On June 11, 2020, Michael Hickson died of complications of COVID-19. The father of five was forty-six years old. He had contracted the infection the previous month while in a nursing home, and he was transferred on June 2 to a hospital in Austin, Texas. A Black man, Michael Hickson had a career as an auto insurance claims estimator, a career cut short when he experienced sudden cardiac arrest at just forty-three years of age. Complications left him with quadriplegia, blindness, and brain injuries. Although he had difficulty speaking and remembering things, Michael Hickson continued to participate in his family’s life, joking with his children and talking with his wife about their lives.

One Saturday morning in summer 2020, I was savoring the nonurgency of getting out of bed. I eventually rolled over, checked my phone, and opened Twitter to see the latest count of local coronavirus cases; instead, something in the “trending” column caught my eye. “Chadwick Boseman, RIP.” My immediate reaction was disbelief. That couldn’t be. How could the young, handsome, vigorous superhero be gone? I didn’t know his full body of work then, but later learned of an oeuvre that included a long list of roles. I simply knew Chadwick Boseman as T’Challa, or Black Panther. How could this embodiment of African Black Pride be returned to dust at a mere forty-three years of age?

Previous chapters examined how medical providers and the health care financing system have contributed to health inequities that Black people and disabled people in the United States encounter. But having health insurance and getting to see an unbiased, high quality doctor are not necessarily the most important contributors to promoting health and health equity, either for individuals or at the population level. More important are other determinants of health. These include individual behaviors like smoking, diet, and exercise and –critically – the social and physical environments that shape individual conduct.1 To give one example: neighborhood safety and availability of parks or playgrounds nearby influence a person’s ability to exercise conveniently and safely. Healthy behavior takes some individual initiative, but that initiative is far more likely when social and physical environments make healthy options available and easy to choose.2

Motherhood is often idealized. The dominant imagination admires idealized mothers for being loving, self-sacrificing, and nurturing. They are wise in discerning their children’s needs and supportive and generous in meeting them. Idealized mothers are strong and sensible, but always stand ready to offer a warm embrace. Television viewers may recognize the idealized mother in the iconic June Cleaver, whether they watched Leave It to Beaver in its original run during the 1950s and 1960s or in reruns.1 This traditional ideal is firmly grounded in twentieth century, middle-class, White, heterosexual norms of domestic motherhood.2 The ideal of good motherhood has evolved to admit the possibility that women who work outside the home might qualify as good mothers. But recent years have seen a resurgence of the traditional ideal of intensive mothering (which expects mothers to focus their energy and resources on child-rearing) and even competitive mothering (which describes antagonism between different approaches to mothering, often displayed in blogs or social media).3

The unfolding of the COVID-19 pandemic provided the American public with a master class on health care inequality and how vulnerability to ill health is created. Black people and disabled people, along with folks in other marginalized communities, have suffered disproportionately from the coronavirus’s ravages of sickness and death, as well as its economic burden.

On July 28, 2017, Senator John McCain walked onto the floor of the Senate Chamber and into the middle of an intense congressional debate over the future of health care in the United States. Since earlier that year, a Republican majority in Congress had been pushing proposals to repeal the Affordable Care Act (ACA) and make fundamental changes to the Medicaid program. Although McCain previously had expressed his opposition to the ACA, at the time of the vote, his support for the repeal legislation was in question. McCain entered the chamber as voting was underway. Instead of heading to his seat on the Republican side of the chamber, he paused before the Senate chair and extended his arm. Then came McCain’s dramatic gesture: Thumb’s down on the bill. With that simple motion, McCain upended Republican efforts to scuttle a central piece of President Obama’s legacy. He also preserved the existing structure of Medicaid against Republican efforts to weaken and shrink it, efforts that posed especial threats to Black Americans and disabled Americans.1

The rates at which Black people, disabled people, and disabled Black people have borne the brunt of suffering and death in the COVID-19 pandemic have made structural inequities visible. They also drive home the need to pay attention to and think more comprehensively about the lives of people who are both Black and disabled, who live at the intersectionality of race and disability: How are their experiences of the world different from and similar to those of nondisabled Black people and disabled White people?

During President Barack Obama’s second term, White medical students and residents at a prestigious public university participated in a research study exploring beliefs associated with racial bias in pain management, an area with well-documented racial disparities in clinical care. These highly educated doctors in training completed a questionnaire asking the extent to which they thought that fifteen factual assertions about biological differences between Blacks and Whites were true or untrue. They also read two mock medical cases about patients (one Black and one White) with a painful condition (kidney stone or ankle fracture), rated how much pain they believed the patients were in, and made recommendations for treating that pain.1

Few people, if they paused to reflect on the question, would disagree with the idea that various aspects of a person’s identity have a bearing on their experiences in the world. There are differences in how a person of twenty-five years versus one of sixty-five years mediates a dispute, trains to run a marathon, or walks into a dance club. Completing a graduate degree versus dropping out of high school affects the opportunities a person has when applying for a job or running for office. Identifying as a woman, a man, or neither will affect a person’s experience of serving in the military, seeking a job promotion, or being the primary caregiver for young children (at least in many locales). Most of these variations in experience have little to do with persons’ biological differences. Instead, they grow out of social environments and others’ expectations. To the identifiers of age, education, and gender suggested above, we can add race, disability, immigrant status, sexual orientation, and other markers of identity. And it is the intersection of those multiple various aspects of a person’s identity, combined with personal choices and life experiences, that make each person distinctive and shape each person’s experience.

Distrust of health care system or providers can affect a patient’s decisions concerning whether to seek medical care, how openly to share health concerns, and how closely to follow a provider’s advice. A person’s health literacy and understanding of disease can also shape their interactions with medical professionals. Some analyses of racial health disparities have considered how patient “preferences” and behavior might contribute to those disparities or provide a basis for doctors’ stereotypes of Black patients as “noncompliant.”1 Various initiatives have sought to increase the trust that Black people or those from other marginalized communities place in medicine, approaching patients’ low trust levels as if they were a vitamin deficiency that needed correcting.