Analysis of: Black women on the nightmare of seeking healthcare in the US: ‘I have to be my own doctor’
The Guardian | January 27, 2026
TL;DR
Black women face systematic dismissal in US healthcare, forced to become their own advocates just to receive basic medical attention. This isn't individual prejudice—it's how a profit-driven system devalues bodies it cannot extract maximum value from.
Analytical Focus:Class Analysis Material Conditions Historical Context
The healthcare experiences detailed in this Guardian report reveal how the US medical system operates not as a universal service but as a site of racialized class warfare. Black women, positioned at the intersection of racial and gender oppression, encounter a healthcare apparatus that systematically devalues their testimony, their pain, and their very bodies. This isn't a matter of individual racist doctors—though implicit bias certainly exists—but of a system structured around profit extraction that has always treated Black bodies as expendable. The material conditions underlying this crisis are stark: healthcare in the United States functions as a commodity rather than a right. When care is organized around profit maximization, providers face pressure to minimize time with patients, dismiss complex cases, and defer expensive diagnostics. Black women, who face both the legacy of medical experimentation and contemporary economic marginalization, become particularly vulnerable to these cost-cutting imperatives. The fact that race-concordant care produces better outcomes isn't simply about cultural understanding—it reflects how providers racialized similarly to their patients may be more likely to take their concerns seriously against institutional pressure to dismiss. The article documents a profound contradiction: Black women are simultaneously expected to be hypervigilant medical advocates while being denied the credibility necessary for their advocacy to succeed. They must become 'their own doctors' and 'lawyers making a case for their health' precisely because the system refuses to treat them as patients deserving of care. This forced self-reliance represents a form of unpaid reproductive labor—the work of keeping oneself alive against a system designed to let you die.
Class Dynamics
Actors: Black women patients as working-class healthcare consumers, Healthcare providers as professional-managerial class, Hospital administrators and healthcare corporations as capitalist class, Insurance companies as financial intermediaries, Black physicians navigating institutional constraints
Beneficiaries: Healthcare corporations profiting from privatized medicine, Insurance companies that benefit from denied or delayed care, The broader capitalist system that extracts value from racialized health disparities
Harmed Parties: Black women facing dismissal, misdiagnosis, and death, Black communities bearing disproportionate health burdens, Working-class patients generally who lack resources for sustained self-advocacy, Healthcare workers forced to operate within inadequate systems
The patient-provider relationship, ostensibly one of care, functions as a site of class and racial power. Providers hold credentialing authority while patients—particularly Black women—are structurally positioned as unreliable narrators of their own bodies. The burden of proof falls entirely on patients, inverting the caring relationship. When Christina Brown must 'grab their hands and show them where the lump was,' we see how medical authority supersedes lived experience, requiring patients to perform expertise to receive basic care.
Material Conditions
Economic Factors: Profit motive in healthcare delivery incentivizing dismissal of complex cases, Time pressures on physicians reducing quality of patient interaction, Cost of medical training creating barriers to diversifying physician workforce, Insurance structures that reward throughput over thoroughness, Economic segregation limiting access to quality healthcare facilities in Black communities
Healthcare under capitalism operates as commodity production, where the 'product' is billable procedures rather than health outcomes. Physicians, despite their professional status, function increasingly as workers subject to productivity metrics imposed by hospital administrators and insurance companies. The patient becomes simultaneously consumer and raw material—their body the site of value extraction. Black women's bodies, historically constructed as less valuable, receive correspondingly less investment in their care.
Resources at Stake: Black women's labor power (health as prerequisite for work), Healthcare dollars flowing to insurance and hospital profits, Time and emotional labor extracted from patients forced into self-advocacy, Reproductive capacity as Serena Williams' near-death demonstrates, Intergenerational wealth depleted by medical crises and inadequate care
Historical Context
Precedents: Tuskegee syphilis experiments establishing medical institution as site of racial violence, Henrietta Lacks and extraction of Black bodies for medical profit without consent, Exclusion of Black patients from early health insurance schemes, Jim Crow hospital segregation and its lasting effects on facility distribution, Medical school curricula developed around white bodies as 'default'
The current crisis represents continuity with slavery and Jim Crow-era medicine, which constructed Black bodies as both experimental subjects and less deserving of care. The post-civil rights era saw formal integration without material transformation of these relations. Neoliberal healthcare restructuring since the 1980s has intensified profit imperatives while gutting public health infrastructure, exacerbating existing racial disparities. The 'implicit bias' framework, while acknowledging the problem, often obscures these structural continuities by locating the problem in individual psychology rather than systemic design.
Contradictions
Primary: Healthcare organized as commodity production requires patients to be both compliant consumers and expert advocates—a contradiction that becomes impossible when the system refuses to grant certain bodies credibility. Black women must simultaneously trust medical authority and challenge it, be passive patients and active 'lawyers,' defer to expertise and become 'their own doctors.'
Secondary: The healthcare system depends on labor power it simultaneously undermines by failing to maintain worker health, Medical training that centers white bodies while claiming universal scientific objectivity, Race-concordant care improves outcomes but the solution cannot be 'more Black doctors' when medical education remains inaccessible, Individual providers may genuinely want to help while operating within structures that prevent adequate care
These contradictions cannot be resolved within the current system. Calls for cultural competency training or implicit bias workshops address symptoms while leaving the profit motive intact. The article's physicians correctly note that 'the burden should not fall on Black women themselves, but on healthcare systems'—yet the system cannot transform itself because its fundamental purpose is profit extraction, not health. Resolution requires decommodifying healthcare entirely: removing the profit motive, democratizing medical institutions, and restructuring care around community need rather than shareholder returns.
Global Interconnections
The US healthcare crisis for Black women connects to global patterns of racialized capitalism. The same logic that devalues Black bodies domestically drives the extraction of resources and labor from the Global South. Pharmaceutical companies develop drugs using clinical trials in African countries while pricing those drugs beyond reach for local populations. Medical training hierarchies that marginalize non-Western approaches mirror colonial knowledge hierarchies. Meanwhile, care workers from the Philippines, Caribbean, and Africa staff US hospitals at low wages—their labor maintaining a system that fails patients who look like them. The emphasis on individual self-advocacy as survival strategy reflects neoliberal ideology's penetration into healthcare: the patient as entrepreneur of their own wellbeing. This framework shifts responsibility from collective provision to individual navigation, obscuring how health outcomes are determined by class position and racial formation. When Christina Brown must research her own diagnostic options and argue for appropriate imaging, she performs unpaid labor that should be the system's responsibility—a form of surplus extraction from those least able to bear it.
Conclusion
This crisis will not be resolved through diversity initiatives or bias training within existing structures. The testimonies collected here point toward a fundamental truth: healthcare organized around profit cannot serve those it constructs as unprofitable. Building power requires connecting healthcare struggles to broader working-class organizing—recognizing that the same system denying Black women adequate care is union-busting nurses, extracting labor from underpaid care workers, and bankrupting families through medical debt. The demand must be for healthcare as a right, publicly funded and democratically controlled, with community accountability replacing corporate governance. Black women's survival strategies—building knowledge networks, seeking concordant care, documenting everything—are already forms of collective resistance. The task is scaling these practices into movements capable of transforming the system entirely.
Suggested Reading
- Women, Race & Class by Angela Davis (1981) Angela Davis's analysis of how race, gender, and class interlock is essential for understanding why Black women face compounded healthcare discrimination—not as additive oppressions but as a unified system of exploitation.
- Black Reconstruction in America by W.E.B. Du Bois (1935) Du Bois documents how post-Civil War institutions, including early healthcare, were structured to maintain racial hierarchy despite formal emancipation—patterns that persist in contemporary medical settings.
- Capitalism and Slavery by Eric Williams (1944) Eric Williams demonstrates how racial capitalism constructed Black bodies as instruments of profit extraction rather than subjects deserving care—a logic that continues to shape healthcare delivery.