As a nurse, I have been with patients during their first breath and their last. While with grieving families, one statement that stays with me is, “At least now she/he can rest.”

This statement almost always comes from a grieving Black family who lost a family member to a premature death of a preventable or manageable disease. Why must we wait until we are six feet under to rest?

As a Black woman, I intimately understand the demands to “push through,” but I wonder: What is the physical cost of perpetual resilience?

A personal history of loss

Beyond my professional experience, I have personally experienced premature death. I have lost two siblings under the age of 30 years old from gun violence, lost my mother at the young age of 55 years old to heart disease, and my father at 53 years old to cirrhosis of the liver. Both of my parents died more than 20 years short of the average life expectancy in the United States, due to preventable diseases.

Yet, that is only the prologue of my story of adversity. I know that I am strong, and I don’t want to have to be that way. I am sick of this story, but I realize it is the story of so many other people, and this is why I do this work. And I don’t want this to be about me. Here is the story I want to write.

The cost of resilience

According to the American Psychological Association, resilience is the ability to overcome adversity. Resilience has long been regarded as a necessary adaptive behavior and protective factor.

While this is true, context matters. Resilience can also be exhausting, and when recurring and severe, it becomes maladaptive. What doesn’t kill you doesn’t always make you stronger; it can make you sicker. For Black women in the U.S., resilience may be an unseen pathway of health inequities. Resilience may be a risk factor.

Data from the American Heart Association shows that heart disease, a type of cardiovascular disease (CVD), continues to be the number one cause of death among women in the U.S. and disproportionately affects Black women. More than half of Black women aged 20 years and older live with some form of CVD.

According to the Centers for Disease Control and Prevention (CDC), Black women are three times more likely to die from pregnancy-related causes. One in five Black women report being treated unfairly by a health care provider due to their race or ethnicity.

Chronic stress from racism has been found to accelerate biological aging in Black women, making them biologically up to nine years older than white women of the same chronological age. Although a growing body of literature suggests that racism is associated with these health disparities, shifts in the political climate and research priorities could stymie advancing women’s health.

The political landscape of health equity

Under the Biden administration, officials took several positive steps to advance health equity. There were increases in investments in Black communities, such as the $16 billion invested in historically Black colleges and universities (HBCUs), along with increases in loans to businesses, maternal health investments, and judicial representation by the appointment of 40 Black women to federal judgeships, including the elevation of Supreme Court Justice Ketanji Brown Jackson.

However, the Trump administration has reversed or threatened many of these initiatives. Funding for maternal health research has been slashed, diversity, equity, and inclusion (DEI) programs have been dismantled, and social programs to support the underserved or vulnerable populations, such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP), are targeted for drastic cuts.

Addressing systemic factors

The systemic factors that perpetuate inequities in stress and resilience must be addressed to ensure everyone can achieve their best health. As a nurse, I am trained to care for people first, and see them holistically.

I care because I have seen firsthand the impacts of chronic stress, structural barriers, and maladaptive resilience. Findings from my research support available data and found that among young Black women between the ages of 18 and 40 years, nearly one-third had high blood pressure/hypertension, abdominal adiposity, and obesity.

How do we turn this around? We, clinicians, scholars, and researchers, should move beyond individual-level interventions and commit to structural changes that eliminate the conditions, such as violence exposure, neighborhood deprivation, and unequal access to health-promoting resources that predispose Black women to poor health outcomes.

We should incorporate complementary and alternative medicine techniques such as mindfulness and yoga into treatment plans and health-related resources. Understanding that stress management techniques in isolation are insufficient, funding for maternal health equity must be restored at the policy level, including community-based doulas, midwifery models, and DEI initiatives the current administration dismantled.

Funding of research to further investigate drivers of health disparities is needed, and it is imperative that we reject divisive language. Uplifting work by other scholars, such as Drs. Keisha Bentley-Edwards and Valerie Adams, which supports my call to action, we must “rethink the resilience of Black women and girls.” Gaining a deeper understanding of health and disease and creating tailored, equity-focused interventions to improve health outcomes for all is just, particularly for populations that need them most, because the suffering and burden are greater amongst them.

I echo the words of the IPS Bridging Our Divide Campaign with Dr. Vincent Guilamo-Ramos: “Your health is my health.” And truth be told, we all deserve rest before we are six feet under.

Latesha K. Harris is a registered nurse and nurse scientist focused on understanding and addressing health inequities among historically underserved populations, particularly Black women. She is a clinical associate at Duke University School of Nursing and a postdoctoral fellow in the National Clinician Scholars Program. She is also a fellow in the Nursing Science Incubator for Social Determinants of Health Solutions at Johns Hopkins University.

Dr. Harris’s interdisciplinary research examines resilience, psychosocial stress, structural inequities, and their effects on health across the life course. A sampling of her scholarship includes work on cardiovascular disease risk among young Black women published in Ethnicity and Health, research on police violence and Black women’s health in The Journal of Nurse Practitioners, analysis of psychological distress during the COVID-19 pandemic in SSM Mental Health, and studies of spiritual experiences and cardiometabolic risk in midlife Black women published in Menopause. 

Her research has been supported by the National Institutes of Health National Institute of Nursing Research, the Rita and Alex Hillman Foundation, and the Robert Wood Johnson Foundation Health Policy Research Scholars program. Professional updates are available on LinkedIn.