Lizzo Feeling Bad About Weight Comments Could Be The First Step Toward Better Health

Lizzo threatened to quit her monumental musical career this week, citing online comments critical of her weight.

On Wednesday, the celebrity icon of the pro-fat movement locked her Twitter account and published a series of tweets complaining about online commentators who highlight Lizzo’s brand as the queen of “body positivity.”

“How is Lizzo still THIS fat when she’s constantly moving this much on stage?! I wonder what she must be eating,” wrote author Layah Heilpern.

The remark pointing out that it’s impossible to outrun a bad diet left the 35-year-old stadium singer enraged.

“JUST logged on and the app and this is the type of s**t I see about me on a daily basis It’s really starting to make me hate the world,” Lizzo wrote, according to the Daily Mail. “Then someone in the comments said I eat ‘lots of fast food’ I LITERALLY STOPPED EATING FAST FOOD YEARS AGO… I’m tired of explaining myself all the time and I just wanna get on this app w/out seeing my name in some bulls**t.”

The pop star’s Twitter account remains locked Friday afternoon, with only her 2.4 million followers able to access tweets.

Despite her rigorous routine as a world-famous performer, Lizzo’s size still calls into question the activist’s eating habits. While exercise is important to regulate metabolic function, weight is dictated by diet more than anything else, wherein hormones and enzymes control whether fat is stored or lost. Lizzo’s Instagram still features the plus-size influencer sipping beer and capitalizing on gluttony.

The outrage expressed Wednesday, however, could also be the first step towards better health and a better life, not just for Lizzo but for her millions of fans who fall into the trap of aggressive body positivity that leaves them fat, sick, and depressed.

A real commitment to health begins in the kitchen starting with the complete elimination of deadly ultra-processed foods. Industrialized foods, however, make up 60 percent of calories in the typical American diet, probably because, on average, they’re 52 percent cheaper courtesy of taxpayer subsidies. Americans who raise the white flag on the obesity epidemic would clearly rather be rich and sick than healthy and poor.

Cultural influencers such as Lizzo are providing little incentive to reverse the trends in obesity and a deteriorating lifespan. Obese teens today can already expect to live five fewer years than their parents and will likely have to pay at least twice as much in health care expenses. Meanwhile, research shows clear correlations between diet and brain health.

As cliche as it sounds, the first step to solving any problem is to acknowledge it. It’s not enough to simply “manifest” your way into any situation. Lizzo’s breakdown could be the trigger that she and her fans need to prioritize health above anything else. Black Americans in particular, who suffer from the highest prevalence of obesity, could use a health-conscious Lizzo’s activism.

Ways that DeSantis’ government approach changed Florida

TALLAHASSEE — As Gov. Ron DeSantis takes his “great American comeback” tour to the early primary states of Iowa, New Hampshire and South Carolina this week in his pursuit of the Republican nomination for president, he promises audiences he will deliver results by bringing his norm-breaking approach to government in Florida to Washington, D.C.

So what can America expect if DeSantis is in charge?

Elected as a Trump-embracing conservative who promised to expand school choice and protect clean air and water, DeSantis morphed into an advocate of the aggressive use of state power to usher in a radical shift in education and health care policy, a bigger role for state government in business and personal life, new limits on local government control, and, in the process, less government transparency.

In the last four years:

  • Disney, once considered a state treasure as a tourist magnet and economic engine, now is an enemy of the state.
  • The LGBTQ+ community, which had been riding a wave of broader societal acceptance after the passage of same-sex marriage, now has members leaving Florida because they don’t feel welcome anymore — a decision cheered by the governor’s staff.
  • The state has gone from enabling a narrow slice of the K-12 population to be eligible for school vouchers to one in which every student is eligible at a potential cost of billions of dollars.
  • Florida’s colleges and universities, where state officials had for decades maintained a hands-off approach to academics, are now prohibited from teaching materials that constitute “identity politics” or are rooted in critical race theory. They also now must respond to increased pressure from the governor’s political appointees, who have been given unprecedented authority over what students and faculty members can do and say.
  • Industries from agriculture to tourism and construction, which rely on migrant labor, now must verify the citizenship status of employees.
  • And abortion services, once the most liberal in the Southeast, may soon be banned at six weeks, before many women know they’re pregnant.

And the Florida economy boomed

As the governor focused on being an “energetic executive” to check the power of private businesses and what he saw as the “woke” policies of the left, Florida’s economy boomed.

As the state’s in-migration numbers returned to levels the state hadn’t seen since the 1980s, its unemployment rate became the lowest in the nation, and the state budget — with a massive injection of federal funds from infrastructure and pandemic-era programs — now boasts one of the highest surpluses in the country.

DeSantis appealed to traditional conservatives and signed into law deep restrictions on business liability lawsuits, continued tax breaks and temporarily lowered tolls. He enjoyed a surge in Republican voter rolls and retained his appeal with many environmentalists by approving new investments in the Everglades that have made its water quality healthier than it has been in decades.

But Florida’s governor has also presided over an era of steep increases in the cost of homeowners insurance. Floridians today are paying on average more than $4,231 — triple what Americans pay nationwide, according to the industry-supported Insurance Information Institute.

Not all policy changes sailed through

Less watched, however, has been how he has managed his achievements.

One of the three super PACs supporting his candidacy is called Never Back Down, but on nearly a dozen high-profile issues, DeSantis was forced to back down from his original positions and settle for compromise language sought by more traditional factions of the compliant Republican Legislature. Those issues include his ban on COVID restrictions for business, the sale of real estate to certain foreign buyers, election access issues, loosening state gun restrictions, banning vaccine passports, eliminating Disney’s taxing district, and imposing new rules on businesses to target illegal immigration.

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“We proved it can be done. We chose facts over fear, education over indoctrination, law and order over rioting and disorder,” the governor declared during his scripted but glitch-filled campaign rollout on a Twitter livestream last week. “… This whole business we are in is about producing results.”

When some of DeSantis’ policy results were found to be unconstitutional, or faced legal scrutiny, the governor had the Legislature revise the law, and in some cases had the changes apply retroactively.

Those issues include the retroactive rewrite of the law authorizing the relocation of migrants — to allow him to avoid transporting them into Florida first; the rewrite of the law targeting Disney — to allow the taxing district to continue but under the control of the governor’s appointees; the rewrite of the law that allowed DeSantis to accuse 20 people of voter fraud but which was in legal jeopardy, and a retroactive exemption added to the public records law so that the governor’s travel records will no longer be subject to public scrutiny.

“Buckle up when I get in there because the status quo is not acceptable,” DeSantis proclaimed last week.

But achieving those goals in politically divided Washington, D.C., would be vastly different from governing in Florida.

He would immediately face more friction than he did with a Republican legislative majority that is more homogeneous in its ideology than ever before, showing a willingness to support DeSantis in breaking long-held Florida traditions of refraining from interfering in academic freedoms, doctor-patient relationships and public records access.

“The reason that we were so successful is that we had a speaker of the House, myself, and a governor who were aligned,” said Senate President Kathleen Passidomo, R-Naples, at a bill signing with the governor in Southwest Florida in early May. “We have the same political philosophy. We care deeply about this state and the freedoms that we enjoy as Floridians.”

DeSantis changed himself first

DeSantis didn’t begin with a big government, grievance-focused approach when he was first elected to Congress in 2012, but as he changed Florida as its governor, his political philosophy changed, too.

In his 2011 polemic, “Dreams of Our Founding Fathers: First Principles in the Age of Obama,” DeSantis espoused traditional Republican values of small government, lower taxes, and the populist views of the Tea Party movement that swept him into Congress.

He ran for governor with hard-line policies on immigration and abortion and vows to overhaul what he called a “historically liberal” Florida Supreme Court.

Water quality focus

After he was narrowly elected governor in 2018, his first actions were as an environmental centrist, taking policy positions that acknowledged climate change was occurring and promising to remove business influence on water policy. In one of his first acts, he removed Big Sugar’s allies on the South Florida Water Management District board and replaced them with members who supported a shift in how water is managed in Lake Okeechobee.

The approach has been “a game changer” that has led to noticeable improvements in the quality of water flowing south into the Everglades, said Anna Upton, executive director of the Everglades Trust, a Tallahassee-based advocacy group.

DeSantis has committed $3.5 billion to Everglades clean-up projects, prioritized funding to protect the Indian River Lagoon, as well as delivering $1.1 billion in local government resiliency efforts that allow communities to determine their vulnerabilities to sea level rise and inland flooding.

The investment also has led to a reduction in the salinity levels in Florida Bay — necessary to avoid the massive seagrass die-off that has happened in the past, Upton said, and it has also resulted in improving fishing conditions.

Health care mistrust

The governor’s small-government approach shifted most dramatically during the COVID-19 pandemic, especially regarding health care and education. He used his executive authority to ban mask and vaccine mandates, business restrictions and punished local governments that countermanded his approach.

DeSantis also went from banning vacation rentals, endorsing COVID vaccines for seniors and organizing vaccination events in gated communities, to questioning science and hiring a surgeon general whose outlier views about the mRNA vaccine brought condemnation from medical colleagues.

Now, doctors are prohibited from providing transgender medical care to children, and health care providers are allowed to deny medical care for moral reasons.

The governor called Anthony Fauci “one of the most destructive bureaucrats in American history” and public health experts generally “a stridently partisan, highly ideological mess.”

The governor’s hands-off approach to the pandemic came when “he recognized the political advantage of aligning himself with the anti-vax, anti-public health measures right-wing branch of his party,” said Aileen Marty, a distinguished professor of infectious disease at Florida International University.

“After his shift, he argued that his policies were good for the economy and hand-picked ‘experts’ with fringe — often dangerous — views to support them,” she said.

For example, the governor’s claim that masks or N95-style respirators are ineffective is flawed, she said.

“When masks/respirators are used appropriately, all studies show that the proper use … reduces transmission,” Marty explained. But studies of mask mandates “have nothing to do with the proper use of masks or respirators” to prevent infections, and that has led to confusion.

DeSantis spells out his reasoning in his new book, “The Courage to Be Free: Florida’s Blueprint for America’s Revival.”

“After reviewing the data from March to April 2020, I made the judgment that draconian measures would do major damage to the economy and society while making little to no impact on the trajectory of the disease.”

He has proudly compared Florida’s per capita COVID mortality rates with those of New York and California, saying he protected seniors first. Florida leads the nation in deaths of people 85 and older, with 9,828 COVID-related deaths in that age group, according to the U.S. Centers for Disease Control and Prevention, and the state ranks 45th in the percentage of the vaccine-eligible population that has completed a two-shot or single-dose COVID-19 vaccine and had one booster.

But to public health experts on the front lines of battling the COVID-19 pandemic, the governor’s rhetoric and policies had a measurable impact: a decline in trust of public health professionals and higher per capita loss of life.

Scott Rivkees, the first Florida surgeon general appointed by DeSantis, has written several opinion articles outlining how anti-vaccine misinformation has led to an erosion of respect in the experts and an “expansion of denialism — the rejection of facts — with potentially very harmful consequences.”

Marty said she believes the DeSantis policies cost people’s lives.

“The clearest evidence that the health policies came with a physical cost to Floridians is that in the latest ranking by the CDC of deaths per capita, Florida ranked 14th highest in the nation with 28 deaths for every 100,000 Floridians,” she said. “Even adjusting for the high percentage of elderly that live in Florida, the Florida pandemic performance was on the poor side of the midpoint.”

Increasing state control over schools

The pandemic also played a role in shifting the governor’s education priorities.

He came to office with the goals of expanding school choice and increasing teacher pay, but his agenda shifted when he and former education commissioner Richard Corcoran insisted Florida would keep schools open after briefly shutting them in the early months of the pandemic. The governor adopted a more combative approach to school policy after he came under withering criticism and lawsuits from some school districts and teacher unions.

He withheld funding from districts for requiring vaccines and masks and, when the pandemic subsided, the governor continued to refine his approach by introducing two issues that had not previously been at the forefront of educational debates in Florida: race relations and gender identity.

Heavily influenced by conservative think tanks like the Claremont Institute and the Manhattan Institute, the governor began to embrace a view of education espoused by Christian fundamentalists that argue contemporary education has become “indoctrinated” by the “woke ideologies” of the left and the conservative crusade was akin to a broader religious fight between good and evil.

DeSantis energized Republicans on the right and appealed to parents across the political spectrum by calling for classroom instruction restrictions on many contemporary subjects — including Black Lives Matter, queer life and the debate over slavery reparations.

Education officials rejected social studies and math textbooks because of certain racial and gender-specific material. They ordered books be removed from classrooms and libraries until they are reviewed. And a new Advanced Placement course on African American studies was rejected for what the state deemed was a lack of “educational value.”

Now, one school district is being sued for removing dozens of books based on the recommendations of a single teacher. Teachers are more vulnerable to investigations for what they do in the classroom. Parents can sue a school district if they object to lessons related to race and sexual orientation. Diversity programs are banned from public universities and community colleges, and schools are restricted from using trans students’ preferred pronouns.

Educators say the policies are chilling teacher behavior, academic freedom and administrative decision-making and exacerbating teacher shortages.

“I find myself a lot more deliberate when I am speaking about certain things, like civil rights,” said Richard Judd, a Nova High School social studies teacher with 23 years of experience. “A lot of the time it comes up when teaching something like slavery or a topic of race.”

Judd says he now uses general terms to avoid mentioning race when teaching about emotional historic events, like “Bloody Sunday” in 1965 in Selma, Alabama, or explaining why white segregationists wielded signs that read “Race Mixing is Communism” when protesting Black children being admitted to all-white schools.

Other educators warn that these policies have begun to negatively shape the way students think.

“We’re taking away [students’] ability to think critically and to know there are many sides to an issue,” said Mayade Ersoff, who teaches U.S. history and world history at Palmetto Middle School in Pinecrest. “They’re going to know only one side of an issue, [and] that’s not reality.”

Bill Husfelt, the superintendent of schools in Bay County, a conservative county in the Panhandle, sees DeSantis’ actions as a response to what the populace wants.

“He is a very savvy politician. You might not agree with him, but he is not signing bills that parents are saying why did you do that, he is signing bills that parents are excited about,” said Husfelt, who is also the president of the Florida Association of District Superintendents.

Mixed results

By August 2022, there were 6,006 advertised teacher vacancies tallied by the Florida Education Association — a 174% increase from the number of vacancies in August 2020.

Higher education did not escape the governor’s culture war battle.

All tenured professors in the state college and university system must now undergo review every five years and can be let go for poor performance. Faculty committees have a diminished role in hiring, and university and college presidents can now make direct hires. Higher education institutions are banned from asking faculty and students to abide by principles of respecting diversity and equity and to include multiple viewpoints and ethnic backgrounds in their activities.

When it comes to the governor’s initial priorities of raising teacher pay and expanding school choice, Florida has made significant progress. All Florida school-aged children regardless of family income will soon have access to private school vouchers, and the state has invested roughly $3.3 billion into teacher raises.

“The biggest and most positive thing has been the increase in teacher salaries,” said Husfelt.

But the state still lags behind. A 2022 report from the National Education Association found that Florida ranks 16th with average starting teacher salaries of just over $44,000 a year. The average Florida public school teacher still only makes about $51,000 — placing Florida 48th in teacher compensation nationwide.

Student performance scores are also mixed. Florida fourth graders are doing well but that progress collapses when it comes to eighth grade, according to the National Assessment of Educational Progress (NAEP). In the last three cycles — 2017, 2019 and 2022 — Florida ranked sixth, fourth and third among states in fourth-grade math. In those same years, Florida eighth-graders ranked 33rd, 34th and tied for 31st.

Rising insurance rates

Florida’s property insurance crisis may be the one area where DeSantis has avoided headlines associated with his policies. He is not the first governor to preside over a property insurance crisis, but he is the first to largely cede dealing with the crisis to the Legislature.

Since Hurricane Andrew upended the insurance market in 1992, the industry has seen booms and busts, most recently in 2006, just before then-Gov. Charlie Crist took office. But DeSantis’ response was far different than Crist’s.

Crist took an active role during multiple legislative sessions on property insurance in 2007, personally bargaining with legislative leaders to focus on driving down the cost of premiums and by expanding the state-backed Citizens Property Insurance Corp. to make it competitive with private insurers and capping Citizens’ rate increases. Rates overall went down the next two years.

By contrast, DeSantis signed into law measures allowing Citizens to impose higher rate increases than before, giving $3 billion in taxpayer dollars to help struggling insurers and limiting lawsuits against insurance companies.

For more than 100 years, Florida law allowed homeowners to have their attorneys’ fees paid when suing an insurer in an effort to level the playing field between the insurance company and the policyholder. But lawmakers removed that provision last year at the request of the insurance industry.

When state regulators demanded data from insurers about their litigation this year, 71% of companies submitted “no data.” Despite the change in law, property insurance rates continue to rise.

Less transparency

Since DeSantis took office, the number of exemptions to the state’s public records law has expanded, and the interpretation of what is a public record has shifted. He has signed into law exemptions on public records on public officials, including his current and past travel, and he has enacted exemptions about candidates for state college and university presidencies — allowing him to handpick favorites with little scrutiny.

During the pandemic, agencies cherry-picked what data would be released. His top aide in charge of the migrant flights to Martha’s Vineyard used an email alias to communicate with operatives. And, reporters have found, DeSantis’ office routinely delays access to records by holding them for long periods of time.

“They know they have not just a statutory duty but a constitutional duty to provide access to those records in a reasonable period of time, yet they sit on them,’’ said Barbara Petersen, director of the Florida Center for Government Accountability, a records watchdog group that has sued the governor for the migrant flight and university records.

“I worry that if he’s doing this here now, what would he do once he’s president? If he doesn’t want us to know who he is meeting with as governor, what’s to stop him from trying to do the same if he were president?”

Times/Herald Tallahassee Bureau reporters Ana Ceballos and Lawrence Mower and Miami Herald reporter Sommer Brugal contributed to this report.

Startup Consultant Corey Shader Discuss Why Your Business Needs to Start Experimenting with ChatGPT Now

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Five takeaways on a surprisingly strong May jobs report

Five takeaways on a surprisingly strong May jobs report | The Hill

A hiring sign is posted in Downers Grove, Ill., Wednesday, April 12, 2023. On Thursday, the Labor Department reports on the number of people who applied for unemployment benefits last week. (AP Photo/Nam Y. Huh)

A hiring sign is posted in Downers Grove, Ill., Wednesday, April 12, 2023. On Thursday, the Labor Department reports on the number of people who applied for unemployment benefits last week. (AP Photo/Nam Y. Huh)

The economy added 339,000 jobs in May, once again blowing past analysts’ expectations and showing the strength of the U.S. labor market — even as the unemployment rate made one of its sharpest jumps in months, from 3.4 percent in April to to 3.7 percent last month.

The mixed results could be a Rorschach test for the Federal Reserve, which has raised interest rates up to 5.1 percent, the expected ending point for 2023. That gives the central bank some liberty to see what it wants to see in the economy.

Friday’s jobs report from the Labor Department confirmed a slowing trend in wage growth.

The decline is bad news for workers but good news for the Fed, whose job it is to keep prices stable at the expense of higher take-home pay.

Inflation watch: Fed: Companies boasted ‘unusually high profits’ after supply issues eased

The report also showed a sharp increase in unemployment for Black Americans while unemployment for Hispanic Americans tied a record-low. The civilian labor force increased by 130,000 people, while the labor force participation rate held steady at 62.6 percent.

Here’s what to take away from Friday’s jobs report.

Reductions in self-employment could be behind the unemployment spike

Some analysts Friday were paying attention to a rise in the number of people who left self-employed status to start their own businesses, implying the sharp uptick in unemployment could be more trivial than the 0.3 percentage-point increase would suggest.

“The most banal possible explanation for the weak household numbers: 412,000 people left self-employed unincorporated status [while] 302,000 people became self-employed incorporated,” wrote Adam Ozimek, chief economist for the Economic Innovation Group, a think tank and advocacy organization.

“Self employed workers [are] becoming small businesses.”

Other economists sounded a more negative tone, pointing to more general employment trends in the economy.

“Unemployment rate rose for all the wrong reasons. More employed people [moved] into unemployment and fewer unemployed workers [found] jobs,” wrote Nick Bunker, an economist with online job platform Indeed.

Wage growth is trending downward, but low-earners are still seeing gains

FILE - Cut stacks of $100 bills make their way down the line at the Bureau of Engraving and Printing Western Currency Facility in Fort Worth, Texas, Sept. 24, 2013. All the hand-wringing over a potential government default if Congress doesn’t increase the national debt limit has conjured up images of past government shutdowns. In fact, there’s a big difference between a government default and a government shutdown. A default would occur if the government exceeds its legal borrowing limit and can no longer pay all its creditors or pay for existing programs. (AP Photo/LM Otero, File)
FILE – Cut stacks of $100 bills make their way down the line at the Bureau of Engraving and Printing Western Currency Facility in Fort Worth, Texas, Sept. 24, 2013. (AP Photo/LM Otero, File)

Wages in May rose by 0.3 percent, or 11 cents, to $33.44 an hour, the Labor Department reported. Over the past 12 months, wages have increased by 4.3 percent — a dip from a 4.4-percent annual gain in April.

“Nominal wage growth has unmistakably slowed down, and is now at levels approaching those from 2019,” University of Massachusetts Amherst economist Arin Dube confirmed.

Dean Baker, senior economist at the Center for Policy and Economic Research, noted that wages grew at 4.0 percent annual rate over the last three months and 3.9 percent rate over the last six months.

While wage growth is cooling, earners at the bottom-end of the income spectrum are still pulling in the best wage gains — one of the hallmarks of the post-pandemic recovery.

Wages for leisure and hospitality sector workers increased at a 7.9 percent rate taken over the last three months, according to Friday’s data.

“The pandemic increased the elasticity of labor supply to firms in the low-wage labor market, reducing employer market power and spurring rapid relative wage growth among young non-college workers who disproportionately moved from lower-paying to higher-paying and potentially more-productive jobs,” Dube wrote in a paper earlier this year.

Employment for Black Americans fell off a cliff in May

Black unemployment increased by nearly a full percentage point, jumping to 5.6 percent from 4.7 in April, which had been a record low.

The spike concerned some economists, who warned that Black Americans are often the first to lose their jobs as a recession takes hold of the economy.

“The increase in Black unemployment from 4.7 percent to 5.6 percent is the canary in the coal mine for the rest of the economy. The historic gains we’ve seen for Black workers were always fragile, and we’re seeing what happens when the Fed raises rates 10 times in a row,” economist Rakeen Mabud of the progressive think tank Groundwork Collaborative wrote online.

Employment for Hispanic Americans moved in the opposite direction, falling to 4 percent from 4.4 percent in April.

Those numbers follow a rise in the number of job openings, which increased to 10.1 million and brought the ratio of job-seekers to available jobs back up to 1.8.

Health care and professional services added the most jobs

In a photo provided by the University of Vermont Health Network, licensed nursing assistant Jordan Bushy, right, and a student nurse care for newborns at the University of Vermont Children’s Hospital in Burlington, Vt., Friday, April 28, 2023. Research led by Dr. Leslie Young of the children’s hospital has found that babies born to opioid users had shorter hospital stays and needed less medication when their care emphasized parent involvement, skin-to-skin contact and a quiet environment. (Ryan Mercer/University of Vermont Health Network via AP)
(Ryan Mercer/University of Vermont Health Network via AP)

The health care and social assistance sector added 74,600 jobs in May, while the professional services sector added 64,000 jobs.

Other notable contributors to May’s hiring surge include the transportation and warehousing sector with 24,200 jobs, construction with 25,000 and retail trade with 11,600.

The information service sector dropped 9,000 jobs as tech companies shed workers and grabbed headlines. Nondurable goods producers also let go of 5,000 jobs in May.

No clear answer for the Fed

Federal Reserve Chairman Jerome Powell speaks during the Thomas Laubach Research Conference at the William McChesney Martin Jr. Federal Reserve Board Building in Washington, Friday, May 19, 2023. (AP Photo/Andrew Harnik)
Federal Reserve Chairman Jerome Powell speaks during the Thomas Laubach Research Conference at the William McChesney Martin Jr. Federal Reserve Board Building in Washington, Friday, May 19, 2023. (AP Photo/Andrew Harnik)

The simultaneous boom in hiring and spike in joblessness poses a challenge for the Fed ahead of its next policy meeting in June.

Fed officials have been pondering whether to pause their rapid series of rate hikes, which began in March 2022, later this month.

While inflation is falling steadily and the broader economy is slowing, stubbornly high price growth and steady job gains have raised tough questions for the Fed.

Many market commentators noted that the mixed May jobs report will offer Fed officials the opportunity to cherry-pick the data they like to build a narrative for the economy that they’d most like to see.

“Job growth is humungous, but unemployment is up and wage growth slowing,” New York Times columnist Paul Krugman wrote Friday. “If you want to make the case that the economy is running too hot, and we need more rate hikes, you can find data to support that. If you want to argue that a soft landing is in progress, there are numbers for that too.”

Markets currently expect the Fed to pause at its next rate-setting committee meeting later this month.

“Not a ton to glean from this report. Things are probably fine but [we] don’t want to sound complacent. [There are] more conflicting signals in contrast to the last two reports, when job growth was uniformly impressive,” Skanda Amarnath, director of the Employ America think tank, which advocates for high levels of employment, wrote Friday.

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America’s religious leaders sharply divided over abortion, a year after Roe v. Wade’s reversal.

In the year since the Supreme Court struck down the nationwide right to abortion, America’s religious leaders and denominations have responded in strikingly diverse ways — some celebrating the state-level bans that have ensued, others angered that a conservative Christian cause has changed the law of the land in ways they consider oppressive.

The divisions are epitomized in the country’s largest denomination — the Catholic Church. National polls repeatedly show that a majority of U.S. Catholics believe abortion should be legal in most or all cases, yet the U.S. Conference of Catholic Bishops supports sweeping bans.

Among Protestants, a solid majority of white evangelicals favor outlawing abortion. But most mainline Protestants support the right to abortion, and several of their top leaders have decried the year-old Supreme Court ruling that undermined that right by reversing the Roe v. Wade decision of 1973.

For example, the presiding bishop of the Episcopal Church, Michael Curry, said he was “deeply grieved” by that ruling.

The decision “institutionalizes inequality because women with access to resources will be able to exercise their moral judgment in ways that women without the same resources will not,” Curry said.

Some religious Americans have gone beyond expressions of dismay, filing lawsuits contending that new abortion bans infringed on their own religious beliefs. Jewish women played roles in such lawsuits in Indiana and Kentucky; in Florida, a synagogue in Boynton Beach — Congregation L’Dor Va-Dor — contended in a lawsuit that a state abortion ban violated Jewish teachings.

Dr. Sara Imershein, who performs first-trimester abortions in northern Virginia, said her Reform Judaism beliefs informed her decision to choose that path.

“I looked more at the liturgy of Judaism and found that it really supported my work,” she said. “I studied with my local rabbi.”

Imershein was in college when abortion was legalized nationwide. Now, at 69, she has seen Roe’s demise.

“Laws that restrict abortion … ignore our Jewish teachings that are very old, and they stomp on our religious freedom,” she said.

In Buddhism, Islam and Sikhism, there also is widespread acceptance of abortion in some circumstances. Most U.S. Hindus are “very much in support of choice,” said Dheepa Sundaram, assistant professor of religious studies at the University of Denver; she cited the concept of karma which holds that each person has the liberty to act and face the consequences of their actions — good or bad.

Randall Balmer, a professor of American religious history at Dartmouth College, says the abortion debate is so intractable in part because believers in the opposing camps view the Bible — which doesn’t include the word “abortion” — as supporting their side.

“It shows the pliability of Scripture — the way that each group tries to marshal arguments on its behalf,” he said. “The Bible can be manipulated.”

“What strikes me about both sides is there’s no humility in their position,” Balmer added. “They stake out what they believe is God’s will, and everybody else is a heretic.”

Even within individual churches, divisions over abortion can flare. Bishop Timothy Clarke, pastor of First Church of God in Columbus, Ohio, frequently exhorts his predominantly African American congregation to respect those with opposing views.

Clarke describes himself as “biblically pro-life,” yet he criticizes the stringent abortion bans enacted in numerous Republican-led states as “excessive and extreme.”

Referring to laws that would criminalize abortion-providing doctors and deny abortion to victims of rape, he said many people in his church “are saying this is going too far. It’s beyond the pale.”

There is similar sentiment among some U.S. Catholics, says Kathleen Sprows Cummings, a professor of American studies and history at the University of Notre Dame and director of its Cushwa Center for the Study of American Catholicism.

“There are some horrific stories coming out of pregnant women with severe issues who are being denied health care,” she said, referring to the consequences of some state abortion bans.

“We have to have a more human approach,” she said. “I think we’ll see more Catholics saying, ‘I’m not pro-abortion. But I want mercy. I want health care.’”

As a group, Catholic bishops are unwavering, as conveyed in a statement earlier this year from their conference’s president, Archbishop Timothy Broglio.

“The Catholic bishops of the United States are united in our commitment to life and will continue to work as one body in Christ to make abortion unthinkable,” he said.

A poll last year from The Associated Press-NORC Center for Public Affairs Research showed a clear gap between the prevalent views of U.S. Catholics, and the anti-abortion positions of the bishops. According to the poll, 63% of Catholic adults said abortion should be legal in all or most cases, and 68% opposed Roe v. Wade’s reversal.

“On every issue having to do with sexuality or reproductive health, there’s a huge gap between the way lay Catholics think and what the hierarchy is teaching,” said Jamie Manson, president of Catholics for Choice.

“What’s challenging,” she said, “is that even though most Catholics believe abortion should be legal, they don’t speak about it publicly because of the taboo … the fear of being ostracized by their community.”

Manson noted that a 2014 survey by the Guttmacher Institute, a research organization that supports abortion rights, found that nearly one-fourth of U.S. abortion patients identify as Catholic.

“There’s an all-male hierarchy telling them they’re complicit in murder,” Manson said. “I wish what bishops and priests would do is listen to these women, listen to their stories of why they choose abortion.”

Among mainline Protestant denominations, there have been official statements acknowledging that abortion is a complex issue, but prevailing sentiment is that last year’s Supreme Court ruling was an injustice to women, particularly those already facing economic hardships and racial discrimination.

“This decision further complicates the struggle and creates division, anger, and chaos in an already divided and conflicted country,” wrote Bishop Thomas Bickerton, president of the United Methodist Church’s Council of Bishops.

Some Protestant pastors have emerged as outspoken advocates of abortion rights; among them is Jacqui Lewis, the first African American and first woman to serve as a senior minister in New York City’s historic Middle Collegiate Church.

She evoked the fear and heartache felt by many of the women affected by the new abortion bans.

“These are the poorest of us, the most disenfranchised and they’re struggling more because some portion of Christianity feels they have the right to decide for other people what is moral,” Lewis said. “It breaks my soul to see religion weaponized this way … it’s the opposite of what religion should be.”

Among the leaders of the Southern Baptist Convention, by far the largest evangelical denomination, there’s unified opposition to abortion. However, there has been sharp disagreement over whether to impose criminal penalties on women who get abortions.

The SBC’s president, Bart Barber, opposes criminalization of women in such cases and has sparred verbally with Baptist pastors who argue that such women. in some instances, should be considered murderers.

“I think it is unjust, unnecessary, and unwise to include in abortion laws the prosecution of women who seek or obtain an abortion,” Barber writes in a lengthy article. “The abortionist is the murderer, and any law banning abortion should identify the abortionist uniquely as such.”


AP reporters Tiffany Stanley in Washington and Deepa Bharath in Southern California contributed.


Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

Program shows the benefits of relatable reading options for students

Buffalo Next

Buffalo State, BPS middle schools cap yearlong reading with famous author visit

For 400 Buffalo Public Schools middle school students, the big event of this school year came at the end, and they worked toward it all year: a visit to a college campus, a pizza lunch and meeting a famous Black author who writes for kids like them.

Jason Reynolds speaks at Buffalo State

Young adult author Jason Reynolds addresses middle schoolers at SUNY Buffalo State in Buffalo, May 1, 2023.

Buffalo middle school teachers and librarians unveiled the project in the fall by telling students they already had reserved seats at a sold-out event in May 2023, a visit to Buffalo State University by writer Jason Reynolds, the National Ambassador for Young People’s Literature and winner of a Newbery Medal, an NAACP Image Award and several Coretta Scott King honors.

Reynolds’ name and awards didn’t mean much to students at first, said Angelica Tennant, librarian at Martin Luther King Jr. Multicultural Institute. Then, they started reading his books.

People are also reading…

“We read parts of his book ‘Long Way Down’ each week and discussed it,” Tennant said. “It has mature themes – gun violence, death and grief – and it’s in verse, but easy to read. Many of my students have experienced these things in their daily lives. They could relate, and some shared that they had lost someone, too.”

Middle school teacher Gary Crump’s class was among the Buffalo Public Schools classes that read Jason Reynolds’ work in preparation to see him at SUNY Buffalo State.

The collaboration between Buffalo State and the BPS schools – whose students are 80% Black, brown and Asian – focused on how representation in children’s literature improves reading outcomes for diverse students. It came out of Buffalo State’s Professional Development Consortium, a group of 60-plus certification programs including early childhood, childhood, secondary and special education, and P-12 programs such as art and music.

The consortium engages with city schools and provides resources for current and future teachers through the year, with an annual conference in September. At last year’s event, the university’s teacher education team announced Reynolds’ booking and launched the project. The consortium provided mini grants to schools to buy sets of books and prepare students in grades 5-8 for their visit to campus.

Jason Reynolds speaks at Buffalo State

Glenroy Williams, 11, a sixth-grader in Buffalo Public Schools, smiles as young adult author Jason Reynolds answers his question at SUNY Buffalo State in Buffalo, May 1, 2023.

Tennant said research shows reading about characters who look like them increases students’ interest in books – but according to the Cooperative Children’s Book Center, only 9% of children’s books published in 2021 were by Black authors. Tennant said her students “saw themselves” in Reynolds’ books, and when the big day came, they were excited to see “the guy we read about.”

Wearing long dreadlocks and a backward ball cap, Reynolds bounded onstage at the Campbell Student Union and announced, “This ain’t school, so it ain’t gonna be like school.”

He opened his story with, “I was a ramen noodle baby. Any of y’all like ramen noodles?”

He peppered his presentation with not only ramen, but Kool-Aid, “government cheese,” peanut butter and ice cream trucks, but also “a new disease running rampant, HIV/AIDS,” drugs and “family members in the game and using,” the 1985 debut of Air Jordans and a new genre of music, rap, “the most powerful music in the world.”

Reynolds said he never read a book until college because he couldn’t relate to those assigned in school.

“The teachers would say, ‘We know you’re coming from all that, but we need you to read this book about a man on a boat with a whale,’ ” he said. “I never seen no boat or no whale! I was confused that, ‘Every time you give me a story to read it’s got no relationship to my life.’ ”

Jason Reynolds speaks at Buffalo State

Mackenzie Voorhees, 11, takes a photo of sixth-grader Breonna Hall, 12, with young adult author Jason Reynolds after Reynolds signed a copy of her book at SUNY Buffalo State in Buffalo, May 1, 2023.

So he didn’t read books – but he did read the liner notes in his older brother’s cassette tapes of hip-hop originals Queen Latifah, Tupac Shakur and Biggie Smalls, and realized “Man, these people are writing poetry!”

At age 9 1/2, he started writing his own poems and, asked what he wanted to be when he grew up, would say, “Queen Latifah.”

He said he made it to college without reading a book, failed English 101 and showed his poems to teachers with zero interest. Luckily, another college teacher at the University of Maryland told him why he should read – “Reading is the gym for your brain” – and handed him “Black Boy” by Richard Wright.

“I ended up reading it cover to cover, and then I read everything else they wanted me to read, and it turned out to be pretty good,” he said.

Jason Reynolds speaks at Buffalo State

Young adult author Jason Reynolds signs a book at SUNY Buffalo State in Buffalo, May 1, 2023.

Reynolds went on to publish several poetry collections, a first novel in 2014 and 20 other books. At the end of his presentation, Buffalo middle school students’ questions included:

“How do you make your work stand out?” (“By being the only version of me.”)

“How is anti-racism important in your books?” (“I’m not thinking about anti-racism, but about how can the book serve to show Black and brown people’s humanity.”)

And, of course, “What’s your favorite ramen flavor?” When Reynolds answered “chicken,” a chorus of students shouted, “Word!”

Want to know more? Three stories to catch you up:

• Buffalo State Urban Teacher Pipeline helps teacher aides, assistants become teachers

• Buffalo State’s Global Book Hour goes global, literally

• Global Book Hour helps kids navigate the world through reading

Welcome to Buffalo Next. This newsletter from The Buffalo News will bring you the latest coverage on the changing Buffalo Niagara economy – from real estate to health care to startups. Read more at


Local health insurers want hefty rate hikes.

SUNY Buffalo State has a new interim president.

Hilbert College wrapped up an acquisition.

Work could start soon on Douglas Jemal’s Mohawk Ramp project.

Worker training provider Bitwise is going belly up.

The visitor center is opening in the African American Heritage Corridor.

Uniland plans to build a third warehouse in Lackawanna.

A Chautauqua County batter maker is seeking tax breaks.

A Dutch beverage company plans to add a second plant in Dunkirk.

A Busti solar project is looking for tax breaks.

Tomatoes, flowers and pot at the farmers market? It could happen.

Dick’s House of Sport is coming to Buffalo Niagara.

Demolitions are reshaping a project planned for Genesee and Oak streets.

Plug Power is plugging away on its Genesee County project.

Chautauqua County plans to add a significant shovel-ready site off the Thruway.

A national right-to-work group is backing Starbucks workers who want to try to decertify union votes.

New York is repealing its Covid-19 vaccine mandate for health care workers.

KeyBank’s CEO says the bank is weathering the regional bank turmoil just fine.

An Amherst medical management company was fined $550,000 by the state for failing to protect patient data.

Five reads from Buffalo Next:

1. The Cummins engine plant near Jamestown is refueling for the future, courtesy of an upcoming $452 million investment.

2. The growth of sports memorabilia and the trading card market has been reflected in the boom of local shops selling those products.

3. For one mental health counselor, helping survivors of the Tops Markets mass shooting has been a continuing mission.

4. The Tops Markets mass shooting put a spotlight on food security issues in East Buffalo. A year later, some progress has been made, but much more needs to be done.

5. A fund created after the May 14 mass shooting has raised more than $6 million, but its focus is on making a long-term impact.

The Buffalo Next team gives you the big picture on the region’s economic revitalization. Email tips to or reach Buffalo Next Editor David Robinson at 716-849-4435.

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For COVID-19 vaccination, the emergency may be over, but the fight continues

By Martha Dawson

Public health officials have spent the past two years urging people to get vaccinated and boosted against COVID-19, but despite free and available vaccines, many have yet to take their advice. Now, we are entering a new phase. With the end of the federal Public Health Emergency (PHE) on May 11, the government will no longer pay for COVID-19 tests or vaccines. In addition, World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus announced earlier this month that his organization will lift the COVID-19 emergency status.

Even so, COVID-19 persists with new variants emerging and infections in the U.S. still numbering more than 77,000 per week. We need a new public health framework that can safeguard our communities, especially those most at risk, from the ravages of the virus. In healthcare, we talk about a community-based approach often, which is especially necessary when trying to reach those most at risk, including African Americans.

COVID-19 remains the third-leading cause of death among Black Americans nationwide, attributed partly to pre-existing medical conditions and higher exposure risks. According to CDC data, Black Americans are 2.1 times more likely to be hospitalized for COVID-19 and 1.6 times more likely to die due to infection than White Americans.

The end of the federal PHE calls for a turning point in our work. In reaching communities, collaborating across local, state and federal levels to promote vaccination is an approach that works—as generations of school vaccinations have demonstrated—and is the approach called for now.

Vaccination rates among Black Americans have improved compared to the weeks that followed the rollout of the first COVID-19 vaccines. Still, many remain unvaccinated or not up to date with their COVID-19 immunizations and boosters. From conversations I have had with members of our community, among the many reasons lie seeds of mistrust in the government, confusion and mis-and disinformation about the COVID-19 vaccine. In 2023, we are still struggling, with the CDC estimating that less than 30 percent of Black American adults have received a COVID-19 bivalent booster shot.

I believe that one way to build confidence and protect more people is to offer and educate our communities about the diverse portfolio of vaccine options we are now fortunate to have in this ongoing fight. While the mRNA vaccines were first to market and helped protect millions of Americans, from conversations I have had, many people cannot or will not receive them for various clinical or personal reasons. That is why for some, a traditional, protein-based COVID-19 vaccine may have a vital role to play. As I testified before the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC), COVID-19 vaccines developed using a long-standing, well-understood technology – the same used for shingles and hepatitis B – adds the traditionally based weapon that, what I believe, our COVID-19 arsenal needs to ensure vaccine choice and increase vaccination and booster rates.

Another hurdle we need to overcome is simple exhaustion, from both the public and health care providers. We are entering the fourth year of a crisis we were initially told might last weeks. A report by the International Council of Nurses (ICN) suggests we will need up to 13 million more nurses over the next decade to fill a growing shortage brought on by the pandemic. As a nurse who leads the National Black Nurses Association (NBNA), whose members tirelessly work to educate, test and vaccinate people every day, I can clearly attest to COVID-19 fatigue within myself and in our members. Yet, the fight against COVID-19 continues, we are committed, and we cannot afford to lower our guard. We understand this virus is mutating and the risk to public health is ongoing.

Our nation’s nurses have a critical role to play in COVID-19 vaccine education and combatting hesitancy. Gallup reports that nurses are more trusted by Americans than any other profession. As warriors on the front lines, we should have a seat at the table in the efforts to offer more vaccine options, debunk misinformation, and create solutions that help protect our health. We must help our communities understand that getting vaccinated against COVID-19 will be ongoing and that it is “not just about me, but about we.”

As the president and CEO of the NBNA, I represent more than 300,000 nurses nationwide. As a practitioner, I represent one caregiver and one voice. In each of these capacities, I feel as much urgency today as I did in March 2020. The danger remains, and the end of the federal PHE opens a new period. To help protect public health for everyone, each player in the healthcare system needs a plan to educate, advocate, and vaccinate. At the community level, I encourage everyone to know what their vaccine options are and to lean on trusted community members, such as nurses, to understand how best to help protect themselves and their families. The ‘emergency’ may be over, but we still have much more work to do.

​​Martha Dawson, DNP, MSN, RN, FAAN, FACHE, is president of the National Black Nurses Association and Associate Professor at the University of Alabama at Birmingham School of Nursing. This commentary was written with editorial support from Novavax.

Faith Matters: Baptist ‘Congress’ returns with new direction

Congress will soon be back in session. Not that Congress.

For the first time since the pandemic, the Fourth District Congress of Christian Education is returning June 6-9 with major changes and the launch of a “different direction” to help member churches in all areas of ministry and beyond.

“I’m excited because we’re starting to move again,” said the Rev. René Brown, president of the Baton Rouge-based Fourth District Missionary Baptist Association, which sponsors the annual Congress of biblical classes, seminars and worship.

“Congress is vital because Congress is the teaching arm of the church and of the convention, and where our churches are lacking is teaching.”

This year’s theme is “Reengaging Christian Education” taken from 2 Timothy 3:16-17: “All Scripture is given by inspiration of God, and is profitable for doctrine, for reproof, for correction, for instruction in righteousness, that the man of God may be complete, thoroughly equipped for every good work.”

The Fourth District comprises more than 135 churches in six parishes: East and West Baton Rouge, East and West Feliciana, Iberville and Point Coupee.

While the Congress’ emphasis on biblical training and principles of Christian living will not change, Brown said what has changed is the location and format.

In previous years, Congress for all six parishes was held at Scotlandville High School in Baton Rouge. This year, Congress will be held from 6 p.m. to 9 p.m. June 6-8 at three district churches: Mount Zion First Baptist Church, 356 T.J. Jemison Blvd., Baton Rouge (for churches in East and South Baton Rouge areas); New Sunrise Baptist Church, 966 Maryland Ave., Port Allen (West Baton Rouge, Iberville, Pointe Coupee); and Shady Grove First Missionary Baptist Church, 16443 Plank Road, Baker (North Baton Rouge, East Feliciana, West Feliciana). 

All the parishes will join for the closing night from 6 p.m. to 9 p.m. June 9 at Second Baptist Church, 9513 Highway 19, in Wilson.

“When we go this, we’ll know better what to do next year,” said Brown, also the pastor of Mount Zion First Baptist Church.

In addition to the nightly adult classes, the district will also host youth classes from 8 a.m. to noon June 6-8 at Shady Grove (East Baton Rouge, East and West Feliciana parishes); and Shiloh Missionary Baptist Church, 950 Seventh St., Port Allen (West Baton Rouge, Iberville, Point Coupee parishes).

Another change is reduced class and seminar options from previous years. Among this year’s classes will be “Effective Bible Reading,” “Theology and History of Christianity” and “The African American Church and Social Justice.”

Brown hopes the Congress is just the start of the Fourth District’s renewed efforts to assist churches beyond biblical training and finding pastors. He said the Fourth District will host seven major workshops before the end of the year to help with more practical issues such as 501(c)3 status, disaster relief, technological assistance, health care, COVID-19 help and retirement for pastors.

“We’ve got to teach them all new stuff,” Brown said. “So that means we’re going to have classes on more than how to study the Bible, the Old Testament or the New Testament.”

Too many churches have been stagnant since COVID-19 and even before that because they were unable to take advantage of the plethora of available resources to help themselves, their congregations and their communities.

“It’s been challenging because a lot of the pastors haven’t known what to do. And as a result, a lot of their members haven’t known what to do. Because of that, it kind of hinders what we can do,” Brown said.

Getting churches to understand why they need 501(c)3 status to get funding is top priority, he said.

“There’s a lot of things that we’re doing that’s got to go through the churches, but it can’t go through the churches because the churches don’t have the proper legal stuff taken care of,” Brown said. “For too long, our (Black) churches have been slow to address the governmental needs out of fear that we’re not capable of managing resources, so we’d rather just not do it. … We don’t have the necessary paperwork. Let’s do the paperwork.”

It’s part of the Fourth District’s new direction, Brown stressed.

“We’re not the association we used to be,” he said. “We’re trying to relabel. We’re more than just here to help you get a pastor. We’re here to give you the tools necessary for your churches to be successful. … We’re not going to be able to return back to the old days of the association where you meet, greet and eat. Those days are gone. There has to be a social justice component. There has to be a component dealing with the laws, what’s on the books with the government. There has to be a ministry that’s going to take on modern-day issues.”

The pandemic only underlined the need for churches to branch out.

“We have gotten caught up in the building, and our ministry should have never have been in that building. God had to force us out of that building,” Brown said. “We’ve got to get back to the fact that God says be in the world but not of the world. That doesn’t mean isolation. … We got to be in the world without the world being in us.”

Starting his second five-year term, Brown resolves to help all churches be more  effective in ministry.

“I may be president of the Fourth District and just may be Baptist, but my calling is to reach all the people and that’s regardless of ethnicity or denomination. I refuse to be hindered by denomination.”

Unpacking Averages: Understanding the Potential for Bias in a Sepsis Prediction Algorithm, a Case Study

Would it surprise you if I told you that a popular and well-respected machine learning algorithm developed to predict the onset of sepsis has shown some evidence of racial bias?[1]  How can that be, you might ask, for an algorithm that is simply grounded in biology and medical data?  I’ll tell you, but I’m not going to focus on one particular algorithm.  Instead, I will use this opportunity to talk about the dozens and dozens of sepsis algorithms out there.  And frankly, because the design of these algorithms mimics many other clinical algorithms, these comments will be applicable to clinical algorithms generally.


This may sound like an intimidating technical topic, but I’m going to keep it simple.  I went to public schools, so I’m going to leave the complicated math to MIT graduates.[2]

Before I dive into the topic, I just want to prepare you for a potential aha moment.  To have that moment, there’s basically only a few things you need to understand.

  1. Averages.  If I calculated the average age at an AARP meeting and the average age in a high school classroom, they would likely be significantly different, even though we’re all Americans.  Okay, now you know all the math you need to know.
  2. We are all different, even biologically or perhaps especially biologically.  Everyone talks about personalized medicine because our genetic makeup makes us individuals, but I’m also talking about the fact that there are subgroups in America that are different from other subgroups.  There are, for example, important medical differences between treating kids and senior citizens.  But there are also important differences in things like our average vital signs depending on the social determinants of health.  If one group struggles with getting adequate, healthy, low-sodium food and suffers from higher stress due to job or other financial insecurity, that will show up in their vital signs. 
  3. It is reasonably well established, for example, that there are differences in average vital signs between Blacks and Whites.  This might blow your mind.  Using only six common vital signs, and using only standard machine learning techniques (nothing too fancy), researchers were able to predict a person’s race with a high level of accuracy.[3] Think about that.  The patterns in vital signs are so significant that we can predict a person’s race just from 6 vital signs.
  4. Combining the ideas in 1 and 2, and you may see an important insight.  Look at this chart:

    If you take the average blood pressure at the AARP meeting, it may well be 135/70 mm Hg, whatever that means.  If you are a doctor treating an 18-year-old woman, if you use that value as the “normal,” it might affect how you treat that 18-year-old woman to her detriment.
  5. As a result, when I say bias, please don’t automatically assume I am talking about the bias that is the product of prejudice in the dark recesses of human thoughts.  Sometimes bias—unwanted bias—comes simply from the fact that a minority is, well, a statistical minority.  They may be statistically underrepresented in some calculation that is then used for clinical decision-making, and that can mean they get inferior care if the number is not a good benchmark for them.  The 18-year-old woman in my example may get the wrong care as if her blood pressure is too low because the benchmark calculation reflected a group that didn’t include many people like her.

A nonmedical example of this underrepresentation principal is the research that was done on facial recognition algorithms that did a pretty good job of identifying white men, but a much less accurate job of identifying black women, simply because the algorithms hadn’t been trained on very many black women.[5]  Underrepresentation in the data from which the algorithm learns about the world is a mathematical problem that impacts the performance of the resulting algorithm on that underrepresented group.  No human prejudice is required.

That’s all the math you need to know to make sense of the risk of bias in a sepsis prediction algorithm.

I wanted to label this section Background on Math and Clinical Practice, but I was afraid you wouldn’t read it.

Introduction – For Real This Time

To begin the topic of algorithms that predict sepsis, let’s start with its clinical use and importance.  A few contextual facts to keep in mind.

  • Sepsis, a combination of infection, inflammation and shock, is a common and deadly disease. About 1.7 million adults develop sepsis every year in the United States and more than 250,000 of them die.[6]
  • Sepsis, similar to conditions like a stroke, requires immediate treatment to increase the chance of a successful outcome.  Literally minutes matter.
  • The onset of sepsis is not obvious.  It presents subtly at first, and is notoriously difficult to recognize.  Indeed, despite its lethal outcomes, the medical establishment has had difficulty even defining precisely what sepsis is.[7]  It appears very amorphous.
  • Therein lies the clinical problem, in that many people die of sepsis because healthcare providers didn’t or couldn’t see it soon enough to treat it effectively.
  • And that’s the clinical opportunity that the sepsis algorithms are designed to address, namely using an algorithm fed with data to recognize the potential for sepsis earlier such that treatment can begin earlier and be more effective.   This has led some experts to observe that these algorithms could save thousands of lives.[8]

Hospitals all around the world are developing sepsis algorithms designed to flag patients who may be developing sepsis earlier than their human caregivers might otherwise see.  There are scores of articles describing these algorithms in the scientific literature, and of course many uses of novel experimental products do not get reported in the scientific literature.  Each algorithm tends to be slightly or maybe even significantly different.  Here, at a high level, is how they work based on a review of the literature:[9]

  • The developer of the algorithm selects different types of data to feed into the algorithm.  As already noted, they tend to be different for each algorithm, but here are the general categories of data that are fed into some of these algorithms:
    • The most popular data are vital signs, which include such things as blood pressure, heart rate, respiration rate, temperature, oxygen saturation and so forth.  Often these data are fed into the EHR automatically from devices attached to the patient, such as an SpO2 monitor.
    • Clinical laboratory values from tests on, for example, blood which are entered into the EHR.  There are literally dozens of different analytes that are tracked in these laboratory tests where the values get fed into the EHR.  Examples include total white cell, culture results, lactate, high-sensitivity C-reactive protein, artificial blood gas and something called procalcitonin.  I have no idea what that is.
    • Clinical data.  This is a catchall for other so-called structured data (for example using drop-down menus) that clinicians might enter into the EHR either from physical observation or therapies the doctor selects such as the use of a vasopressors or antibiotics.
    • Medical images.  Some hospitals are experimenting with taking information from radiological or pathology images and including them in the training data.
    • Physician notes.  A clever group in Singapore noted that there is tremendous amount of information maintained in clinician notes in EHRs and that such information, or at least the topics addressed in those notes, should be considered by these algorithms to give a broader perspective on the patient.[10]  This includes a wide variety of information including such things as diagnostic observations that on their face are unrelated to sepsis, other drugs or medications that the patient is on and so forth.  The study done by the Singapore group observes that there is some benefit to the accuracy of the algorithm in predictions during the first four hours, but there’s a very considerable benefit in the predictive value of the algorithm in identifying potential sepsis during the 4 hour to 48 hour time period.
  • The hospital then chooses how to implement the algorithm, and it might, for example, run the algorithm on all the data in the EHRs of all of the patients in the ICU at the hospital every hour to see whether any patients appear to be trending toward sepsis.
  • If the algorithm spots a patient who appears to be trending toward sepsis, an electronic alert is sent to the human caregivers that they should take a closer look at the patient and consider beginning treatment.

Many of these algorithms developed by individual hospitals or medical centers appear, based on preliminary research, to be a significant improvement over human observation alone.  They are catching sepsis earlier, and saving lives.

But the question is, are they biased?  Are they working better for some subpopulations than others?  Calculating an average improvement across all people does not give us any insight into how well these algorithms work on specific subpopulations.

How We Start the Process of Evaluating a Healthcare Algorithm for Bias

In employment law, many of the statutes and regulations specify categories of “protected classes,” groups of people who have been found by lawmakers to be vulnerable because of historic discrimination and who need to be protected from further discrimination.[11]  Healthcare lawyers, on the other hand, must start by figuring out who the categories of people are that need to be statistically evaluated.  The law doesn’t designate any protected categories or classes of people.

Instead, healthcare law uses an admittedly vague standard of “reasonable” evaluation and testing taken from tort law.  We first must think about who might be disadvantaged by the algorithm based on historical facts.  In other words, we must come up with our own categories based on historical data. In healthcare, we ask where are the health disparities?

Healthy People 2030 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”[12] That’s quite a list, and not very tightly defined.

For purposes of the rest of this blog post, I’m going to make it easy again.  I’m going to pick just one category – race – and then show how we think about that one category for potential bias.  But just remember, to do this right, we must come up with all the categories and do the same for each.

Thinking About the Potential for Racial Bias in a Sepsis Algorithm

To do this phase of the analysis right requires much more than this short blog post can address, but we need to begin by thinking broadly about all the different ways through which race can enter this seemingly scientific process of analyzing data from an EHR to try to predict the potential onset of sepsis.  We must consider things like how:

  • the features were selected for use in the algorithm, and whether there were other features that should have been included that would have provided a more balanced insight into all the races,
  • each of the data points used by the algorithm are created and then filtered before they are fed into the algorithm,
  • the algorithm itself works from a technical standpoint, and whether the math behind it is somehow leading to bias, and
  • the output is used, to spot whether it might somehow lead to more accurate results for one race over another.

The starting point is to make a list of vulnerable populations that could be hurt, given that general nature of the data and the algorithm.  To do this, we develop a broad list of the different places where demographics and the social determinants of health affect the data.  For example, gender bias might be present when the training data are the product of clinical trials. This is because clinical trials heavily skew male, due to the typical exclusions for pregnant women, women in menopause, and women using birth control.[13]  Much of the research in biomarkers, for example, comes out of clinical trials, and so the use of such biomarkers as features in an algorithm may well interject gender bias.[14]  Or algorithms that recommend a drug for the same reason.  The point is we must start with a general understanding of where different groups have been historically disadvantaged, or where the data are skewed, when looking at a new algorithm.

For purposes of this blog post, I’m simply going to illustrate a few obvious examples of how race might ultimately impact the effectiveness of these sepsis algorithms.  Consider three examples.

  1. The use of vital signs that are racially skewed. From a statistical standpoint, one of the most important types of features considered by this algorithm are vital signs, which as already pointed out are highly correlated to race.  If we are using vital signs to predict the onset of sepsis, and if vital signs are correlated to race, and if the majority of the training data set used to create an algorithm are the majority race, then it’s quite possible that the algorithm won’t be as effective when used for racial minorities.  I won’t repeat that but you might want to read that sentence again because it contains a lot.  The simple point is that if we are using vital signs that represent the racial majority in the United States, it’s quite possible that an algorithm that relies on those vital signs will perform less well when used with racial minorities.  I said that vaguely because for all I know maybe the algorithm will produce more false positives or more false negatives.  Remember false positives are the algorithm predicating that a person might be trending toward sepsis when in fact she isn’t.  That produces its own harm in that the patient might get treated when she shouldn’t be with expensive and risky antibiotics, or healthcare professionals might start to realize that the algorithm doesn’t work very well with minorities and stop using it.  At the very least there is an opportunity cost, in the sense that we had the opportunity to improve the health care minorities and we didn’t do it.  The downsides of a false negative – saying that someone is healthy when she isn’t – are more obvious and include the potential for death.
  2. The use of hardware that performs differently for people of different races. I indicated above that one of the data points collected is SpO2, which as you may know is collected via an electronic pulse oximeter.  Those are the little gadgets they attach to the tip of your finger that read the oxygenation rate in your blood by shining a light.  It turns out that those gadgets don’t work as well on people with dark skin.  The FDA has been pursuing a solution.[15]  Here there was no prejudicial intent, but nonetheless the technology simply didn’t work as well for all races.  Given that pulse oximeters are a data source for some of these sepsis algorithms, the bias from that hardware could be expected to infect the performance of the algorithms.
  3. The use of physician text notes.  As I indicated earlier, some researchers in Singapore realized that adding information collected from EHR physician notes could improve the performance of sepsis algorithms especially over the longer haul, meaning from 4 hours to 48 hours.[16]  While the improved accuracy is wonderful, adding physician notes does necessarily raise issues of potential bias given its source in human judgment and communication.  On the one hand, human judgments, which include physician judgments, may be racially biased.  It’s well-established, just as an example, that physicians interpret information from Black patients about pain differently than they do White patients. Physician implicit bias has been associated with false beliefs that Black patients have greater pain tolerance, thicker skin, and feel less pain than White patients.[17]  At any rate, bias in the physician/patient interaction is hardly a newsflash.  But it goes well beyond mental bias.  People who are uninsured, which may be a higher number of Black Americans over White Americans, will simply have less information in their EHRs because they encounter the healthcare system less.  According to the Census Bureau, the U.S. uninsured rate in 2021 across race and Hispanic origin groups ranged from 5.7% for White, non-Hispanic people to 18.8% for those identifying as American Indian and Alaska Native, non-Hispanic. Hispanic or Latino people had among the highest uninsured rate in the nation at 17.7%.[18] Indeed, there are simply disparities in the number of encounters that people of different races have with primary care physicians, whether it’s related to insurance or not.[19]  The point is there are lots of reasons to believe that there may be racial differences in the meaning and value of physician notes that would end up then impacting the effectiveness of the sepsis algorithm.

These are just a few of the ways that race can impact a sepsis algorithm.  A true analysis would need to explore other avenues as well.

Solutions To Bias Found

I’d like to point out that each of these challenges prompts arguably different solutions.  For example, the fact that vital signs are correlated to race may mean that race needs to be explicitly considered by the algorithm.  That way, the algorithm can differentiate between Black patients and White patients, for example, and giving them each a better prediction.

The hardware problem involving pulse oximetry obviously would benefit from a hardware solution.  In the absence of a hardware solution, predictions for people with darker skin need to be taken with a grain of salt and the users alerted to the potential bias.

The hardest to solve is any bias found in the physician notes.  We can’t make information out of thin air, so if the information is simply not included for many of the users, there is no solution to that other than a more fundamental improvement in our healthcare system.  So again, perhaps the best we can do is make sure that the physician users are sensitive to the bias.

What’s the Practical Effect of All This?

What I provided above is theory built on facts from research.  I started my analysis with research into what is understood clinically about such things as vital signs, and research on how race manifests itself in healthcare data.  But theory built on facts is still theory.  So it needs to be tested.  More to the point, these clinical algorithms generally need to be tested clinically to determine whether they are safe and effective for use, and in particular tested for differential impact on vulnerable categories of people.

As already noted in the preamble to this post, a developer did the responsible thing in analyzing its sepsis algorithm for its impact on sex and race.  What they found is that while their algorithm had a confirmation rate generally of 36% for all patients, for black patients the rate was only 33% and for Asian patients the rate was 42%.  In other words, the algorithm performed less well on average for Black people, and better than average for Asian patients.  The developer also clinically validated its algorithm.  If you want to read about the performance of the algorithm in a large clinical trial, the developer published its research.[20]

But beyond that, for the rather large number of sepsis algorithms out there in use, I haven’t seen any other systematic evaluations of these algorithms for racial bias or for that matter other demographic features.  I have seen, however, some broad research doing a “Comparison between machine learning methods for mortality prediction for sepsis patients with different social determinants.”[21]  It supports the idea that testing and evaluation of these machine learning algorithms for demographic factors requires more attention.

The Legality Question

I am not a philosopher or expert in ethics.  People don’t come to me with interesting philosophical questions.  They come to ask me whether their algorithm follows the law.

As a result, you might ask me, are the algorithms described above lawful?  First, I would ask you back, can you clarify the question?  Are you asking me:

  1. Do the algorithms comply with FDA’s law on clinical decision support software, which would often require preapproval? The answer, in part, depends on whether the particular algorithm developed by a particular hospital is fully embedded in the practice of medicine and thus in effect subject to regulation by the state boards of medicine, or in reality is being commercialized outside the professional practice of medicine.[22]  The answer also depends on how transparent and explainable the algorithm is to its users, as well as on the specific features used to train the algorithm and on the nature of the output.[23] According to FDA guidance, the agency regulates clinical decision support software whose output (a) suggests “that a specific patient ‘may exhibit signs’ of a disease or condition” or (b) “identifies a risk probability or risk score for a specific or condition.”  Sounds kinda like certain sepsis algorithms.  If FDA has jurisdiction over an algorithm, the question then becomes whether an algorithm with potential bias is safe and effective enough for all anticipated patients to earn FDA approval.  FDA sets the bar high, but it’s also possible to manage which patients are “anticipated” through the labeling of the algorithm.
  2. Do the algorithms give rise to liability under state tort law, including malpractice and product liability law?  Let’s say someone dies of sepsis at a hospital that used its own software for detection, which given the nature of the disease is not unusual.  The question would be whether the developer has done an adequate job of evaluating and testing the software, and if necessary forewarning the users of the potential inaccuracies for specific populations. 
  3. Do the algorithms give rise to potential liability under the HHS proposed rule under the Affordable Care Act that algorithms not discriminate?[24]  The answer depends on what the provider institution has done to evaluate the software, but at the same time that rule has not yet been finalized.
  4. Do the algorithms comply with the proposed ONC rules for transparency designed to allow users to understand whether they might have discriminatory effect?[25]  Obviously that requires a lot more information on what was disclosed, and that rule is still in proposed form.
  5. Do the algorithms comply with the Federal Trade Commission guidelines on ensuring that algorithms don’t discriminate?[26]  That’s a complicated and lengthy topic, but I suspect the defense would be an argument that the hospital’s use of its own algorithm is outside of the FTC’s jurisdiction for consumer protection of unfair business practices.[27]  However, the FTC seems to want to take the lead on software that falls outside of FDA’s jurisdiction, so the answer in practice will be influenced by the answer to number one above. If FDA regulates the products, then FTC would be unlikely to bother with such a stretch.  But given the very direct patient impact, FTC might pursue it if other regulators don’t. FTC certainly has asserted its right to regulate software used by healthcare professionals when the issue is patient privacy, even if the software is simply used in practice management.[28]  Further, FTC can assert that the software is certainly used on patients to impact their care and uses patient data, even if the results are only communicated to the physician on behalf of the patient.  Sometimes FTC takes an expansive view of its jurisdiction, even concluding that small businesses constitute “consumers” if they feel otherwise there’s a gap in the regulatory scheme.[29]  Consider the primary example FTC uses in suggesting that companies be vigilant against unintended bias in algorithms.  That example from 2021 follows: “COVID-19 prediction models can help health systems combat the virus through efficient allocation of ICU beds, ventilators, and other resources. But as a recent study in the Journal of the American Medical Informatics Association suggests, if those models use data that reflect existing racial bias in healthcare delivery, AI that was meant to benefit all patients may worsen healthcare disparities for people of color.”[30]  That example is eerily similar to the sepsis example.  The FTC seems to suggest it has jurisdiction over such algorithms.  Right below the example FTC argues: “Section 5 of the FTC Act… prohibits unfair or deceptive practices. That would include the sale or use of – for example – racially biased algorithms.”  Notice the word “use.”
  6. Does the algorithm give rise to liability under general civil rights laws?  I have no idea: you have to ask one of my partners.

Apart from such legal issues, obviously the developer should evaluate the impact on its reputation should its algorithm be determined to discriminate against vulnerable groups of people.


The purpose of this post at least nominally is to explain how race can manifest itself in what might seem to be a purely clinical algorithm.  More generally, hopefully this post gave some insight into bias audit methodology, starting with research into what has gone before in this area and ultimately finishing with testing to verify theory. These algorithms have incredible potential to improve healthcare.  But it will help everyone if the implementation is done responsibly such that users can truly trust these algorithms.


[2] One of my partners in the FDA law practice went to MIT for engineering and I’m always amazed at how smart he is.










[12]Health Equity and Health Disparities Environmental Scan March 2022, HHS Office of Disease Prevention and Health Promotion

[13]Https:// and


















©2023 Epstein Becker & Green, P.C. All rights reserved.
National Law Review, Volume XIII, Number 152

Black women dying pregnant and not being taken seriously

BIRMINGHAM, Ala. (AP) – Angelica Lyons knew it was dangerous for Black women to give birth in America.

As a public health instructor, she taught college students about racial health disparities, including the fact that Black women in the U.S. are nearly three times more likely to die during pregnancy or delivery than any other race. Her home state of Alabama has the thirdhighest maternal mortality rate in the nation.

Then, in 2019, it nearly happened to her. What should have been a joyous first pregnancy quickly turned into a nightmare when she began to suffer debilitating stomach pain.

Her pleas for help were shrugged off, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was suffering from normal contractions, she said, even as her abdominal pain worsened and she began to vomit bile. Angelica said she wasn’t taken seriously until a searing pain rocketed throughout her body and her baby’s heart rate plummeted.

Rushed into the operating room for an emergency cesarean section, months before her due date, she nearly died of an undiagnosed case of sepsis.

Even more disheartening: Angelica worked at the University of Alabama at Birmingham, the university affiliated with the hospital that treated her.

Her experience is a reflection of the medical racism, bias and inattentive care that Black Americans endure. Black women have the highest maternal mortality rate in the United States – 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.

Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives.

“Race plays a huge part, especially in the South, in terms of how you’re treated, ” Angelica said, and the effects are catastrophic. “People are dying.”

To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer’s and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter. From birth to death, regardless of wealth or social standing, they are far more likely to get sick and die from common ailments.

Black Americans’ health issues have long been ascribed to genetics or behavior, when in actuality, an array of circumstances linked to racism – among them, restrictions on where people could live and historical lack of access to care – play major roles.

Discrimination and bias in hospital settings have been disastrous.

The nation’s health disparities have had a tragic impact: Over the past two decades, the higher mortality rate among Black Americans resulted in 1.6 million excess deaths compared to white Americans. That higher mortality rate resulted in a cumulative loss of more than 80 million years of life due to people dying young and billions of dollars in health care and lost opportunity.

BEFORE FIRST BREATH Angelica Lyons’ pregnancy troubles began during her first trimester, with nausea and severe acid reflux. She was prescribed medication that helped alleviate her symptoms but it also caused severe constipation.

In the last week of October 2019, while she was giving her students a test, her stomach started to hurt badly.

“I remember talking to a couple of my students and they said, ‘You don’t look good, Ms. Lyons,”’ Angelica recalled.

She called the University of AlabamaBirmingham Hospital’s labor and delivery unit to tell them she was having a hard time using the bathroom and her stomach was hurting. A woman who answered the phone told her it was a common pregnancy issue, Angelica said, and that she shouldn’t worry too much.

“She made me feel like my concern wasn’t important, and because this was my first pregnancy, I decided not to go because I wasn’t sure and thought maybe I was overreacting,” Angelica said.

The pain persisted. She went to the hospital a few days later and was admitted.

She had an enema – a procedure where fluids are used to cleanse or stimulate the emptying of bowels – to alleviate her constipation, but Angelica continued to plead with them that she was in pain.

“They were like, ‘Oh, it’s nothing, it’s just the Braxton Hicks contractions,”’ she said. “They just ignored me.”

She was sent home but her stomach continued to ache, so she went back to the hospital a day later. Several tests, including MRIs, couldn’t find the source of the issue.

Angelica was eventually moved to the labor and delivery floor of the hospital so they could monitor her son’s heartbeat, which had dropped slightly. There, they performed another enema that finally helped with the pain. She also was diagnosed with preeclampsia, a dangerous condition that can cause severe pregnancy complications or death.

Then she began to vomit what appeared to be bile.

“I got worse and worse with the pain and I kept telling them, ‘Hey, I’m in pain, ‘” Angelica said. “They’d say, ‘Oh, you want some Tylenol?’ But it wasn’t helping.”

She struggled to eat dinner that night. When she stood up to go to the bathroom, she felt a sharp pain ricochet throughout her body.

“I started hollering because I had no idea what was going on,” she said. ”I told my sister I was in so much pain and to please call the nurse.”

What happened next remains a blur.

Angelica recalls the chaos of hospital staff rushing her to labor and delivery, putting up a blue sheet to prepare her for an emergency C-section as her family and ex-husband tried to understand what went wrong.

She later learned that she nearly died.

“I was on life support,” recalled Angelica, 34. “I coded.”

She woke up three days later, unable to talk because of a ventilator in her mouth. She remembers gesturing wildly to her mother, asking where her son, Malik, was.

He was OK. But Angelica felt so much had been taken from her. She never got to experience those first moments of joy of having her newborn placed on her chest. She didn’t even know what her son looked like.


Maternal sepsis is a leading cause of maternal mortality in America. Black women are twice as likely to develop severe maternal sepsis, as compared to their white counterparts. Common symptoms can include fever or pain in the area of infection. Sepsis can develop quickly, so a timely response is crucial.

Sepsis in its early stages can mirror common pregnancy symptoms, so it can be hard to diagnose. Due to a lack of training, some medical providers don’t know what to look for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, particularly Black women, not being heard.

“The way structural racism can play out in this particular disease is not being taken seriously,” said Dr. Laura Riley, chief of obstetrics and gynecology at Weill Cornell Medicine and New YorkPresbyterian Hospital. “We know that delay in diagnosis is what leads to these really bad outcomes.”

In the days and weeks that followed, Angelica demanded explanations from the medical staff of what happened. But she felt the answers she received on how it occurred were sparse and confusing.

A spokesperson for the University of Alabama at Birmingham said in a statement to The Associated Press that they couldn’t talk about Angelica’s case because of patient privacy laws. They pointed to a recent internal survey done by its Obstetrics and Gynecology department that showed that most of its patients are satisfied with their care and “are largely feeling respected,” and said

the university and hospital “maintain intentional, proactive efforts in addressing health disparities and maternal mortality.”

Angelica’s son, Malik, was born eight weeks early, weighing under 5 pounds. He spent a month in intensive care. He received home visits through the first year of life to monitor his growth.

While he’s now a curious and viva cious 3-year-old who loves to explore the world around him, Angelica recalls those days in the ICU, and she feels guilty because she could not be with him.

“It’s scary to know I could have died, that we could have died,” Lyons said, wiping away tears.


For decades, frustrated birth advocates and medical professionals have tried to sound an alarm about the ways medicine has failed Black women. Historians trace that maltreatment to racist medical practices that Black people endured amid and after slavery.

To fully understand maternal mortality and infant mortality crises for Black women and babies, the nation must first reckon with the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.

“The history of this particular medical branch … it begins on a slave farm in Alabama,” Owens said. “The advancement of obstetrics and gynecology had such an intimate relationship with slavery, and was literally built on the wounds of Black women.”

Reproductive surgeries that were experimental at the time, like cesarean sections, were commonly performed on enslaved Black women.

Physicians like the once-heralded J. Marion Sims, an Alabama doctor many call the “father of gynecology,” performed torturous surgical experiments on enslaved Black women in the 1840s without anesthesia.

And well after the abolition of slavery, hospitals performed unnecessary hysterectomies on Black women, and eugenics programs sterilized them.

Health care segregation also played a major role in the racial health gap still experienced today.

Until Congress passed the Civil Rights Act of 1964, Black families were mostly barred from well-funded white hospitals and often received limited, poor or inhumane medical treatment. Black-led clinics and doctors worked to fill in the gaps, but even after the new protections, hospitals once reserved for Black families remained under-resourced, and Black women didn’t get the same support regularly available for white women.

That history of abuse and neglect led to deep-rooted distrust of health care institutions among communities of color.

“We have to recognize that it’s not about just some racist people or a few bad actors,” said Rana A. Hogarth, an associate professor of History at the University of Illinois, Urbana-Champaign. “People need to stop thinking about things like slavery and racism as just these features that happened that are part of the contours of history and maybe think of them more as foundational and institutions that have been with us every step of the way.”

Some health care providers still hold false beliefs about biological differences between Black and white people, such as Black people having “less sensitive nerve endings, thicker skin, and stronger bones.” Those beliefs have caused medical providers today to rate Black patients’ pain lower, and recommend less relief.

The differences exist regardless of education or income level. Black women who have a college education or higher have a pregnancy-related mortality rate that is more than five times higher than that of white women. Notably, the pregnancyrelated mortality rate for Black women with a college education is 1.6. times higher than that of white women with less than a high school degree.

In Angelica Lyons’ home state of Alabama, about 40 mothers die within one year after delivery. The toll on Black mothers is disproportionate.

The state’s infant mortality rate for 2021 was 7.6 deaths per 1,000 live births. The disparities between Black and white babies is stark: The infant mortality rate in 2021 for white mothers was 5.8, while the infant mortality rate for Black mothers was 12.1, an increase from 10.9 from the prior year.

Black babies account for just 29% of births in Alabama, yet nearly 47% of infant deaths.