring complaints are reviewed and penalties are enacted in real time, or addressing the racial disparities in incarceration rates for cannabis use, she said. They could also look like free access to physical and mental health care.</p>
<p id="c2fXMd">But that free care, says Ponder, must be safe. </p>
<p id="hQwmzR"><small>This series on reparations is made possible by a grant from the </small><a href="http://www.rwjf.org/"><small>Robert Wood Johnson Foundation</small></a><small> to Canopy Collective, an independent initiative under fiscal sponsorship of Multiplier. </small><small><em>All Vox reporting is editorially independent. Views expressed are not necessarily those of Canopy Collective or Robert Wood Johnson Foundation</em></small><small>. </small></p>
<p id="ZIEpCG"><small>Canopy Collective is dedicated to ending and healing from systemic racialized violence. Multiplier is a nonprofit that accelerates impact for initiatives that protect and foster a healthy, sustainable, resilient, and equitable world. Robert Wood Johnson Foundation is committed to improving health and health equity in the United States</small>.</p>
https://www.vox.com/policy-and-politics/23529685/healthcare-reparations-slavery-equityJulia CravenMargo Snipe, Capital B2022-12-23T08:00:00-05:002022-12-23T08:00:00-05:00It’s all too easy to get sick right now. Here’s how to protect yourself.
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<p>Navigating flu, RSV, and Covid all at once can be overwhelming, but a bit of planning and vigilance goes a long way.</p> <p id="bFxqrh">Right now, the US is in the middle of an infectious disease trifecta. The “tripledemic” of the coronavirus, influenza, and respiratory syncytial virus (RSV) has led <a href="https://www.nyc.gov/site/doh/about/press/pr2022/health-department-issues-commissioners-advisory.page">New York City</a> and <a href="https://www.latimes.com/california/story/2022-12-13/why-mask-wearing-urged-again-amid-high-covid-flu-levels">Los Angeles County</a>, among others, to “strongly recommend” masking indoors. Officials in <a href="https://abc7news.com/oakland-mask-mandate-covid-cases-surge-indoor-public-buildings-masks/12568176/">Oakland</a> and <a href="https://www.cbsnews.com/sacramento/news/masks-could-return-to-sacramento-schools-as-covid-19-transmission-levels-rise/">Sacramento</a> may follow suit soon. The CDC, which has barely spoken about masking for the past year, now advises wearing one based on Covid-19 community levels — a recommendation that <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/indicators-monitoring-community-levels.html">considers hospital admissions, beds available, and the number of case rates</a>. </p>
<p id="nlwYgU">Look, I’m not trying to freak you out with this objectively scary information. The data simply speaks to how crucial it is to prepare to weather this season. There’s a sense of fatigue especially when it comes to Covid: It’s been almost three years since that particular pandemic started, and the recommendations from officials have remained confusing. It’s overwhelming; I totally get that. But addressing the emotional reality of navigating these illnesses can go a long way toward protecting you and your loved ones. </p>
<p id="3q3jDw">Covid-19 cases have <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">increased</a> by 26 percent over the two weeks preceding December 19, while hospitalizations and deaths have seen a 14 percent and 63 percent jump, respectively. And this flu season is on trend to be <a href="https://www.vox.com/2022/12/6/23494948/flu-influenza-rsv-covid-vaccine-chart-tripledemic-tridemic">one of the worst</a> in recent years. The CDC <a href="https://www.cdc.gov/flu/weekly/">estimates</a> that 15 million people have contracted the flu this season. As of December 16, at least 150,000 people have been hospitalized, and 9,300 have died from flu rates higher than average. And even though RSV is beginning to trend <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">downward</a>, infection rates remain high. These high rates of illness are also putting a major <a href="https://www.cnn.com/2022/12/13/us/covid-rsv-flu-viruses-trifecta-hospitals/index.html">strain</a> on hospitals and pharmacies. </p>
<p id="8nMDBC">So how can we best navigate this icky viral chaos? I asked Elizabeth Stuart, a Johns Hopkins Bloomberg School of Public Health professor, and James Conway, a physician specializing in pediatric infectious disease at the University of Wisconsin. Here’s their advice, edited for length and clarity. </p>
<h3 id="2MuWOg">Don’t engage in presenteeism: Stay home if you’re sick</h3>
<p id="DPUST9">This one feels the most obvious, but for many reasons, it doesn’t always pan out. <a href="https://www.minnpost.com/other-nonprofit-media/2022/12/flu-rsv-and-covid-are-wreaking-havoc-but-teachers-dont-feel-like-they-can-stay-home-when-theyre-sick/">Some employers</a> have exploitative <a href="https://www.cnbc.com/2022/10/24/cold-and-flu-season-is-here-and-people-are-showing-up-to-work-sick.html">workplace policies</a> to ensure workers come in even when they don’t feel well. Some employees succumb to the idea that working while sick makes them an ideal employee, someone willing to sacrifice their well-being for the company.</p>
<p id="qqriuV">But symptoms of any sort, mild or severe, are a clear sign to stay home. “For far too many years, whether in the workplace or for important social engagements, people took it as a badge of pride that they would tough it out and go to work even if they were sick,” said Conway. “I think people have finally come around to recognizing that’s both impractical and a little disrespectful to others.” </p>
<p id="8hpanO">For people who <a href="https://www.ucihealth.org/blog/2018/01/working-while-sick">can’t miss a shift</a> — the reality for many in the service industry, especially —other measures like masking, handwashing, and vaccination will be crucial to your well-being and everyone else’s. (The biggest help, of course, would be a universal sick leave policy.) </p>
<h3 id="jmLNOs">Get vaccinated!</h3>
<p id="4AeIqX">Ensure you’re up to date with your vaccines. Unfortunately, both <a href="https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-doses-distributed.html">flu vaccine</a> and <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">Covid booster rates</a> are lagging this year, which is concerning considering the severity of the season.</p>
<p id="qmN6uY">“The vaccines are a really very good match this year for what’s circulating and are performing well,” said Conway. </p>
<p id="5sXgn5">Some <a href="https://theconversation.com/politicizing-covid-19-vaccination-efforts-has-fuelled-vaccine-hesitancy-175416">remain hesitant</a> when it comes to vaccines, some <a href="https://theconversation.com/beyond-vaccine-hesitancy-understanding-systemic-barriers-to-getting-vaccinated-193610">lack access</a> to the vaccines they need, and others don’t think they’re necessary. For Covid boosters, specifically, Conway says people are likely to believe that receiving their primary series, recently contracting the coronavirus, or some combination of both protects them well enough. (If you contract Covid-19 before you get vaccinated or boosted, the CDC does recommend <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html">delaying the shot by three months</a> after the start of symptoms or a positive test. You’ll get the most out of your vaccine if you ride out your post-viral immunity.) </p>
<p id="A5eW9q">“That probably was decent enough back in the delta era,” he said. “But with these rapidly emerging omicron variants, especially this new BQ subvariant that’s replaced the BA.4 and BA.5, you’re basically unprotected unless you’ve had the bivalent booster.” </p>
<h3 id="xjzjcI">New Covid subvariants might <a href="https://www.cnbc.com/2022/12/14/covid-news-bq-xbb-omicron-subvariants-pose-serious-threat-to-boosters.html">cause more breakthrough infections</a>. Wear a mask and wash your hands.</h3>
<p id="RyvZrW">Both Stuart and Conway advised keeping a lot of masks around — hang one by your car keys, keep a few in your bag, throw an extra in your coat pocket, and share them with others. The same goes for hand sanitizer or, preferably, washing your hands regularly. </p>
<p id="KkP3T9">“Some of these viruses do aerosolize and fly through the air, but the majority of respiratory viruses are transmitted by what we call droplets, where people cough and sneeze and they land somewhere,” explained Conway. “And then you touch that space and touch your own face. Wearing a mask is a way of keeping your hands away from your face. Hand hygiene is an extra layer.”</p>
<p id="ZwKUSn">Finding a mask that fits you well is essential, too, added Stuart. If you like your mask, you’ll be more likely to wear it, and you can buy that winner in bulk. </p>
<p id="92yBKw">The caveat is that masks can be pricey. Stuart advised checking to see if any organizations in your area are giving them away for free. In Washington, DC, for instance, masks are available to anyone who wants them at local Covid centers. The CDC also has a tool that allows people to find <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/free-masks.html">free N95s</a> based on their zip code. A quick search showed CVS, Walgreens, local pharmacies, and <a href="https://nymag.com/intelligencer/article/how-to-get-free-n95-face-masks-from-the-us-government.html">several major grocery store chains</a> are a significant part of the program in more rural areas, which still suffer from <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14636-1">limited access to vaccines</a>. </p>
<p id="L1AGsr">If you manage to grab an N95 or KN95, you can use it until it’s visibly dirty, too loose-fitting, or falling apart — knowledge that lets you know it’s cool to stretch that mask for the week. “Masks are disposable but not single-use,” said Stuart. “You don’t need a new mask every single day or for every single interaction.” </p>
<h3 id="yOQ98c">Let the outside air come inside and clear out anything icky</h3>
<p id="lpyDCm">If you share a home with someone sick, don’t be afraid to wear a mask inside or crack open a window to help ventilate the space. </p>
<p id="tEh9MV">“This week, my daughter has been sick, and I’m now wearing a mask inside the house when I’m with her,” said Stuart. “We hopefully have learned from the past couple of years to have more appreciation for ventilation and how to prevent spreads — whether that’s cracking the windows a little bit or wearing masks, especially in large groups.” </p>
<p id="dMocEs">You can also circulate air throughout your home by putting a fan in the window, turning on the exhaust fan above the stove or in the bathroom, <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-home.html">which helps move air outside the house</a>, or grabbing a HEPA air filter if you can afford it. A <a href="https://khn.org/news/article/how-better-ventilation-can-help-covid-proof-your-home/">humidifier</a> could come in handy, too, since the coronavirus isn’t a fan of damp air. </p>
<h3 id="VMkDwj">Set the tone with friends and family</h3>
<p id="aNVhE8">Setting boundaries with your loved ones isn’t always easy, but it benefits everyone to do so during this tripledemic. So don’t feel guilty for declining invitations to crowded parties or not allowing anyone who isn’t vaccinated to attend a gathering you’re hosting. </p>
<p id="V7HBNh">Besides, requiring vaccination for flu and Covid, or a rapid test prior to arrival, might not be that big of a deal to them anyway. </p>
<p class="c-end-para" id="WwMUmm">“I’ve been sort of pleased with some of the invitations I’ve received for social gatherings where people are saying their expectation is that everybody’s vaccinated,” said Conway. “Where that would be considered provocative in the past, I think it is becoming a little bit more normalized.” </p>
<p id="r0yO5P"><a href="https://www.vox.com/authors/julia-craven"><em><strong>Julia Craven</strong></em></a><em> is a writer covering anything she thinks is cool, and she’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em><strong>Make It Make Sense</strong></em></a><em>, a wellness newsletter.</em></p>
<p id="OV6sP6"><a href="http://www.vox.com/even-better"><em><strong>Even Better</strong></em></a><em> is here to offer deeply sourced, actionable advice for helping you live a better life. Do you have a question on money and work; friends, family, and community; or personal growth and health? Send us your question by filling out this </em><a href="https://docs.google.com/forms/d/e/1FAIpQLSfiStGSlsWDBmglim7Dh1Y9Hy386rkeKGpfwF6BCjmgnZdqfQ/viewform"><em><strong>form</strong></em></a><em>. We might turn it into a story.</em></p>
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https://www.vox.com/even-better/2022/12/23/23516609/tripledemic-covid-flu-rsv-tipsJulia Craven2022-10-21T09:00:00-04:002022-10-21T09:00:00-04:00How to move your body when your brain won’t cooperate
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<p>The mental health benefits of moving your body are considerable, even though the barriers to entry can feel high. </p> <p id="BNh7nU">Six days out of the week, at roughly 2 pm, I exercise. It’s my midday pick-me-up (as opposed to having another cup of coffee), helping me catch my second wind and finish out the day. How intense it is depends on how I’m feeling. It could be a Peloton class or a heavy weight-lifting session. Or it could be a more restorative practice such as yoga or a long walk. </p>
<p id="qfburA">It seems like a simple enough endeavor, baked into my schedule, and ready for me to execute. There are many days, though, when I just don’t want to. I could be sitting in my gym clothes, with my bag packed and by the door, willing myself to get up and go move my body. These are the moments when I step back and assess if I should push myself, do something lighter than planned, or consider it a rest day and watch <em>Rick and Morty</em> reruns. </p>
<p id="uDjqPM">This is a feeling most of us know well. There are days when you have the motivation, others when you have to muster up your willpower to get moving, and some when you decide to just take the day off. But movement, and resolving to do <em>something</em> even when you don’t feel up to it, doesn’t need to be about getting fit or hitting a personal record in the gym. The best benefits of being active in some way are often the ones we don’t see touted on Instagram — like having <a href="https://www.health.harvard.edu/exercise-and-fitness/does-exercise-really-boost-energy-levels">more energy during the day</a>, building strength, boosting <a href="https://ucfhealth.com/health-tips/lift-the-brain-fog-with-aerobic-exercise/#:~:text=Most%20people%20think%20of%20exercise,brain%2C%20memory%20is%20typically%20enhanced.">brain health</a>, and other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#:~:text=Exercise%20improves%20mental%20health%20by,self%2Desteem%20and%20cognitive%20function.&text=Exercise%20has%20also%20been%20found,self%2Desteem%20and%20social%20withdrawal.">mental health benefits</a>. Movement provides nearly everyone and every body with these benefits — <a href="https://www.vox.com/even-better/2022/8/17/23306357/aesthetic-fitness-workout-tiktok-mindset">no “perfect” aesthetic necessary</a>. And while someone who is navigating a serious bout of depression or anxiety likely won’t have the same intrinsic motivation capacity as someone whose mental health is stable, everyone benefits from moving in some way. </p>
<p id="3agqK3">So how can we structure our lives and environments to ensure that we get moving, in some way, on those days when we’re struggling to do so? I spoke with several fitness experts to see how. Here’s what they said. </p>
<h3 id="ht7Fxg">Remind yourself how good it feels to move your body, and reframe what’s considered movement</h3>
<p id="pqP40Q">The Department of Health and Human Services recommends getting <a href="https://www.cdc.gov/physicalactivity/basics/adults/index.htm">at least 150 minutes</a> of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week, plus two days of strength training. </p>
<p id="EgVAfy">This doesn’t mean you need to visit your gym each day and push heavy weights or take a HIIT class. There’s a difference between exercise and physical activity. The former refers to structured activity in pursuit of a fitness goal, while the latter can be anything that requires you to move — including going on a walk, taking a virtual yoga class, dancing around your apartment, playing with your kids or pets, or some light stretching. On those days when you don’t feel up to your exercise routine, taking it easier than usual can still be a way to hit the recommended physical activity benchmarks. </p>
<p id="FhN1Qm">We feel different every day due to sleep quality, stress, work, family obligations, and our mental health. Saving the tough workouts for the days you feel amazing, and modifying on the days you don’t, allows you to take better care of your body in the long run. Striving for perfection is a sure way to burn out. It’s okay to deviate from the plan in order to meet yourself where you are and figure out why you don’t feel up to your usual. Is it a need for more sleep? Better stress management? Or more food? </p>
<p id="HtVGZ8">“Any movement that you can do is going to benefit your body, whether or not it’s at the gym or structured exercise,” said Katie Heinrich, a professor of kinesiology at Kansas State University. “So maybe you’re in your gym clothes. You’re like, ‘Man, I just do not want to go to the gym.’ That’s fine. Just move. Put on a song you like to dance to. Or do 10 pushups, 10 situps, and 10 squats. Even just standing and moving is better than sitting.”</p>
<h3 id="Se0Hob">Find an accountability buddy</h3>
<p id="nljrWI">Having friends who support you in moving your body can be the deciding factor between getting some steps in for the day or crashing on the couch, according to Sami Yli-Piipari, a physical activity specialist at the University of Georgia. Making physical activity a group endeavor can foster a sense of community and make you feel like others are on your side — a powerful motivator. “Humans have a need to be autonomous. They have a need to be competent in what they are doing, but also they need to feel like a relationship is there,” he explained. </p>
<p id="wTOqkQ">Plus, it’s harder to opt out of a pre-planned activity if friends or a trainer are waiting on you before class. Yli-Piipari also noted that less straightforward things, like scheduling an Uber in advance to pick you up for the gym, can help. </p>
<h3 id="Pm0KRa">Create an environment that promotes sustainable movement </h3>
<p id="EiCrK6">Our personal environments can <a href="https://www.takingcharge.csh.umn.edu/how-does-your-personal-environment-impact-your-wellbeing">promote or hinder our well-being</a> — a complex reality influenced by someone’s various privileges and disadvantages — and it has a direct influence on how motivated we are to get something done. Taking your workout clothes to work, packing your gym bag the night before, laying out workout clothes in advance, or placing them on a chair you walk by frequently are just a few tips the experts I spoke to offered for building an environment that promotes movement. </p>
<p id="cGUOi4">It’s imperative to take stock of how you can fit bouts of movement into your day. Maybe it’s with a standing desk or walking around your room every hour. For others, scheduling physical activity in a digital calendar or planner the same way you’d note a doctor’s appointment is effective. For those of us who love crossing things off a list, writing down exercise as if it’s a task helps too. </p>
<p id="BtPVI7">But it’s also vital to be realistic about when it happens. If you’re not a morning person, don’t schedule morning workouts. If your evenings are spent wrangling family obligations or you want to go out with your friends, then maybe a lunch hour session is best. And if an hour block isn’t feasible, Heinrich suggests breaking it up into smaller chunks, which may work best for those with rigid or unpredictable schedules. Parents can also squeeze in workouts by joining their kids in running around on the playground, or doing a circuit as they’re watching their kids play. (A big selling point for at-home workouts is the fact that you can watch your children, take a meeting, or cook a meal in the oven during an exercise session.)</p>
<p id="T3MUxA">“Every minute of activity that you can do creates physiological and mental responses in your body,” she explained. “And typically, if someone is feeling exhausted, if you move your body, you will find that you feel better. And those aches and pains that you are starting to feel may just go away.” </p>
<h3 id="MJlxiJ">Know the difference between feeling sluggish and actually needing to rest</h3>
<p id="OTAla8">Everyone I spoke with was clear that movement isn’t always the best solution to feeling blah. Perhaps the most important thing you can do is figure out the difference between needing to take a walk and needing to rest your body. Tiredness can occur for a number of reasons. Sometimes you’ve been looking at your screen for too long, and you need an activity break. Other times, you could need a nap. If the fatigue is overwhelming or persistent, your body could <a href="https://www.thecut.com/2022/09/what-is-adrenal-fatigue.html">be signaling</a> that there’s an underlying medical issue that needs to be addressed. And of course, if you’re experiencing a fever, pain, or an injury, that’s a clear indication that you need to focus on getting better. </p>
<p id="64Au26">But Brittany Brandt, the fitness and well-being coordinator for West Virginia University, said that if you just feel tired and want to skip that day’s physical activity, that’s okay too. Try not to beat yourself up over “breaking a streak,” and instead afford yourself some grace, she said. Throwing in a little something daily — whether it’s a walk around the block or a quick stretch before bed — will do your body much better than stressing out over not moving as you had planned for the day. </p>
<p class="c-end-para" id="Kfjs93">“People put themselves in a box sometimes of, ‘Oh, I have to work out Monday through Friday,’ or only on certain days, and if they get derailed, they say, ‘I’ll just try again on Monday,’” she said. “But there’s no stigma on that. You can move every day.” </p>
<p id="r0yO5P"><a href="https://www.vox.com/authors/julia-craven"><em>Julia Craven</em></a><em> is a writer covering anything she thinks is cool, and she’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em>Make It Make Sense</em></a><em>, a wellness newsletter.</em></p>
<p id="OV6sP6"><a href="http://www.vox.com/even-better"><em>Even Better</em></a><em> is here to offer deeply sourced, actionable advice for helping you live a better life. Do you have a question on money and work; friends, family, and community; or personal growth and health? Send us your question by filling out this </em><a href="https://docs.google.com/forms/d/e/1FAIpQLSfiStGSlsWDBmglim7Dh1Y9Hy386rkeKGpfwF6BCjmgnZdqfQ/viewform"><em>form</em></a><em>. We might turn it into a story.</em></p>
https://www.vox.com/even-better/23412818/exercise-movement-work-out-motivation-mental-healthJulia Craven2022-08-17T08:00:00-04:002022-08-17T08:00:00-04:00You don’t need to look perfect to work out
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<figcaption>Aspirational fitness content can create unrealistic expectations. Here’s how to tune it out. | Shanée Benjamin for Vox</figcaption>
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<p>Don’t focus on aesthetics — fitness is a feel-good ritual.</p> <p id="xTNNe7">You’ve probably seen her before, all over your TikTok feed. She likely woke up before sunrise in a tastefully but minimally decorated apartment. <a href="https://www.tiktok.com/t/ZTRAA8fQk/?k=1">By 7 am</a>, she’s putting on a matching workout set and slicking her hair back into a sleek bun. After her workout, which was probably pilates or a weight-lifting session, she contorts her body into the perfect pose for the mandatory post-workout mirror selfie. She often proclaims to be “that girl,” and her online aesthetic is a moment of fleeting perfection. She’s stunning. She’s fit. She has <em>the look</em>. </p>
<p id="EXxZBT">“That girl” hasn’t strayed far from its original status as a way to hype up your girlfriends. But now, that badge of honor has morphed into a ubiquitous health and wellness archetype that panders to Western beauty ideals, especially on TikTok. (It’s also dominated by thin white women.) To date, the hashtag #thatgirl has accrued more than 5.7 billion views on the platform. </p>
<p id="rPBG2t">Online fitness is becoming more and more intertwined with performing pleasantness — and, by extension, being perceived as beautiful at all times. Whether this is positive or negative depends on the person consuming the content. It could inspire some consumers to pursue healthier habits or to organize their days in a way that makes more sense for them. And believing oneself to be an it girl can serve as a confidence booster. </p>
<p id="tuPRUw">But for others, aspirational content can exacerbate pre-existing insecurities. “There are certain people who are more susceptible to being influenced by others,” explained Joe Phua, a social media expert and professor at the University of Georgia. “They may feel like they need to live up to those standards that are seen in the video in order to be liked or to feel good about themselves.” </p>
<p id="Tjl1Or">As more people post this type of content, it can become a convention. Those social codes can create unrealistic expectations and potentially cause people to think if their workout doesn’t fit into the bounds of that pattern, it’s not <em>real</em>. It enunciates the fine line between aspirational content and the reality of working out, which often results in looking a mess once the hard work is done. But since social media is a highlight reel of someone’s life, what does it mean to post this content online and uphold it as an aesthetic to hundreds or thousands of impressionable followers? And what are the effects of it becoming a trend? </p>
<p id="ZLpsSZ">I took this context into my conversation with Dr. Michele Kerulis, a former fitness instructor who is now a professor of counseling at the Family Institute at Northwestern University, specializing in sport and exercise psychology. During our conversation, we discussed what it means to uphold a look over health, the negative aspects of community building online, and how anyone who wants to post their content can do so honestly. </p>
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<p id="Fhbv92"><strong>What are the pitfalls of uplifting an aesthetic in terms of exercise? Do you think this is an extension of externally derived gratification that’s commonly seen in fitness spaces? </strong></p>
<p id="BEHRWp">While a lot can be controlled about the way we look, there is also a lot that we cannot control about our looks. A pitfall of focusing on aesthetics is that people might become preoccupied on some of these factors we can’t change. This can lead to a dangerous downward spiral of low self-confidence and high social comparison. Another pitfall is that focusing on aesthetics can distract you from the point of exercise — to maintain a healthy mind and body. Additionally, some people spend a small fortune on workout gear and clothes, so if people don’t budget well, they might overspend trying to keep up with others. </p>
<p id="V4eZWq">Before I was a professor, I was a group fitness instructor and I worked diligently to choose my language carefully as a way to uplift my exercisers’ confidence in their own unique abilities. I worked with people from a variety of ages and physical abilities, and it was important to me not to comment on their physical looks. After I demonstrated an exercise and watched the exercisers perform their reps, I would say things like, “Your form looks great!” or “Awesome technique!” I avoided phrases like, “You look great” because I wanted them to focus on the physical feeling of the movements, not on their aesthetic during exercise. </p>
<p id="OYKUVZ"><strong>What are the potential issues with focusing on how someone looks during or after a workout?</strong></p>
<p id="twVRa6">Many people are concerned about how they look and often compare themselves to others. This is called social comparison theory, and it is seen frequently in the gym and other fitness spaces. During exercise, people look at others to see how easy or challenging workouts might be. This can be especially true in group fitness classes. If someone looks very put together and poised at the gym, others might think the workout that person is doing looks easy, when actually it could be quite hard. </p>
<div class="c-float-right"><aside id="4yDSpX"><q>Focusing on aesthetics can distract you from the point of exercise — to maintain a healthy mind and body.</q></aside></div>
<p id="L4ynF5">Looking good is subjective. We all have a different idea of what attractiveness is and what we can do to enhance our own attractiveness. It can be hard to maintain what one defines as looking amazing during a workout, depending on the level of exertion and type of workout. For example, a person who takes a restorative yoga class might conclude class looking really good, and that same person might take a hot yoga class and end class looking like a hot, sweaty mess. Restorative yoga is meant to be relaxing in body and mind, and hot yoga is intended to increase heart rate and strengthen muscles in a high heat and humidity temperature-controlled room. We can assume this exerciser achieved the intended fitness goals during different workouts — relaxation in restorative class and an intense workout in hot yoga. With this example in mind, it is hard for us to tell others’ fitness goals based only on how they look. </p>
<p id="FfeKvf">I encourage people to focus on themselves during workouts so they can be in tune with their bodies and minds. When people constantly look at others for comparison — with the exclusion of your personal trainer or group fitness instructor — they not only put themselves at risk of becoming physically hurt by using improper technique, but they also could be negatively impacting themselves. Potential issues include decreased self-esteem by comparing yourself to others, the possibility of injury by not focusing on yourself, decreased focus on your own goals, and the inability to “mind-read” someone else’s goals just by looking at them. </p>
<p id="NLqhgL"><strong>How can this play out online?</strong></p>
<p id="DfFX01">Almost everything is amplified online due to the nature of the internet, and I see different types of interactions between people, specifically when we’re looking at fitness. But one thing that we know is having other people be aware of someone’s goals helps people stick to their goals. When you’re creating that kind of community around your fitness, that could be extremely positive. </p>
<p id="ohMBGp">It can be negative when people are posting for more harmful psychological purposes, such as boosting their self-esteem, as opposed to their true fitness goals. And other people might make negative comments and start trolling and really misinterpret the original poster’s intention. </p>
<div class="c-float-right c-float-hang"><aside id="cyPeAa"><q>It’s perfectly okay to have confidence and want to put our best foot forward. But we have to make sure that that’s for ourselves and not for others.</q></aside></div>
<p id="XXk4eS"><strong>So much of the fitness content we consume online is about achieving a certain body type. Do you think this trend is supporting that endeavor? </strong></p>
<p id="xN5xOb">The trends we see on Instagram and TikTok definitely encourage certain body goals. For some, this can be motivating, but for others, this can lead to problems like eating disorders. We used to watch workouts on VHS and DVD to try to achieve our body goals, and that has evolved to streaming and social media. Motivational examples include Peloton instructors whose literal job it is to look good and motivate others, people who have overcome challenges related to illness and chronic disease, healthy weight loss success stories, and people who have healed from amputations. All of these people have different body types, and we can find many social media accounts that fall into these categories that encourage people to try their best to reach their own fitness goals. This might or might not include a specific body type. </p>
<p id="W8AOoI">It is okay to admire someone else’s physique and to be motivated by their social media accounts. This becomes problematic when someone thinks there is only one acceptable body type. We also must keep realistic expectations for our body type and body shape. There’s this beautiful curvy look that’s in right now. It’s okay to want to look curvy, but what does curvy mean for your own body? It’s okay to want to look strong. So what does strong look like for your specific body?</p>
<p id="Yc9nSl">But I am pleased to see so many different body types, physical abilities, ages, and health conditions represented in positive ways on social media, and their aesthetic is a part of what makes their accounts successful and motivational. </p>
<p id="zve6Xu"><strong>What’s the difference between focusing too much on an aesthetic and having a feel-good ritual? For instance, I wear all black when I go to the gym because it gets me in the right head space. How is that separate from “I wanna look a certain way during and after this workout so that I’m conveying a specific message to my followers”?</strong></p>
<p id="kEjYpm">Getting into that mindset and following your rituals is definitely important, and that’s for you. So as the exerciser, you’re saying, “I feel good when I have a new pair of shoes, when I’m in all black, or when I have my lucky headphones.” That’s an internal motivation for you. Wanting to look good before or after the physical workout is more of an external validation where people are looking for others to confirm that they’re worthy or good enough. With external validation, somebody might be looking for more comments, more followers, or more likes for a self-esteem boost and not necessarily for the passion of sharing exercise and fitness. Someone getting into their routine and posting that might encourage other people to find rituals that would be helpful for internal motivation. </p>
<p id="wWJE7y">It’s also fine for people to want to look good. It’s perfectly okay to have confidence and want to put our best foot forward. But we have to make sure that that’s for ourselves and not for others. When it starts being more for others than yourself, that’s when we notice some red flags. And sometimes, after a great workout, you might not look as good, but that’s okay too. You’re sweating!</p>
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<p id="e6eVEO"><em>Julia Craven is a writer covering anything she thinks is cool, and she’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em>Make It Make Sense</em></a><em>, a wellness newsletter.</em></p>
https://www.vox.com/even-better/2022/8/17/23306357/aesthetic-fitness-workout-tiktok-mindsetJulia Craven2022-06-15T06:26:23-04:002022-06-15T06:26:23-04:00Juneteenth merch is American consumerism at its most crass
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<p>From enslavement to the “Black tax,” Black people have been asked to pay for freedom for far too long.</p> <div class="c-float-left"> <figure class="e-image">
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<p id="vCo1Rf"><em>Part of the </em><a href="https://www.vox.com/the-highlight/23096448/juneteenth-history"><em><strong>Juneteenth issue</strong></em></a><em><strong> </strong></em><em>of </em><a href="https://www.vox.com/the-highlight"><em><strong>The Highlight</strong></em></a><em>, produced in partnership with </em><a href="https://capitalbnews.org/"><em><strong>Capital B</strong></em></a><em>. </em></p>
<p id="TkBk6n">In November 1855, Elizabeth Keckley made an extraordinary purchase: her freedom. </p>
<p id="lyu00a">After spending years supporting her enslaver and his family by making dresses for the wealthy women of St. Louis, Keckley finally asked him how much it would cost to secure freedom for herself and her son. He reluctantly set the price at $1,200 (<a href="https://www.in2013dollars.com/us/inflation/1855?amount=1200">nearly $40,000 today</a>). After several more years of supporting the enslaver’s family — a tumultuous time that included his death, the transfer of his estate to a new enslaver, and Keckley’s marriage to a man she didn’t much like — she had raised the money required. </p>
<p id="LheHlP">“The twelve hundred dollars were raised, and at last my son and myself were free. Free, free! what a glorious ring to the word,” Keckley <a href="http://historymatters.gmu.edu/d/6224">wrote</a> in her autobiography <em>Behind the Scenes: Thirty Years a Slave, and Four Years in the White House</em>. “Free! the bitter heart-struggle was over. Free! the soul could go out to heaven and to God with no chains to clog its flight or pull it down. Free! the earth wore a brighter look, and the very stars seemed to sing with joy.” </p>
<p id="wecTJa">Freedom has been a peculiar thing in America. Here, the fundamental human right of ownership of one’s body has been sought, chased, bestowed, and purchased. Many of us are taught that this parable of America is a beautiful one — it is a nation where you can do or be anything if you work hard enough for it. But Keckley’s story reflects a more sinister expectation that persists today: that Black people who want to savor America’s sweetest dream must pay for it, again and again. </p>
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<p id="ozv5W7">You could argue that Juneteenth, which acknowledges the day when news of their freedom finally reached the last enslaved persons in 1865, made its most prominent mainstream appearance in 2020. Following the summer’s antiracism demonstrations, the holiday was infused with a new level of significance. Several prominent corporations — including Nike, Twitter, and Target — made Juneteenth a company holiday in an attempt to push forward antiracist policies. </p>
<p id="FyzTY9">Soon, municipalities moved to codify the holiday. Last year, a <a href="https://time.com/5853800/juneteenth-national-holiday/">decades-long fight to make Juneteenth a national holiday</a> was won, underscoring how the circumstances of delayed freedom more than a century ago remain relevant today. Incorporating the legacy of Juneteenth would, the thinking went, bolster the history of Black Americans while highlighting the disparities we still face. </p>
<p id="jGzM5n">“Juneteenth reminds us that freedom, as a lived experience, is still not shared equally. But it is also an observance of resilience in a centuries-old journey,” reporter Audra D.S. Burch <a href="https://www.nytimes.com/2020/06/19/us/juneteenth-2020-in-photos.html">wrote</a> in the New York Times. “It is Black joy and Black hope and the protection of Black hearts and Black celebration in the very streets where demonstrators have shouted the names of Ahmaud Arbery, Breonna Taylor, George Floyd, Rayshard Brooks.” </p>
<p id="UibeWL">Black people are indeed tormented by America today. The country’s capitalist system is no small tormentor, exerting its consequences through high poverty rates, a militarized police force, and so many other derivative structures we come into contact with on a daily basis. That truth is why Black celebrations are sacred. It’s how we commemorate our history. And it is why freedom, for us, is complicated. We’re celebrating a milestone of our ancestors even as we acknowledge a reality we don’t fully have. </p>
<p id="EcGfQT">That’s why it’s so galling to see corporations and businesses dig their nails into Juneteenth as if it’s a trend and not a day of reverence for freedom’s complexities. </p>
<p id="vZxdjO">The commercialization of the holiday has already begun. While a gimmicky <a href="https://www.target.com/p/big-dot-of-happiness-happy-juneteenth-freedom-day-party-favor-kids-stickers-16-sheets-256-stickers/-/A-86435003?ref=tgt_adv_XS000000&AFID=google_pla_df_free_online&CPNG=storefront&adgroup=53-21">sticker pack</a> appears to have been removed from Target’s website, J.C. Penney is still selling Juneteenth <a href="https://www.jcpenney.com/p/juneteenth-mens-reversible-bucket-hat/ppr5008199058?pTmplType=regular&country=US&currency=USD&selectedSKUId=53730350018&selectedLotId=5373035&fromBag=true&utm_medium=cse&utm_source=google&utm_campaign=Bucket%20Hats&utm_content=53730350018&cid=cse%7Cgoogle%7CMens%7cBucket%20Hats_53730350018&kwid=productads-adType%5EPLA&gclid=CjwKCAjwp7eUBhBeEiwAZbHwkVZd2CLuAM0uhiwVbalAf6Gbv5EGdzQpMJOE5qN1a4pJkYeJGRMwcxoCkqMQAvD_BwE&gclsrc=aw.ds">bucket hats</a>. Can coolers declaring “<a href="https://twitter.com/DRWANNLUTHAKING/status/1528733842168741889?s=20&t=kVAixbCzj7EkfYp1rkcTLw">It’s the freedom for me</a>” — a horrendous attempt at African-American Vernacular English — have been spotted. Walmart released a <a href="https://twitter.com/KimberlyYayyyy/status/1528343257905758208?s=20&t=u1O_GmBkL1pJGE8ya3rUbA">Juneteenth-themed red velvet cheesecake ice cream</a>. After it was met with the intense backlash online, the store <a href="https://www.cnn.com/videos/business/2022/05/24/walmart-juneteenth-backlash-vo-meade-hln-ldn-vpx.hln">pulled the product</a>, releasing a statement it had “received feedback that a few items caused concern for some of our customers and we sincerely apologize.” (Here’s <a href="https://travelnoire.com/29-of-the-best-black-owned-ice-cream-brands-across-america">a list of Black-owned ice cream brands</a> to support.) To add insult to injury, all of these products featured the Pan-African flag colors — not the red, white, and blue of the official Juneteenth flag. It only further proves that corporations see Juneteenth as little more than a cash grab. </p>
<p id="8lOsdK">To accurately assess why people are upset about these crass ploys to get money from Black consumers, we have to look at what was historically America’s most profitable financial asset: Black people. “As overseers and plantation owners managed a forced-labor system aimed at maximizing efficiency, they interacted with a network of bankers and accountants and took out lines of credit and mortgages, all to manage America’s empire of cotton,” <a href="https://www.vox.com/identities/2019/8/16/20806069/slavery-economy-capitalism-violence-cotton-edward-baptist">wrote</a> P.R. Lockhart for Vox in 2019. “An entire industry, America’s first big business, revolved around slavery.” </p>
<p id="iV2kv9">Freedom was no less intertwined with American capitalist zeal. On June 19, 1865, Maj. Gen. Gordon Granger of the Union Army reached Galveston, Texas, with the message that all enslaved persons were now free. “This,” he relayed, “involves an absolute equality of rights and rights of property between former masters and slaves, and the connection heretofore existing between them becomes that between employer and hired laborer.”</p>
<p id="lgUssP">Liberation for the enslaved Black Texans, however, came with caveats, as it always does in America. The enslavers not only got to decide how to announce the news, they also could delay that freedom until after the harvest season. Black Texans took the memory of that day with them as they migrated, and the next year, in 1866, <a href="https://www.vox.com/2020/6/18/21294825/history-of-juneteenth">the first Juneteenth was celebrated</a>. Those who left Galveston and their descendants marked the occasion with sporting events, cookouts, fervent dances, parades, Negro spirituals, and, in some instances, fireworks. They also took the time to measure their progress: How far had they come since being freed?</p>
<p id="GAYAIK">That complicated question remains relevant, especially financially. Their freedom from enslavement came with a slew of broken assurances to help Black families gain true liberation. The promise that Black families would receive <a href="https://www.npr.org/sections/codeswitch/2015/01/12/376781165/the-story-behind-40-acres-and-a-mule">a land grant of 40 acres</a> and, in some cases, a mule, was broken following President Abraham Lincoln’s assassination. (“This is a country for white men, and by God, as long as I am President, it shall be a government for white men,” President Andrew Johnson declared in 1866 after he rescinded the order.) </p>
<p id="468dU8">As the Jim Crow years began, so did the mounting cost of simply being Black in America. In the 1890s, poll taxes, buoyed by “grandfather clauses,” were levied to prevent Black people from casting ballots. By excluding domestic and farmworkers, the 1935 Social Security Act <a href="https://www.brookings.edu/policy2020/bigideas/why-we-need-reparations-for-black-americans/">excluded</a> 60 percent of Black Americans. In 1944, despite being federally mandated, the G.I. Bill was executed at the local level and was stymied by redlining and racist housing covenants. (Eventually, that evolved into <a href="https://www.thenation.com/article/archive/mortgage-industry-bankrupts-black-america/">balloon loans</a>.) </p>
<p id="zc94er">It’s estimated that racism has resulted in a staggering <a href="https://www.rochester.edu/alumni/news/the-staggering-cost-of-being-black-in-america">$70 trillion</a> loss for Black Americans, an appraisal most well evidenced in the country’s wealth gap. Enslaved Africans built the infrastructure of this country, and the production of cotton in the South laid the foundation for America’s economic prosperity; America’s <a href="https://www.vox.com/the-highlight/22323477/personal-finance-black-tax-racial-wealth-gap">“Black taxes”</a> are a glimpse into the ways our capital has been demanded, despite our labor never being properly compensated.</p>
<p id="yV334r">The resulting overall gap in wealth could be alleviated by <a href="https://www.brookings.edu/policy2020/bigideas/why-we-need-reparations-for-black-americans/">paying reparations</a>. Or by <a href="https://www.brookings.edu/research/closing-the-racial-wealth-gap-requires-heavy-progressive-taxation-of-wealth/">taxing the wealthy,</a> not to mention multibillion-dollar corporations like Walmart, Target, and J.C. Penney — the same companies attempting to exploit Black Americans’ complex relationship to freedom with shoddy Juneteenth merchandise. </p>
<p id="yC9JYx">The Black people who work in these sorts of stores are <a href="https://www.cnbc.com/2021/04/16/black-workers-face-promotion-and-wage-gaps-that-cost-the-economy-trillions.html">promoted less, and have lower wages</a>, <a href="https://www.americanprogress.org/article/african-americans-face-systematic-obstacles-getting-good-jobs/">worse benefits</a>, and higher job instability than their white peers. (Walmart, which filled its shelves this year with Juneteenth merch, is <a href="https://www.nbcnews.com/think/opinion/walmart-exploits-black-lives-while-paying-lip-service-black-lives-ncna1231493">one of the worst culprits</a> of this.) These corporations were able to build their immense fortunes due to the legacy of white supremacy affording white business owners more capital and opportunity. </p>
<p id="y3SNVp">With Juneteenth ice cream, bucket hats, and other knickknacks no one asked for, they’re taking the desire to celebrate freedom and converting it into products to sell back to us, paying no mind to why we observe the holiday in the first place: We, like Keckley, were once the products, expected to purchase our own autonomy. </p>
<p id="yVOfOa"><em>Julia Craven is a reporter covering health. She’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em><strong>Make It Make Sense</strong></em></a><em>, a weekly health and wellness newsletter, and her work has been featured in HuffPost, Slate, and the 2021 edition of </em>The Best American Science and Nature Writing<em>.</em></p>
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https://www.vox.com/the-highlight/23150067/juneteenth-walmart-icecream-consumerism-merchJulia Craven2022-03-29T07:59:02-04:002022-03-29T07:59:02-04:00The FDA made mail-order abortion pills legal. Access is still a nightmare.
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<figcaption>Paige Vickers for Vox</figcaption>
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<p>Restrictive states have already set their sights on a new wave of telehealth companies that were supposed to be a panacea for a post-Roe world. </p> <p id="P6lfpK"></p>
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<p id="1UjoZ8"><em>Part of the </em><a href="https://www.vox.com/features/22989349/drugs-issue"><em><strong>Drugs Issue</strong></em></a><em><strong> </strong></em><em>of </em><a href="https://www.vox.com/the-highlight"><em><strong>The Highlight</strong></em></a><em>, our home for ambitious stories that explain our world.</em></p>
<p id="5Cmhd7">When Emma found out she was pregnant in February, it was too late for an in-clinic abortion. </p>
<p id="4MT9BB">She estimated that she was at six weeks, but Texas, <a href="https://www.plannedparenthood.org/planned-parenthood-gulf-coast/sb8">a bastion of retrograde abortion policy</a>, bans the procedure at roughly that mark, so any local options were out of the question. Her local Planned Parenthood told her to prepare to travel out of state and offered to connect her with a clinic. Emma, who takes medication that makes her cycle irregular, wanted an ultrasound to confirm her recollection of the gestation age. But the clinic didn’t have an appointment for the next two weeks. </p>
<p id="UqXLOw">“If I was below six weeks at the time of booking, I certainly wouldn’t be by the time I would make it to the clinic,” she said.</p>
<p id="r4K7AU">Emma, who is well-versed in reproductive health care, knew there was an additional option. So she started researching telehealth services that would ship mifepristone and misoprostol, two medications required to induce abortion safely at up to 10 weeks, through the mail. She decided on a cheery-looking telehealth startup that markets the pills. (Emma asked to use only her first name, since Texas law allows abortion providers or anyone who assists in accessing the procedure to be sued.) </p>
<p id="cHx3TU"><a href="https://msmagazine.com/2020/11/16/just-the-pill-choix-carafem-honeybee-health-how-telemedicine-startups-are-revolutionizing-abortion-health-care-in-the-u-s/">Telehealth companies focused on abortion access</a> use a straightforward model. Once a patient decides on a service that’s legally allowed to ship to their state — like <a href="https://www.heyjane.co/">Hey Jane</a>, <a href="https://www.mychoix.co/">Choix</a>, <a href="https://www.justthepill.com/">Just the Pill</a>, or <a href="https://carafem.org/">Carafem</a> — they fill out a medical history questionnaire, learn about the treatment, and sign a few consent forms. Then, within hours, they’ll hear back from a physician if they’re eligible to manage the procedure at home; the pills arrive in one to five days. “Abortion is something that is underserved,” said Kiki Freedman, the CEO and co-founder of Hey Jane. “Being able to access something more conveniently, more discreetly, more affordably, and more robustly is beneficial.”</p>
<p id="rNjHh6">That’s in an ideal scenario in a progressive state like California or New York. Unfortunately, the process was more complicated for Emma and others who live in states where abortion access is <a href="https://www.guttmacher.org/state-policy/explore/medication-abortion">legally hindered</a>. Texas and Indiana ban medication abortion starting at about seven and 10 weeks, respectively. Thirty-two states require a physician to administer the medication, while 19 states require the prescribing clinician to be physically present when the pills are taken — legalities that amount to a de facto ban on receiving abortion care via telehealth. These laws don’t affect the safety of the procedure, which is <a href="https://www.bloomberg.com/news/features/2022-02-17/abortion-pill-mifepristone-is-safer-than-tylenol-and-almost-impossible-to-get">safer than Tylenol</a>, but, instead, construct barriers to accessing abortion. </p>
<p id="3XiJCq">If the Supreme Court deals a blow to <em>Roe v. Wade</em> this summer, <a href="https://www.vox.com/2021/12/1/22811837/supreme-court-roe-wade-abortion-doomed-jackson-womens-health-dobbs-barrett-kavanaugh-roberts">as many expect it to do</a>, these obstacles will get worse. While telehealth startups focused on reproductive health are hoping to play a role in expanding access, state laws and societal structures such as poverty and lack of access to health care prevent these companies from helping those most in need of their services should Roe be overturned. Nineteen states, including <a href="https://www.kff.org/womens-health-policy/issue-brief/the-intersection-of-state-and-federal-policies-on-access-to-medication-abortion-via-telehealth/">Texas and most of the Deep South</a>, require two or more in-person visits to access medication abortion, while eight others require at least one visit; in 2021, <a href="https://www.npr.org/sections/health-shots/2021/12/06/1060160624/prescribing-abortion-pills-online-or-mailing-them-in-texas-can-now-land-you-in-j">six states</a>, including Texas, passed explicit laws against receiving medication abortion through telehealth. </p>
<p id="FQVJDa">“It’s great that we have so many more options with things like telehealth, but even right now, that’s not available to every single person across this country,” said Renee Bracey Sherman, the executive director of We Testify, an advocacy organization for people who have abortions. “What feels challenging is this idea that people are looking for a panacea to just fix it all. And they’re like, ‘Great! If we just have pills mailed, then everything will be fine. That’s the solution to the crisis around Roe.’ But it is not the solution.” </p>
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<p id="3M0U6r"><strong>When the FDA </strong><a href="https://www.nytimes.com/2021/12/16/health/abortion-pills-fda.html"><strong>announced in December</strong></a> that it would permanently allow mifepristone and misoprostol to be sent to someone’s mailbox, it was hailed as opening a world of possibilities for abortion access. In some ways, it does. </p>
<p id="yzuGNB">Two-dose medication abortion has been available in the US since mifepristone was approved as an abortion pill in 2000. The first pill, a single dose of mifepristone, stops the pregnancy from progressing by blocking progesterone and helping the embryo detach from the uterine wall. Within 48 hours, the patient takes a dose of misoprostol to cause heavy cramping and bleeding, which empties the uterus. In <a href="https://www.smithsonianmag.com/health-medicine/science-behind-abortion-pill-180963762/">2016</a>, softened FDA regulations allowed the misoprostol portion of the procedure to occur at home. The process is a highly safe and less expensive alternative to surgical abortions, with complications occurring in less than 1 percent of cases. (Misoprostol alone also has a high success rate since it <a href="https://www.smithsonianmag.com/health-medicine/science-behind-abortion-pill-180963762/">causes the cervix to open</a> and the uterus to cramp, inducing a miscarriage.)</p>
<p id="PCfUbL">Sending the pills directly to consumers sidesteps several everyday challenges encircling abortion access. Nearly <a href="https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017">90 percent</a> of US counties lack an abortion clinic, according to the most recent data from the Guttmacher Institute; clinics, for various reasons, <a href="https://time.com/5916746/abortion-clinics-covid-19/">continue to close</a>. Multiple states in the South and Midwest rely on <a href="https://www.latimes.com/local/great-reads/la-me-col1-abortion-doctor-20190124-htmlstory.html">doctors from out of state</a>, limiting the number of abortions a clinic can provide. Five states — including <a href="https://www.nytimes.com/2021/11/30/us/mississippi-abortion-clinic-supreme-court.html">Mississippi</a>, North Dakota, and West Virginia — have <a href="https://abortioncarenetwork.org/wp-content/uploads/2020/12/CommunitiesNeedClinics-2020.pdf">one clinic left</a>. </p>
<p id="sGXekL">Mifepristone and misoprostol now are used in <a href="https://www.nytimes.com/2022/02/24/health/abortion-pills-us.html">more than half</a> of the country’s abortions. And <a href="https://www.sciencedirect.com/science/article/pii/S0010782422000075?via%3Dihub=">interest in medication abortion</a> is rising — by choice and <a href="https://liberalarts.utexas.edu/txpep/research-briefs/out-of-state-travel-sb8-brief.php">out of necessity</a>. Many birthing people don’t discover they’re pregnant until <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269518/">the five- or six-week mark</a>, about a week or two after a missed period, which only leaves roughly a four-week window to perform a medication abortion. </p>
<p id="qjremM">“Getting abortion medication in the mail, or just expanding access to abortion medication period, could potentially be a game-changer in a United States, where abortion is illegal in some places and inaccessible in lots of places,” said Mary Ziegler, a law professor at Florida State University and the author of <em>Abortion and the Law in America: Roe v. Wade to the Present</em>.</p>
<p id="UFx5fY">The convenience for people who can’t afford to travel to a clinic, take time off from work, or find child care is unmatched. The more traumatic aspects of visiting an in-person clinic are removed, too: There are no protesters to navigate, no apprehension about being recognized at a small community clinic, and removal from the potential threats of violence clinics often face. Appointment wait times are also shorter, and the cost can be a bit cheaper than in-clinic services, which can cost anywhere between <a href="https://www.thecut.com/2018/11/how-much-does-an-abortion-cost.html">$400 and $1,000</a>, with the price increasing depending on factors such as gestational age of the fetus. </p>
<p id="Y523wc">For example, Hey Jane guarantees patients will see a physician within 36 hours, while Choix promises 24 hours, and Just the Pill offers 48 hours. The cost is $249, $289, and $350, respectively. </p>
<p id="lp505E">Abortion medication by mail is also an alternative for people who’ve had bad experiences with clinicians, those who don’t want an ultrasound, or to discuss their decision any further — all of which rang true for Emma. </p>
<p id="Zbz9Vm">When she had her first medication abortion, Emma attended college in <a href="https://www.guttmacher.org/state-policy/explore/counseling-and-waiting-periods-abortion">one of the 13 states</a> requiring multiple visits to a clinic before a patient can be provided an abortion. She was also required to submit to an ultrasound. It was the dead of winter, and she didn’t have a car. So, on three occasions, Emma took a 45-minute bus trip accompanied by a 20-minute walk to the nearest abortion clinic. Each appointment required taking off work and scheduling the visit around classes. To add to the plight, her partner at the time wasn’t supportive. </p>
<p id="8rg48W">Emma was in it alone.</p>
<p id="tXDbRf">“It was a fairly traumatic experience, having to be in touch with medical professionals that much when I was very clear about my choice, very clear about what I wanted to do,” she said. “It was making unnecessary complications.”</p>
<p id="PRW4PW">“I already knew I didn’t want to continue with this pregnancy, and I had to go through the [transvaginal] ultrasound. So it was another level of intrusive where I’m like, ‘I know I don’t wanna do this,’” she continued. “At least this time I didn’t have to be in contact with medical professionals who may or may not be in support of my choices, but they were under a legal obligation to make me question it.”</p>
<p id="sbTDg4">The same laws complicate the expansion of telehealth startups. If patients don’t live in a state where the telehealth consult and subsequent treatment are legal, the pills can’t be shipped directly to them. Before any of these companies can expand their services, they must consider a state’s laws covering telehealth, what type of clinician can provide abortion care, and any <a href="https://www.guttmacher.org/evidence-you-can-use/targeted-regulation-abortion-providers-trap-laws">TRAP laws</a>, which regulate and restrict abortion providers with the intention of hampering access to reproductive choice. So, patients who can travel to a state with looser restrictions are encouraged to do so. (Hey Jane has partnerships with local abortion organizations to facilitate travel for anyone who needs financial support.) </p>
<p id="xO6qa3">One workaround to improve access would be to make the medications available over the counter, just as emergency contraception is, or allow for an advanced provision of medication abortion — meaning people can have the pills on hand in case they get pregnant. “People who live in a state where it might be restricted and maybe the pills weren’t being sold there, they could travel to another state to get them,” said Daniel Grossman, a physician and the director of Advancing New Standards in Reproductive Health. “Or maybe someone in that state where they’re available could send them to them, or a variety of options that you can think of.” </p>
<p id="alB3L6">Another option is international groups like Aid Access, which will continue shipping medication abortion to birthing people in the US despite demands to stop from the FDA. In September 2021, when Texas’s new law went into effect, Aid Access received 1,831 requests from people in the state for medication abortion, according to <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789428">new data</a> from researchers at the University of Texas at Austin. </p>
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<p id="0W2vwf"><strong>Access to abortion-inducing drugs</strong> may seem like the future of care in America, but it’s been an option for birthing people elsewhere in the world for quite some time. In spite of the criminalization of abortion, in most Latin American countries, misoprostol is available over the counter for other medical purposes, and many people have <a href="https://www.aljazeera.com/news/2021/5/14/women-in-mexico-use-mobile-apps-for-at-home-abortions">used it</a> to induce abortion <a href="https://www.wbur.org/news/2018/01/11/peru-abortion-pill-misopristol">without serious complications</a>. (It’s worth noting that even as American states work to curtail access, several countries in Latin American countries — including <a href="https://www.nytimes.com/2022/02/22/world/americas/colombia-abortion.html?smtyp=cur&smid=tw-nytimes">Colombia</a>, <a href="https://www.newyorker.com/news/news-desk/mexicos-historic-step-toward-legalizing-abortion">Mexico</a>, and <a href="https://www.bbc.com/news/world-latin-america-55475036">Argentina</a> — have made the procedure more accessible.)</p>
<p id="JToU6W">According to Grossman, advocates in Latin America have also developed robust models of care, such as telephone hotlines and other digital networks, to support people throughout the process of ending their pregnancies with medication. Aides help people access the medication and explain how they should use it. In some scenarios, a helper can be physically present to determine if the patient needs to get to a health care facility or if the treatment worked. </p>
<p id="BiyYAz">Before abortion was decriminalized in Uruguay, <a href="https://www.iniciativas.org.uy/quienes-somos">Iniciativas Sanitarias</a>, a reproductive health advocacy group, developed a harm reduction model to assist people who wanted to terminate their pregnancies. They provided safety information and support to people considering self-managing an abortion, including how to use misoprostol. “For example, for [those] beyond 11 or 12 weeks, if they have a bleeding disorder, or are taking blood thinners, it’s not an appropriate method,” said Grossman. “So if people have accurate information, they have access to good quality medications, and they know about the warning signs that should prompt them to seek medical care, I think that self-managed abortion can be very safe and effective,” he added. </p>
<p id="0rCQtV">Similar networks may take root in the states as the fight against access intensifies. Despite the existence of these workarounds, however, abortion access ultimately remains elusive to the people who need it most. Traveling across state lines presents the same challenges as visiting a state’s only clinic; there are travel time and costs to consider, along with taking time off work and finding child care. Meanwhile, telehealth and medication-by-mail are much less likely to reach people who are incarcerated, unhoused, live on low incomes, don’t have an HSA/FSA, or internet access — groups disproportionately made up of Black and brown people. </p>
<p id="GKoXIl">It’s crucial, advocates say, that the current hierarchies to abortion access aren’t replicated as well-intentioned companies search for solutions. </p>
<p id="YJl25G">“That FDA decision is not actually making a difference in the people’s lives who need it most because they simply cannot have [the pills] mailed,” said Bracey Sherman, of We Testify.</p>
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<p id="SZ5DRC"><strong>Emma shipped her pills to an address</strong> in California and someone she trusted sent them to her in Texas, where it’s <a href="https://www.npr.org/sections/health-shots/2021/12/06/1060160624/prescribing-abortion-pills-online-or-mailing-them-in-texas-can-now-land-you-in-j">illegal</a> to access medication abortion through a telehealth service. The workaround meant she got her medication in a week and a half — which would have been a problem had she been further along. Anyone who assisted Emma in receiving the prescription needed for her abortion could have faced legal repercussions under Texas law, which allows private citizens to sue those who help someone access abortion. So Emma had to keep the process hushed, only looping in people she could trust to help. </p>
<p id="hEWbFx">There is some legal risk to forwarding abortion pills through the mail, but it depends on the laws of the states where someone is sending and receiving the pills. And the only way to avoid that risk completely in a state like Texas is to get a prescription in-person from a licensed medical provider and within the state’s legal cutoff. </p>
<p id="STTMVG">“It was an experience that was way more isolating than it needed to be, and just an unnecessary barrier to access that I had not experienced before,” Emma said. </p>
<p id="E2N1dS">Many states maintain that their laws aren’t meant to punish pregnant people. Instead, the focus is on prosecuting in-state abortion providers. This opens the door for national telehealth startups with the gumption to serve patients in states with abortion bans, anyway. (All the companies who spoke with Vox emphasized that they would continue to work within a state’s given laws. Representatives from Just the Pill and Choix said, however, that they’re aware that restrictive state laws compel some pregnant people to take the same route as Emma.) Or companies like Hey Jane could lobby more states to adopt, as some California lawmakers have pledged to do, <a href="https://apnews.com/article/abortion-california-sanctuary-625a118108bcda253196697c83548d5b">a sanctuary state model</a> for pregnant people forced to seek out-of-state abortion care. </p>
<p id="6ySq5s">“States are going continue passing laws to limit access to medication abortion,” said Ziegler, the Florida State law professor. “But they’re also going to have a very hard time identifying when those laws are being broken or enforcing laws, especially against actors who don’t live in the state, and especially if they’re actually serious about not punishing pregnant people.”</p>
<p id="uTCsPO">But there have been instances of prosecutors reaching deep into their briefcases to figure out legal ways to hold pregnant people accountable for perceived crimes against life. This includes, but isn’t limited to, <a href="https://journals.library.columbia.edu/index.php/cjgl/article/download/8061/4147/16026">charging folks with “abuse of a corpse”</a> for a pregnancy loss — whether it be by miscarriage, stillbirth, or an abortion. </p>
<p id="5E01aa">“We talk about this aura of criminality that already exists and surrounds abortion,” said Yveka Pierre, the senior litigation counsel at If/When/How Lawyering for Reproductive Justice. “And that’s all based in the stigma about abortion, about people who have abortions, about folks who are partnered with folks who have an abortion, and all of these existing TRAP laws that have been slowly eking away at the protections.” </p>
<p id="Uf94WW">Fewer legal protections, particularly in states where the right to self-managed abortion isn’t codified at all, could result in more people being criminalized for their pregnancy outcome. There will most likely be a push-pull method at play here, explained Pierre. Some people will be pulled toward a self-managed abortion because it’s an affirming choice for them. Others will be pushed into it even though they would’ve opted for clinical care if they had a choice. That dynamic and any legal crackdowns will be felt most by those who live in overpoliced communities or those who have had prior contact with the criminal justice or family separation systems.</p>
<p id="qezFqN">“Who is likely to have the cops be in their community? Who is likely to have never seen a police officer in their suburb driving around? Who’s likely to have their mail checked? Who is already under surveillance in some sort of way?” said Pierre. “Those are the people that are more likely to experience criminalization — folks that are already at the intersection of oppression from various systems.” </p>
<p id="UbIByk"><em>An earlier version of this story misstated the name of an online provider of abortion medication. That provider is Choix, not My Choix. </em> <br><br><em>Those in a similar predicament as Emma’s can call </em><a href="https://www.reprolegalhelpline.org/"><em>the ReproLegal helpline</em></a><em>.</em></p>
<p id="fV5Mz3"> <em>Julia Craven is a reporter covering health. She’s the brain behind </em><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__juliacraven.substack.com_&d=DwMFaQ&c=7MSjEE-cVgLCRHxk1P5PWg&r=Rg_frVECyHq8RLGpsvHBW3D76DIRpCQrSH_yE2X1iQg&m=Pp_lTxRj3b13d8zOqKI9STNH5DhSONNyiwIt97tczppQl9Uwc_Knp19QCleFB1Q7&s=T5QtS0OqI4dZUEh4gMGEtXlDwa44duUU9S8tVS3CHKc&e="><em>Make It Make Sense</em></a><em>, a weekly health and wellness newsletter, and her work has been featured in HuffPost, Slate, and the 2021 edition of The Best American Science and Nature Writing. </em></p>
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https://www.vox.com/the-highlight/22968993/abortion-pills-mail-medication-fda-texasJulia Craven