Being Black in America Can Be Hazardous to Your Health

In Baltimore and other segregated cities, the life-expectancy gap between African Americans and whites is as much as 20 years. One young woman’s struggle shows why.

By Olga Khazan | The Atlantic | July 4, 2018

 

One morning this past September, Kiarra Boulware boarded the 26 bus to Baltimore’s Bon Secours Hospital, where she would seek help for the most urgent problem in her life: the 200-some excess pounds she carried on her 5-foot-2-inch frame.

To Kiarra, the weight sometimes felt like a great burden, and at other times like just another fact of life. She had survived a childhood marred by death, drugs, and violence. She had recently gained control over her addiction to alcohol, which, last summer, had brought her to a residential recovery center in the city’s Sandtown neighborhood, made famous by the Freddie Gray protests in 2015. But she still struggled with binge eating—so much so that she would eat entire plates of quesadillas or mozzarella sticks in minutes.As the bus rattled past rowhouses and corner stores, Kiarra told me she hadn’t yet received the Cpap breathing machine she needed for her sleep apnea. The extra fat seemed to constrict her airways while she slept, and a sleep study had shown that she stopped breathing 40 times an hour. She remembered one doctor saying, “I’m scared you’re going to die in your sleep.” In the haze of alcoholism, she’d never followed up on the test. Now doctors at Bon Secours were trying to order the machine for her, but insurance hurdles had gotten in the way. Kiarra’s weight brought an assortment of old-person problems to her 27-year-old life: sleep apnea, diabetes, and menstrual dysregulation, which made her worry she would never have children. For a while, she’d ignored these issues. Day to day, her size mostly made it hard to shop for clothes. But the severity of her situation sank in when a diabetic friend had to have a toe amputated. Kiarra visited the woman in the hospital. She saw her tears and her red, bandaged foot, and resolved not to become an amputee herself.Kiarra arrived at the hospital early and waited in the cafeteria. Bon Secours is one of several world-class hospitals in Baltimore. Another, Johns Hopkins Hospital, is in some respects the birthplace of modern American medicine, having invented everything from the medical residency to the surgical glove. But of course not even the best hospitals in America can keep you from getting sick in the first place.It was lunchtime, but Kiarra didn’t have any cash—her job, working the front desk at the recovery center where she lived, paid a stipend of just $150 a week. When she did have money, she often sought comfort in fast food. But when her cash and food stamps ran out, she sometimes had what she called “hungry nights,” when she went to bed without having eaten anything all day.When I’d first met Kiarra, a few months earlier, I’d been struck by how upbeat she seemed. Her recovery center—called Maryland Community Health Initiatives, but known in the neighborhood as Penn North—sits on a grimy street crowded with men selling drugs. Some of the center’s clients, fresh off their