Abstract
In studies on health care, research has largely focused on the link between low socioeconomic status and morbidity. However, in Invisible Visits, Tina Sacks shifts the attention away from low-income Black Americans to middle-class Black women who occupy the often-understudied space between relative privilege and marginalization. Invisible Visits is the culmination of in-depth interviews and focus groups from 2010 to 2011 with 30 middle-class Black women from Chicago. Sacks’s research charts the course of health inequity from America’s history to the present and shares the ways in which the cycles of racism and discrimination continue to impact Black middle-class women in the health-care system today. In Invisible Visits, Sacks’s research suggests that race and gender might ultimately be more salient than class and therefore advocates for solutions that are grounded in a competency framework—an approach that is established on an informed understanding of the enduring legacy and effects of racism and an understanding of the impact of systemic inequalities on individual health.
Throughout the chapters of Invisible Visits, Sacks illustrates the ways in which Black women’s relationship with health-care systems has been, and continues to be, complicated by prevailing patterns of structural discrimination. In response, Sacks says Black middle-class women may attempt to assert their privilege by using their cultural health capital to mitigate the effects of possible disparities in health care in the patient–provider relationship. For Black middle-class women, this assertion is akin to a performance of self, which aims to combat common stereotypical tropes that are often used to justify Black women’s oppression. Sacks notes that these efforts to mitigate discrimination do not always shield Black middle-class women, or any other Black woman, from the structurally destructive impact of racism. However, their efforts may result in chronic stress, delayed or improper treatment, or even premature death. Hence, Sacks’s point is clear: Racism negatively affects the morbidity and mortality rates of Black women across socioeconomic class.
In Invisible Visits, Sacks also pays particular attention to the lasting effects of racism within the scientific realm. According to Sacks, the historical patterns of dehumanization and pathologization of Black Americans, as exemplified by the “Tuskegee Syphilis Study of Untreated Syphilis in the Male Negro,” and the decades-long practice of sterilizing poor Black women without their prior knowledge or authorization, commonly known as the “Mississippi Appendectomy,” illustrate the ways in which the degradation of Black personhood was used to justify unspeakable acts of violence. Moreover, America’s legacy of scientific racism and the atrocities and indignities that resulted still persist today. In Chapter 3, Sacks tells the story of Tammy, a focus group participant whose great-grandfather was involved in the Tuskegee Syphilis Study. This unethical and horrific study was the longest running medical experiment in the United States, where countless Black men were promised a treatment for their “bad blood.” Instead, they suffered years of torment through state-sanctioned medical experimentation and dreadful health care.
The effects of this study, and other terrible practices like it, have remained in the collective consciousness of many Black Americans. Therefore, the resulting distrust for the health-care system, as illustrated in Tammy’s story, is understandable. While Tammy’s refusal to interact with White health-care providers, even in extreme circumstances, may seem inconceivable, Sacks asserts that Tammy’s resistance toward white providers may be an attempt to affirm her free will and humanity. Notwithstanding, Sacks maintains that increased racially concordant patient–physician relationships do not adequately address the problem at hand. Instead, Sacks calls for seismic change.
It is often said that a rising tide lifts all boats. However, when we neglect the boats that are already riddled with holes, we shut our eyes to the casualties that ultimately follow. Our nation’s history and present-day reality tell us that racism and discrimination remain key determinants of health. Therefore, Sacks encourages readers to examine the structural mechanisms that produce and sustain disparate health outcomes for Black Americans. Sacks also urges the United States to develop culturally and structurally competent strategies that aim to decrease health inequity and improve the health outcomes for Black Americans.
