Pulling Back the Curtain on Race and Health Care

Visionaries is a limited series that looks at figures who are trying to transform the way we live. Dr. Rachel Hardeman’s journey to understanding community health care began in Cuba, where she studied medicine and public health at the Latin American School of Medicine from 2002 to 2004.

“That’s really where I learned not just what public health was, but how powerful it could be,” she said. “I saw that there’s a different model for caring for people than what we know and what I’d been exposed to in the United States.”

In February 2021, Dr. Hardeman, who is now a reproductive health equity researcher and associate professor at the University of Minnesota, founded the Center for Anti-Racism Research for Health Equity, which seeks health care solutions to the effects of policies and attitudes that work against people of color. Dr. Hardeman is the first to acknowledge that balancing her academic work and the center can be a challenge. “I feel like I’m building a plane while also flying the plane,” she said. “The work can’t stop while I build the infrastructure for the center.”

While the subjects and data-driven results of her research — survival rates of Black infants who are cared for by Black doctors versus white doctors after difficult deliveries, for example — sometimes garner controversy, Dr. Hardeman believes they are necessary for understanding the Black experience in the United States.

She has also partnered with the Roots Community Birth Center in Minneapolis, one of the first Black birthing centers in the United States. Her work has shown the difference that Roots and similar centers can make for both mothers and their babies, revealing more positive outcomes than many hospital systems.

Government involvement, Dr. Hardeman said, is also key. While she tries to get congressional support, she is leading up a work group with the Centers for Disease Control and Prevention as well as the American College of Obstetricians and Gynecologists, where “we are tasked with developing a tool to help maternal mortality review committees identify racism as a contributing factor in maternal deaths,” she said.

Dr. Hardeman hopes to inspire others to think bigger about policies that hamstring women of color, and in turn, to think of solutions that protect mothers and babies: “We have to be thinking about the complexities of how this all shows up right to be able to have the impact.” (The following interview has been condensed and edited.)

When and how did you determine where you wanted to focus?

At Xavier University of Louisiana, a historically Black college in New Orleans. I was actually on the pre-med path. I talked a lot about health disparities, but I didn’t have the language for what I was seeing, right within my family and my community and certainly in New Orleans. Xavier is surrounded by some really poor and underresourced neighborhoods and a lot of marginalized folks, and so I knew — even in undergrad I knew — that I was really interested in asking: How do we change this reality?

And your path to that was through academia?

I went into my Ph.D. program with the intention of getting the training I needed to go work for a policy institute to use evidence to inform policy. And somewhere along the way, I started looking around at who I learned from and who taught me as a doctoral student, who was saying the words that I wanted and needed to hear about racial inequities and health and who wasn’t.

What did you learn from that assessment?

I realized that as a doctoral student or in the School of Public Health that I’d never taken a class from someone who was Black. So I thought to myself, “If not me, then who?” What could my place be in academia? What would that look like? Can I occupy space in academia and still be true to who I am?

And it seems that you’ve found quite a few roles that accomplish that. Do you feel as if you have to do it all?

I feel like you have to be working at multiple places along the spectrum to actually get the work done. It’s all related, and I’m a big thinker. I like to think big and bold and broadly about this work and the ways that it can be connected. So everything I do is very intentional. I deeply feel the urgency. It’s a matter of life and death.

Do you have any free time?

Laughs I don’t. Work has been really interesting and important because we’ve sounded the alarm on the impact of racism on maternal health outcomes. Now we’re trying to sort of see how we collect these data and identify what’s happening and these maternal deaths, so both of the maternal deaths — mother and child — aren’t in vain. Also, statistically, we need to be able to, either from a quantitative or a research perspective, name what’s happening, and also map out how we intervene.

Does your identity as a Black woman play into your feeling as if you need to do everything in this space?

You’re familiar with the narrative of Black women taking on the caregiver role. My daughter and I both have shirts that say “Black girls save the world.” I think that phenomenon is hard to move away from, especially when I think about the Black role models that came before me who did incredible things: my mom and both my grandmothers, who were just incredible people who cared for their families and their communities and did what they could to affect change in the spaces that they were in. I come from a family where it was very clear to me from a young age that to whom much is given, much is required. I’ve always had this sense of responsibility, in addition to just caring deeply about people — my people — and caring deeply about liberation.

With all of that in mind, how do you care for yourself to prevent burnout?

In the past couple of years, I’ve become more intentional about self-care. I found an amazing Black female therapist who helps me a great deal. I intentionally take time off to go away with my family. Recently, my husband and I booked airfare and we went someplace warm for a few days to relax and get some vitamin D, some sunshine. I’m also trying to shift my thinking. I can’t show up if I’m not taking care of myself.

I think it was the sociologist and New York Times contributing opinion writer Tressie McMillan Cottom who said: “These institutions do not love you or they will not love you back. They’re still there to generate knowledge and generate capital, and you have to recognize that you are someone who’s helping to make that happen. But you don’t owe them anything.” This is advice I need to take personally. We’re all replaceable.

What would you tell another Black woman who’s maybe starting out in her career and feels like she needs to do it all?

I always want to encourage them to be clear about why they’re there and what they want to do. They also have to make sure that’s what’s driving them. I always say my purpose in being here is to manifest racial justice so that Black women and girls can live their full greatness and glory that they can achieve and have the opportunities for health equity. I think you have to know that and be clear about that to be able to be in the space of spaces that I am in and thrive.

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