Although being black in this world certainly comes with its struggles, I wouldn’t trade that integral part of my identity for anything. Black-girl magic is real. But it’s a sad fact that black women are often plagued with disproportionately high incidences or mortality rates for various health conditions, like heart disease , breast cancer , and more.
It sounds scary—and it can be—but knowledge is power, especially when it comes to your physical and mental health. Here are eight health conditions black women should be especially aware of, plus how to best prevent them.
1. Heart disease, stroke, and diabetes
These conditions often occur together or exacerbate each other, and they’re striking black women hard.
Around 7.6 percent of black women have heart disease, compared to 5.8 percent of white women and 5.6 percent of Mexican-American women, according to Centers for Disease Control and Prevention data from 2011-2013. In 2016, around 46 of every 100,000 black women died from strokes , while 35 of every 100,000 white women did. And while white women’s diabetes diagnosis rate is 5.4 per 100, that number is 9.9 per 100 for black women , according to CDC data from 1980-2014—almost double.
A group of risk factors known as metabolic syndrome increases a person’s chance of getting these diseases. These risk factors include having a waist circumference above 35 inches in women and 40 inches in men, high levels of triglycerides (fat in the blood), a low HDL (“good”) cholesterol level, high blood pressure, and high fasting blood sugar.
Someone must have at least three of these factors to be diagnosed with metabolic syndrome, but having even one can signal higher chances of getting heart disease , stroke, and diabetes. Those first two are particularly lethal, killing one woman about every 80 seconds .
The black community’s obesity crisis is a symbol of just how at-risk this segment of the population is. “The vast majority of African-American adult women are either overweight or obese,” Hilda Hutcherson, M.D., professor of obstetrics and gynecology at Columbia University Medical Center, tells SELF. While 37.6 percent of black men ages 20 or over are obese according to the latest data, that number jumps to 56.9 percent for black women. It stands at 36.2 percent for white women.
Various genetic components are likely at play with metabolic syndrome—for instance, some research points to a gene that might make black people more sensitive to salt , thus influencing blood pressure —but much of this issue is societal.
“It’s the foods we eat—many communities don’t have easy access to healthier options,” Dr. Hutcherson says. A 2013 study in Preventive Medicine found that “poor, predominantly black neighborhoods face…the most limited access to quality food.” Dr. Hutcherson also cites stress and adds that a lack of exercise can be a problem, too, if it’s hard to get access to a gym or the neighborhood isn’t safe.
Lifestyle changes like eating better, exercising, and stopping smoking can prevent 80 percent of heart disease events and stroke and lower people’s chances of developing diabetes, according to the CDC . But clearly, that’s sometimes easier said than done.
2. Breast cancer
Black women have a 1 in 9 chance of developing breast cancer ; for white women the odds are 1 in 8, according to the American Cancer Society . But black women are more likely to die from the disease: White women’s probability of dying from breast cancer is 1 in 37, while black women’s is 1 in 31.
“The reasons why black women are more likely to die [from breast cancer than other groups] are very complex,” Adrienne Phillips, M.D., oncologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF, citing “an interplay between genetics, biology, and environment.”
Along with BRCA mutations (which may be higher in black women than experts previously thought), black women are more likely to get triple-negative breast cancer—a particularly aggressive form of the disease—than women of other races. Then there are the environmental factors Dr. Phillips mentions, like socioeconomic issues that lead to trouble accessing early diagnosis and treatment.
Much like metabolic syndrome, lowering your risk of getting breast cancer mainly comes down to exercising, maintaining a healthy weight, not going overboard on alcohol, and quitting smoking. And even though major organizations haven’t found a notable benefit from breast self-exams , many doctors strongly recommend you check your breasts monthly so you’re aware of any changes.
3. Cervical cancer
Research published in January in the journal Cancer found that not only are black women more likely to die of cervical cancer than women of other races, they’re also 77 percent more likely to die from it than experts previously thought. Prior estimates said 5.7 black women per 100,000 would die of the disease, but this new research puts the number at 10.1 per 100,000.
“Unlike breast cancer, cervical cancer is absolutely preventable in this day and age,” Dr. Phillips says. “In 2017, no woman should be diagnosed with cervical cancer.”
That’s partly because the HPV vaccine is excellent at preventing infection of certain strains of human papillomavirus that can go on to cause cancer. But as of August 2016 , only 6 out of 10 girls ages 13 to 17 and 5 of 10 boys in the same age range had started the vaccine series, which doctors recommend getting before age 26 for optimal results. Racial disparities are relevant here—a 2014 report from the CDC showed that around 71 percent of white girls 13 to 17 had completed the three-shot series, compared with about 62 percent of black girls in that age group. ( The CDC changed these recommendations in 2016: It now says only two doses are necessary for optimal protection if the patient is between 11 and 12, but three are still ideal if the patient is between 15 and 26.)
Timely Pap smears are also wonderfully effective at preventing full-blown cervical cancer. “A Pap smear will detect preinvasive cervical cancer, but…studies have shown women who are having Pap smears may not get appropriate follow-up ,” Dr. Phillips says. “A number of barriers exist for proper follow-up, and African-American women may be more vulnerable.”
Another potential factor, though, may be racial disparities in cervical cancer treatment. A 2014 study published in Plos One found that black women in Maryland were significantly less likely than white women to get surgery for cervical cancer instead of radiation or chemotherapy.
“Equivalent treatments are not being administered to white and black patients with cervical cancer in Maryland,” the study authors concluded. “Differences in care may contribute to racial disparities in outcomes for women with cervical cancer.”
A 2016 study in the Journal of Obstetrics and Gynecology reached a similar conclusion. The study looked at more than 16,000 patients who had received care for advanced cervical cancer, finding that white women received National Cancer Institute guideline–based care 58 percent of the time, black women 53 percent of the time, and Hispanic women 51.5 percent of the time.
Black women are three times more likely than women of other races to get uterine fibroids , noncancerous tumors in the walls of the uterus, according to the Department of Health and Human Services Office on Women’s Health . Fibroids are largely genetic, and there’s no known way to prevent them.
“Most of the time, women don’t know they have fibroids because they don’t have symptoms,” Dr. Hutcherson says. “But when [the fibroids] start to grow or increase in number, they can cause a large number of problems, from pain to bleeding to miscarriages , to problems with urination and problems with bowel movements.”
These symptoms can have a lot of other causes, but if you do have fibroids, you and your doctors can work on a treatment plan. To tackle heavy bleeding and pelvic pain, your doctor may recommend hormonal birth control . But doctors can also perform a myomectomy to remove the fibroids or use techniques like uterine artery embolization and radiofrequency ablation to either block the fibroid from getting nutrients or shrink it.
If you’re done having children or are not interested in having them in the first place, as a last resort, doctors can perform a hysterectomy to put a definitive end to fibroids. Since this makes it impossible to get pregnant, it’s an incredibly delicate decision that varies from woman to woman.
5. Premature delivery
Giving birth prematurely, or going into labor before 37 weeks of pregnancy , can predispose a child to breathing issues, digestive problems, brain bleeding, and long-term developmental delays. It can also lead to death—the earlier a baby is born, the higher this danger becomes.
Unfortunately, black women are particularly susceptible to going into labor too early. According to the CDC, the 2015 preterm birth rate in black women was 13 percent ; for white women it was 9 percent.
“This is multifactorial—it can be affected by obesity, by stress, by diet, by increased vaginal infections , and the decreased access to care in some of our populations,” Dr. Hutcherson says. Women having access to prenatal care is incredibly important for slashing the risk of preterm birth, but when socioeconomics come into the picture, it becomes a complex situation with too few solutions. However, the CDC’s Division of Reproductive Health is working on a variety of state- and national-level initiatives to reduce preterm birth in all women.
6. Sickle cell disease
This is an umbrella term for a collection of inherited, lifelong blood disorders that around 1 of every 365 black babies is born with, according to the CDC . Sickle cell disease is caused by a sickle hemoglobin, which happens when the structure of a person’s hemoglobin, the protein that carries oxygen to the red blood cells, is abnormal. Instead of being circular, their red blood cells can look like sickles, a C-shaped farming tool, Dr. Phillips explains.
Sickle-shaped red blood cells can get destroyed in the blood stream, so patients may become anemic . These cells can also clog blood vessels, which can lead to infection, chest pain, and even stroke . And if a pregnant woman has sickle cell disease, it increases the probability of miscarriage, premature birth, and having a baby with a low birth weight, according to the March of Dimes .
Black women who are considering children should get screened for sickle cell no matter what, Dr. Phillips says. It’s possible to not have the disease but have the sickle cell trait, meaning you inherited one sickle cell gene and one normal gene from your parents. If your partner also has sickle cell trait, there is a 25 percent chance your child will inherit sickle cell disease . According to a CDC estimate from 2014 , 73 out of every 1,000 black newborns was born with sickle cell trait, compared with 3 out of every 1,000 white newborns.
With proper care and caution to avoid complications, kids with sickle cell disease can live healthy, happy lives, Phillips says—it’s essential for their parents to get the proper education about how to keep them safe.
7. Sexually transmitted diseases
Here’s a bit of good news: Rates of reported chlamydia cases in black people decreased 11.2 percent from 2011 to 2015, according to the CDC . There was a similar downward trend with gonorrhea, which declined 4 percent in that time frame. But black women still outpace other groups when it comes to new diagnoses of these diseases, along with new diagnoses of syphilis.
This problem also extends to HIV/AIDS . Besides black men, black women comprise a majority of new HIV/AIDS diagnoses per year (although the number is thankfully falling). For example, according to the CDC , in 2015, 4,524 black women were diagnosed with HIV in the United States, while 1,431 white women and 1,131 Hispanic/Latina women received the same diagnosis.
“It’s not like black women are having more sex than anyone else,” Dr. Hutcherson says. “Access to good preventive care is the crux of it—if [women] could see health care providers on a regular basis and be educated about what they should be doing to take care of themselves, we probably wouldn’t have as much of a problem.”
Economic insecurity is also an element—condoms and dental dams cost money, after all—as is a general reticence to discuss safe sex.
“There’s a stigma around talking about sex, so people engage in risky sexual activity without protection,” Dr. Hutcherson says.
8. Mental health issues
Overall, black people are 10 percent more likely to report experiencing serious psychological distress than white people, according to the Department of Health and Human Services Office of Minority Health.
“In 2017, we still face a lot of economic insecurity and racism in general. It’s a problem that causes stress and anxiety, which then can lead into depression, and that’s something we never discuss,” Dr. Hutcherson says. “I wish we could make it more acceptable to talk about this and seek care.” Just like in many other cultures, the black community is wrestling with the stigma of seeking help for mental distress. There’s also the reduced access to this kind of counseling in the first place, and the fact that mental health care can be prohibitively expensive. Many counselors, psychologists, and psychiatrists don’t take health insurance, which may deter people from getting the help they need. Combined, these factors resulted in 9.4 percent of black adults getting mental health treatment or some form of counseling in 2014 versus 18.8 percent of white people age 18 and older, per the Office of Minority Health.
Black women are especially vulnerable to wrestling with their mental health, consistently reporting higher feelings of sadness, hopelessness, worthlessness, and the sense that everything is an effort than white women do. “Black women are frequently the pillars of our community, taking care of everyone’s health but our own,” Dr. Phillips says. “But it’s very important for women to practice self-care and not forget about themselves when trying to be so strong.”
If you or a loved one is struggling with mental health, help is out there. The National Alliance on Mental Illness has a comprehensive page about mental health concerns in the black community and a help line that operates Monday through Friday, 10 A.M. to 6 P.M. NAMI also provides a list of 25 different help lines people can turn to when they need support.
Watch: What Everyone Gets Wrong About Eating Disorders