Colorism, Health Justice, and Black Women’s Health

Health justice offers a theoretical framework for addressing health disparities through law and policy by responding to the structural causes of health disparities. This is a key feature of the health justice framework. Placing critical analyses of colorism in conversation with health justice, and even health law more broadly, offers space for contending with the complicated ways in which skin-color-based discrimination harms health. This is especially critical for darker-skinned Black women who are most harmed by the intersection of gendered colorism and health disparities. 

Colorism as Social Capital 

Colorism is now widely understood as a key site for examining social subordination. Analytically, it refers to the systemic privileging of lighter skin color and proximity to whiteness, which harms people of darker skin color, especially those with Afro-centric features. Lighter skin color is, therefore, understood as a form of symbolic capital that stratifies one’s life outcomes.

Like racism, colorism stems from historical and ongoing contemporary forces, including slavery, colonialism, and ongoing laws and practices that enforce the race and skin-color hierarchies in the United States. It can manifest institutionally or interpersonally. And it manifests intra-racially, wherein people of color discriminate against darker-skinned people of color. The law has also played a pivotal role in upholding discriminatory skin-color practices through the creation of racial categories that served the racial hierarchy in the United States. And, though colorism manifests intra-racially, colorism invariably serves the needs of the dominant ethno-racial group and white superiority.

Today, colorism stratifies key life outcomes like educational and income attainment, labor market success, marital status, and even whether one marries “up” or “down.” The effects of marital outcomes are most stark for darker-skinned Black women who face profound discrimination in the beauty and dating markets. This is due to the ways in which skin color intersects with perceptions of beauty, as well as hair texture and other features. Studies have shown that colorism also affects rates of incarceration and access to justice in the criminal justice system. In short, like racism and classism, colorism materially alters how one navigates life, even if one is unaware of its tangible effects. 

Scholarship on colorism has only recently begun to uncover its health consequences. Sociologist Ellis Monk, for example, has explored how it impacts health outcomes within the Black community. Monk found that health disparities intra-racially within the Black community sometimes mirror or exceed interracial variations between ethno-

racial groups (Ellis Monk, The Cost of Color: Skin Color, Discrimination, and Health Among African Americans, 121 Am. J. Soc. 396 (2015)). While systemic 

racism is now well understood as a serious public health risk, colorism, too, is an important public health risk.

The Health Justice Framework

The health justice framework has emerged as an important conceptual and analytical tool to address structural forces that impact health disparities. Specifically, this framework offers insight into how social subordination, including those related to skin color, might be an avenue for mitigating health inequity for the most marginalized among us. Instead of merely examining traditional health law concerns like health care access and the availability of insurance, for example, health justice aspires to dismantle structural barriers that undermine health through law and policy. This comprehensive approach ensures that the problem of health inequity can be targeted at its root.

The public health literature has canvassed key social and economic determinants of health. These include inadequate housing and residential segregation, environmental racism, poorly resourced hospitals in some communities, transportation access, education, and socioeconomic status. These are also tied to racism and classism as longstanding historical forces of subordination that have shaped health disparities. With increasing attention to the material effects of colorism as an important structural determinant of health, health justice can address health equity concerns for darker-skinned women of color who are most harmed by gendered colorism. 

Colorism and Black Women’s Health

This brings Black women’s health into full focus. Black women’s reproductive health has been a subject of intense conversations in the public health arena. Recent developments in reproductive rights expose the precarious position of marginalized women of color in the context of assaults on reproductive rights. Indeed, we are increasingly seeing the impact of restrictions on access to reproductive rights and health care: It is most harmful to marginalized women and especially in states that are rife with maternity care desserts. 

Additionally, because of inadequate access to maternal health care, the United States now faces dismal maternal mortality rates compared to other developed counterparts. This is primarily due to Black women’s maternal outcomes. Black women are more likely to die in childbirth, not because of any underlying physiological defects but because of systemic defects in health care provision and the routine discrimination they face in medical settings. It is systemic racism that exposes them to adverse maternal outcomes. Intersectional analyses also illustrate that class mobility often fails to offer the same health-protective benefits to Black women that it does to white women. In short, upwardly mobile Black women experience comparable maternal outcomes to lower-educated, lower-income white women.

Unfortunately, darker-skinned women are often obscured in this discourse, even though, considering Monk’s findings, these are the women most likely to be harmed by health inequity. A critical analysis of gendered colorism, therefore, adds to this analysis of Black women’s health, as it accounts for the structural forces that harm darker-skinned Black women particularly.

Skin-Lightening Products and Practice

The case of skin-lightening products and the practice of skin-lightening are illustrative as well. The global market for skin-lightening products has burgeoned in recent years, as skin color is deeply linked with perceptions of beauty. These products are highly toxic, yet they are widely available within immigrant communities domestically and on the shelves of local beauty supply stores in the United States. These products often reinforce problematic stereotypes about darker-skinned women of color as not being beautiful or attractive. 

Public health responses, however, are generally inadequate. Instead of addressing the root causes of the demand for these products, public health actors have traditionally focused on the supposed psychic defects of women of color who consume the products. The problematic assumption is that these women are not only lacking in self-esteem but are also unaware of what it means to be beautiful. 

Likewise, laws regarding chemical ingredients within these products do not address the root cause of skin-lightening use. New York State recently banned the sale of beauty products containing mercury in its Environmental Conservation Law with skin-lightening products in mind. Mercury is a common chemical agent in skin-lightening products. While these measures are necessary, they do not target the root cause of the practice of skin lightening.

With the passage of the federal Modernization of Cosmetics Regulation Act (MOCRA), regulatory law also now imposes more stringent regulations on these products, including reporting requirements. But there are certain gaps between the law and science of cosmetics harm that remain. For example, the new law emphasizes the reporting of serious adverse events, often acute responses that may lead to hospitalization. In emphasizing serious adverse events, however, the law fails to fully grapple with the mundane ways that chronic long-term exposure to these products harms the body. It is not surprising that there has been litigation relating to hair care products and their connection to uterine cancer; these users were likely harmed by long-term chronic exposure. MOCRA does not adequately account for this disjuncture. 

And, again, laws that target product ingredients fail to address a key structural cause of skin-lightening, namely systemic gendered colorism and institutional norms that reify lighter skin color.

How Health Justice Addresses Gendered Colorism and Black Women’s Health

Health justice might attend to these gaps. In doing so, it must also contend with the unyielding cultural reality that many individuals (including men, increasingly) may continue to view these products as an avenue for accessing social, economic, and intimate spaces that exclude them. These individuals have likely calculated that their health risks are justified in light of the benefits. Therefore, until we address the exclusionary skin-color-based practices in our daily lives, we will see a demand for these products and practices. Traditional health law approaches are unlikely to address these core issues if they are devoid of the cultural realities on the ground that create the need for these products in the first place. They will likely miss the mark. 

A first step might, therefore, be to examine how colorism operates structurally and interpersonally on a seemingly mundane basis and how it materially shapes access to resources that are intricately tied to health outcomes. Health justice might also offer us a way forward in public health law and policy that does not reproduce the problematic patriarchal norms in public health practices that have traditionally impeded public health efforts. In other words, health justice might view darker-skinned women of color who consume these products as fully agentic beings capable of navigating the structures of domination within which they exist and the avenues for negotiating with these structures. Placing colorism in conversation with health justice, therefore, opens space to address these complex and nuanced issues.

The author would like to thank their research assistant, Daniel Espineira, for providing terrific research support for this article.