The War on Black American Lungs
An overview for non-Black Americans of how systemic/systematized racism has been legally attacking Black lung health for over 400 years (and what we have to do to disrupt the pattern)
CW/TW: discussion of racialized violence, targeted harming of Black citizens, and historic and contemporary traumas.
I was asked recently if racism was systematic or systemized.
My answer? Both.
In the case of Black American health and safety particularly, the systemic-systematized nature of oppression is as old as the presence of settlers on the North American continent.
There has never been a time when Black people could safely breathe in the United States of America. Our country has been at war with Black lungs for centuries. And while this was perhaps unconscious during the hundreds of years that slavery existed, perhaps inadvertent during reconstruction and the era of sharecropping, by the end of the 19th century it was entirely intentional. With the onset of industrialization and the Great Migration, the war on Black lung health became legally baked into this country’s very bones. And as is evident in the disproportionate impact of the COVID-19 crisis on Black citizens, and the epidemic of police officers ending Black lives via strangulation and suffocation, this war never stopped raging. It falls to us non-Black Americans to effect the changes necessary to end it.
Starting Points: Enslavement, Middle Passage, Cotton as Long-Term Murder
Enslaved Africans were chained at the ankles, wrists and necks when they were forcibly brought to this country; their very livelihoods were compressed by iron, their breathing compromised. And then there were the ships’ holds, where, for weeks at sea, Africans were bound together in their own urine, excrement, and vomit. Starting in 1788, the British government mandated the presence of doctors on slave ships in order to “preserve” the “quality” of the ships’ human cargo, but records show that this legal requirement did nothing to limit prisoners’ deaths during the Atlantic crossing. Venereal diseases were transmitted from crew to prisoners via sexual assault. Reproductive deaths, death by infection, and death by inhumane amputations ran rampant. In terms of lung health, prisoners fared even more poorly: the holds were petri dishes of disease, the same air regurgitated between imprisoned neighbors, dead and alive, for weeks. Fresh oxygen only entered the hold when crew members descended to:
retrieve dead bodies,
do the occasional checking over of the stock,
lead groups up on deck for “exercise,” or
to unchain individuals, in view of other prisoners, and rape them.
There was no light in this hell. No UV rays filtered in to kill the bacteria fomenting in the holds and infiltrating the prisoners’ lungs. By the time ships arrived in the British/French/Spanish/Portuguese/Italian “new world,” their “cargos” were smaller, and ill. The hatches were opened, and hundreds of thousands of kidnapped human beings were dragged out in their chains and onto livestock blocks, put up for sale. Money-holding white men paced the markets, appraising human beings for labor potential. Once individuals were purchased, they were carted off to a shared, violent future: cotton.
I invite you to do an internet search for “lungs and cotton,” and to explore the wealth of medical writing that awaits. Inhalation of unprocessed cotton particles can lead to respiratory problems, bronchitis, asthma and byssinosis (a disease which can lead to decreased lung function and chronic bronchitis— permanent damage, which will only increase if the victim does not halt all exposure). Africans were kidnapped and enslaved in order to suffer these health conditions. The American South and its economy were booming in the 1700s and early 1800s. The region produced, at one point, two-thirds of the world’s raw cotton. There was a need for cheap labor to offset the deadly costs of gathering and refining this cash crop. This fueled a dependence upon African, and eventually Black American, bodies that would persist for over two centuries. The records that were kept (and preserved after the Civil War) hint at the sheer number of individuals who worked up and down rows of cotton plants. Hundreds of thousands of Black peoples were enslaved in order to do the fatal work of breathing in cotton fields that white landowners did not want to pay local white laborers to die doing.
Reconstruction, the Great Migration, Racism as Infrastructure
Post-Civil War, Black labor took on new and different forms, and compromises to lung health evolved in accordance. There was sharecropping, for those who remained in the South following the years-long process of Emancipation. Living in bare-bones structures and working for pittances from landowners, there was no true protection from the elements. Winter would be a deathly visitation each year, likely similar to those on plantations before the war. For those continuing to work in cotton fields, issues of asthma, bronchitis and byssinosis persisted. But for people who began to emigrate northwards, hoping for work and more open doors outside the confines of the South, new threats to Black pulmonary and respiratory systems lay in wait.
The Great Migration, meanwhile, overwhelmed northern cities, and the living quarters hastily thrown together to house new arrivals from the South were cheap, crowded and sequestered from the existing neighborhoods. Or, jammed into already-compromised, poorer areas. Building materials were low-quality, and families were forced to cohabitate in apartments already too small for a single nuclear unit. Dust, mold, and poor ventilation were constant issues, as well as the threat of fire and structural disintegration. Workplaces presented similar threats: long before Upton Sinclair outed modern industry in the early 20th century for its inhumane practices (which have, helpfully, been kept in play in the hundred years since and are still problematic now), laborers were breathing toxic fumes in factories where tanning, meatpacking, automotive, and other industries’ processing went unregulated.
Subjection to air pollution was also a constant threat to Black lung health at the time, and made even worse by the expansion of America’s favorite habit: smoking. Black Americans have experienced, historically and currently, disproportionate exposure to tobacco. There are more advertisements for tobacco products targeting Black consumers (especially Black youth) than any other ethnic group in the U.S. There are more tobacco-selling establishments in Black communities in the U.S. than any other community. Black Americans suffer higher rates of death from tobacco-related illnesses than any other ethnic group. In this country, tobacco’s economic success depends on Black lungs.
Asthma, Systemic/Systematic Prevention of Access, and Some of the Other Myriad Contemporary Threats to Black Lungs and Life
The passage of time has seen no marked improvements in infrastructural conditions for Black lung health. The materials used for the affordable housing that serves largely Black communities are still cheap and dangerous. The structures themselves are still firetraps, notorious for brick dust and asbestos. They are poorly maintained, and go un-updated for decades at a time. They are also located in undesirable areas, often near highways or high-traffic areas (oftentimes due to the fact that said highways obliterated existing Black communities and forced an accelerated, mass relocation). These various factors have created the perfect conditions for a steep spike in respiratory diseases amongst Black citizens. Asthma in particular.
Black children and adults suffer more from asthma than any other group in the U.S., and the failings of the American medical industry have only made this epidemic worse. There is a significant lack of medical education in asthma-impacted communities (predominantly Black), which results in limited awareness of asthma triggers, treatment, and prevention where that knowledge is most needed. Meanwhile, the prices of equipment that protect lung health (inhalers, albuterol, nebulizers) are prohibitive on many medical insurance plans. Caretakers might thus be unwilling to send their children to school or a friend’s with their asthma medications. A child who has a sudden asthma attack at the playground without access to their inhaler has to depend on the arrival of an ambulance. A situation which, in turn, could result in prohibitive fees for families to pay. Asthma is not solely experienced by Black Americans. Black Americans experience asthma disproportionately due to the physical, social, and economic infrastructures in the U.S. that have been built to disenfranchise non-white citizens.
Insurance coverage is an excellent example of how prevalent the systemic/systematic repression of Black American rights is. Insurance in this country, more often than not, is defined by access. Black Americans are compromised when it comes to this access. Black Americans are relegated disproportionately to lower-income neighborhoods thanks to economic and social systems that prevent the Black accrual, and generational transference of, wealth. In these neighborhoods, fewer tax dollars and less income result in poorer-quality school systems and increased rates of policing. That “quality” of education and constant threat of violence from law enforcement, not to mention the stresses of poverty for those children who grow up with it, shapes young Black futures. These factors can help determine:
-what elementary, middle and high schools Black children attend;
-the quality of Black citizens’ physical health and mental health over time, which includes transmitted traumas from centuries of slavery and violence at the hands of the state;
-Black access to opportunities, financial education, exposure to career paths otherwise unmentioned, creative outlets and community events and resources that are more robust in more affluent neighborhoods;
-where Black students go to college, their successes within the culture of the academe, and how they are cared for by the high-learning institutions they attend;
-the professional paths available to Black adults following high school or college graduation, including networking opportunities and recommendations.
These and other factors can help determine the options Black adults and their families can access in the American health insurance marketplace. Good physical health? Top-of-the-line job? Experience navigating the system and self advocating? Daily, Black Americans are legally denied the right to pursue, and preserve, good health.
Underlying all of this is the frank reality of Black Americans being Black. Black Americans do not get to experience anything at the hands of this country as individuals first. They are rendered secondary or tertiary citizens by society. Look at the numbers: Black women are up to six times more likely to die in childbirth than white women. In 2019, 24 percent of all police killings were of black Americans, even though only 13 percent of the U.S. population is black. In 2011, it was reported that only 57 percent of Black students had access to the full range of science, math, and pre-college courses needed for undergraduate readiness, compared with 71 percent of white students (and 81 percent of Asian American students). To say nothing of the brutal numbers emerging from the current COVID-19 pandemic; vast gaps have opened between white death rates and black death rates, while reports of hospitals denying black patients treatment have repeatedly hit the news cycle.
The Disproportionate Impact of COVID-19 on Black Lives, #BLM
The COVID-19 pandemic has become a flashpoint for public awareness the inequity Black Americans have been forced to live with for centuries. Which returns us to our central theme: the lungs of Black Americans, and this country’s commitment to waging war against them. People with several pre-existing conditions are at greater risk of contracting and dying from COVID-19 than those who do not. According to the CDC, those conditions include:
“ 1. People with chronic lung disease or moderate to severe asthma
2. People who have serious heart conditions
3. People who are immunocompromised
4. Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
5. People with severe obesity (body mass index [BMI] of 40 or higher)
6. People with diabetes
7. People with chronic kidney disease undergoing dialysis
8. People with liver disease.” (CDC, 2020)
The CDC also notes that those who are grappling with these conditions during the pandemic are at even GREATER risk if their symptoms are not well-managed. Black Americans who have limited access to health care are at risk. Black Americans who are living in public housing and breathing the particulate-laden air of low-cost building materials, or are living in urban areas are at even greater risk. Individuals with asthma or lung disease are at the top of the CDC’s threatening conditions list. Every day, 10 Americans die from an asthma attack, and Black Americans are three times more likely to die than members of any other ethnic group. Send COVID-19 scything through Black communities, already compromised by racial bias in healthcare systems and resource access, and those thousands of citizens with lesser-functioning lungs will fall first. Have fallen first.
One of the rallying cries of the #BlackLivesMatter movement is “I can’t breathe,” not because someone thought it up in an inspired moment of advocacy work, but because multiple American police officers have been filmed choking Black Americans as they repeat that they cannot breathe over and over again. Until they die. Hell, the TV show Orange is the New Black even recreated this scenario, with a white a prison guard pressing a knee into Black female inmate until she died, facedown, on the floor. Her cries of not being able to breathe rang through the end of the episode, and season, just as they have been on American streets for the past ten years. One of these murders via law enforcement took place in the first two months of this pandemic— an officer kneeling on George Floyd’s neck after he was found to be using a counterfeit $20 bill in a store, until he asphyxiated and died. In the midst of COVID-19 ravaging the Black population of this country, police officers again attacked a Black man via his lungs. It wasn’t enough to see the numbers rising, to learn of how many Black patients with COVID-19 had been turned away from hospitals, to see the violent realities of the racist infrastructure propping up this country laid bare. No, instead, this country had to double down on its truth: that Black citizens are seen as 3/5ths STILL, hundreds of years after this country began bringing enslaved Africans to its shores in 1619. This country STILL has not stopped compromising Black lives, and lungs. Which means WE haven’t. We. Haven’t.
Ending the American War on Black Lungs (and thus, on Black lives)
This will require more than consistent, constant pressure on this country’s white supremacy apparatus. What we, particularly white, non-Black citizens must also do, as far as I can tell, is commit to fighting the battles of the minutiae, in order to undo the larger, oppressive organism. This means intervening when co-workers touch a Black peer’s hair or body, or make inappropriate comments about those peers’ appearances. This means looking at the résumés that any self-identifying Black candidates submit for a job, and skipping over the names of the colleges or high schools they attended in order to honestly examine their work experiences, listed skills, and credentials instead. This means spending money at Black-owned businesses. This means supporting Black medical professionals, reading books by Black authors, and sending your children to schools where all of the teachers and staff are not white.
This means advocating, in particular, for the safe and fair treatment of Black women, in whatever setting, wherever you are. This means shutting up during PTA meetings when Black parents are speaking, and then amplifying what those parents have said if non-Black parents seek to override them. This means helping Black clients secure loans with humane rates from the bank where you work. This means speaking to your children about what racism, and anti-racism, look like, so that they might combat hatred themselves. It means speaking to your neighbors who are condescending to delivery and postal service workers who are Black about reflecting on their actions. It’s about holding relatives accountable at the holiday dinner table, instead of allowing that aunt to make snarky comments followed by the assertion, “but you know I’m not racist!” It’s about calling colorblindness what it is: self-congratulatory ignorance, parading as good faith. It’s about choosing dismantling oppression instead of pretending it isn’t that bad.
It’s about doing millions of repeat daily labors, as non-Black Americans, so that Black Americans do not have to. So that Black Americans can spend energy on loving and raising their children, building careers, and saving money. So that Black Americans can live without fear of violence, if not murder, from non-Black Americans and the American system.
So that Black Americans can breathe.
Places to start, activism wise:
On parenting and schools:
On family dialogue:
On the workplace:
On supporting Black businesses, artists, and other professionals: