During the first year of the COVID-19 pandemic, Angelica Geter was on the frontlines protecting the city of Atlanta, serving as the city’s first chief health officer. Geter took the role before the pandemic started, and some of her pre-pandemic work included creating an initiative focused on emotional wellness for Black women. As she dealt with the immense challenge of helping Atlanta grapple with the health-related dangers of the pandemic, Geter continued to emphasize the importance of addressing the health of Black women in the city.

“I was working with my team to give Black women tools to protect their health in the midst of a global emergency that we now call the COVID-19 pandemic,” Geter says. “Oftentimes, when it comes to addressing population health, you’re looking at multiple communities and groups, and Black women are often left behind.”

Health at Risk

One environment in which Black women can often feel a lack of support is the workplace, according to Geter, and the negative effects of this atmosphere can carry much more than social consequences, especially as it relates to stress and anxiety. A 2020 study from Duke University found the “stress of racial discrimination appears to increase the risk of metabolic and cardiovascular diseases among Black women,” and when combined with the everyday stresses of any job, Black women are in more danger in terms of their health. For example, as reported in The Atlantic, researchers at the University of Michigan, led by Arline T. Geronimus, a professor in the university’s department of health behavior and health education, found, biologically speaking, Black women are 7.5 years older than white women due to stress. In addition, a Gallup poll found only 27% of Black women think their companies present equal opportunities to all employees, while CNBC reported the pay gap for Black women can cost them nearly $1 million in lifetime income.

“When we talk about the effects of racism and gender discrimination and how it’s impacting Black women, we’re really talking about stress,” Geter, who is now the chief strategy officer for the Black Women’s Health Imperative, a nonprofit organization that works to improve the health of Black women in the United States, says. “We’re talking about chronic, long-term experiences of racism and gender discrimination and how it’s impacting our stress levels and affecting us on a cellular level, on a biological level.”

According to Geter, research has shown chronic exposure to stress leads to inflammation, which can be connected to cancer, heart disease, diabetes and Alzheimer’s disease, and can also increase cortisol levels, which makes it harder to lose weight, among other negative health effects, while also eliminating the chance for a healthy work-life balance.

“Even if we eat healthier food, even if we work out as much as we possibly can, our cortisol levels are so high due to our experiences with racism and stress,” Geter says. “We are in this never-ending race to be better, but our stress levels aren’t changing.”

The stress created by experiencing racism isn’t limited to the workplace, but, as Geter explains, since work takes up such a large part of a person’s life, it is one of the most prevalent sources of the problem.

“It happens there and other places, but more often than not, we experience racism and gender discrimination at work,” Geter says. “We have to shift the culture, policies and practices to ensure lasting change and to protect the health of Black women.”

Many companies claim transforming their culture to be more diverse, equitable and inclusive is a focus for them, but DE&I initiatives rarely include discussions about how these policies can affect health.

“At the Black Women’s Health Imperative, we are building an initiative. We’re helping executive leaders understand the connection between stress, racism, gender discrimination and the impact it has on mental, physical and financial health of their employees,” Geter says. “When it comes to DE&I efforts, making this connection has not been a major priority, especially from a population health lens, until now.”

New Approaches

The shortcoming of “traditional” DE&I strategies, which are often discussion- and training-based, is they do nothing more than promote awareness of the problem rather than affecting the actual policies and practices of a company.

“Awareness is a good thing. It’s a great start,” Geter says. “But we need measurable, scalable strategies that promote accountability, transformation, empowerment and transparent conversations about our progress towards an equitable and fair workplace. It’s not enough to be anti-racist. It’s essential to shift the policies, practices and even the culture.”

Geter encourages companies to “think outside the box” when it comes to creating effective DE&I strategies and to begin by examining internal policies through the eyes of employees. That means identifying cultural aspects of a work environment that are hostile to certain groups of employees and ensuring the leadership in charge of conducting this analysis and implementing changes is diverse in terms of race, ethnicity, gender and age, among other characteristics.

The employees being affected by a negative workplace culture cannot be the only people tasked with finding solutions, however. According to Geter, oftentimes that can lead to even more trauma for employees already feeling undue stress related to racism in the workplace.

“I’m very hesitant to say that it should be the employees who need to do that work. It really needs to be the executives,” Geter says. “Black and Indigenous People of Color tend to be placed in DE&I roles. And then not only are we traumatized at work from the experiences of racism and gender discrimination, the pressure and weight of teaching someone who is being racist or discriminating against you, teaching them about why this is not OK, creates another form of trauma.”

Of course, employees are not powerless until leadership steps in, as Geter says they can create committees or councils to encourage safe spaces, but until there is top-to-bottom change, there can only be so much progress.

Beyond employee perspectives, Geter also says companies need to create researched-based policies that link changes to positive health outcomes, particularly for Black women and other groups who are more disproportionately affected by discriminatory workplace environments. In addition, companies must provide safe spaces for employees to share their experiences without fear of repercussions and establish mentoring programs and other avenues and opportunities for advancement. Geter also says companies need to look outside of their own walls for help and partner with organizations, like the Black Women’s Health Imperative, for which moving beyond DE&I to fairness and health is a major focus.

“It’s important for executive leaders to take note of the ‘Great Resignation’ and why their employees are choosing to leave the workforce,” Geter says. “We need to value their perspective, learn from the lessons they are sharing with us and implement change that can support not only their current employees, but the future of their company.”

Promote Progress

Geter is taking such a science-based approach in her current role as chief strategy officer with the Black Women’s Health Imperative. One of Geter’s primary projects since joining the organization in January 2021 has been the creation of its workplace equality initiative. Part of the initiative is the formation of a national equity index, an interactive benchmarking tool used by executive leaders and employees to model and track equitable and fair practices in the workplace. Corporate executives can volunteer to join the index as a “Trailblazing Partner” by visiting the Black Women’s Health Imperative’s website, and the organization will do an assessment of the company’s policies and practices to determine its equity score. The initiative also includes the creation of a tool kit for employees that provides resources on how to navigate the workplace.

“It’s tailored to help Black women protect their health while they navigate the workplace,” Geter says. “But I honestly feel like anyone who feels as if they have been discriminated against could really use this resource.”

Lastly, and perhaps most importantly, Geter and her team at the Black Women’s Health Imperative established a research team conducting longitudinal studies on health outcomes related to the experience of Black women at work. Using this research, Geter and her team plan to create national standards and recommendations to improve the health and wellness of Black women in the workplace.

“We have to move beyond awareness to promote behavioral change through policy, practice and research,” Geter says. “And that’s what we’re doing at the Black Women’s Health Imperative.”

Phil Neuffer is managing editor of ABF Journal.