Ta-Nehisi Coates writes that he doesn’t believe in God, or in souls. The author of Between the World and Me is more concerned with bodies. Specifically, his son’s body: its fragility, its place in the American history of brutality against black bodies. And Coates’ own body: the way it brimmed with fear as a child in West Baltimore, how the fear flooded him again when, as an adult, he was pulled over by the Prince George’s County police, and how that same fear always, always ripples through him as the parent of a black child.
Coates’ book, published last month to critical acclaim, does a lot of things. It breaks open a paper-thin veneer of post-racial harmony in America to reveal deep, unhealed, unhealable wounds. It tears down familiar hiding places for white Americans who want to believe that they can be absolved of our country’s racist legacy.
It also teaches us about health. Coates never writes the word “health” in his 163-page book. But he says more than the best scholars in the health policy field have said about what it means to be black in America, and why it is that across virtually every measure—life expectancy, chronic disease, quality of care—black Americans remain on the losing end.
In health policy conversations, we talk about “social determinants of health” to describe the array of factors, including race, that affect health. The Colorado Trust describes them this way:
The social determinants of health (SDOH) are important aspects that influence our overall health. These include where we live, the education we receive, the work we do, the wages we earn and the opportunity to make decisions that affect our own and our family’s health.
We say that having access to safe streets is important for good health, but we don’t explain why. Coates does. Here’s how he writes to his son about growing up in Baltimore, how everyone around him was “powerfully, adamantly, dangerously afraid,” including and especially the crews of boys on street corners:
I think back on those boys now and all I see is fear, and all I see is them girding themselves against the ghosts of the bad old days when the Mississippi mob gathered ‘round their grandfathers so that the branches of the black body might be torched, then cut away. The fear lived on in their practiced bop, their slouching denim, their big T-shirts, the calculated angle of their baseball caps, a catalog of behaviors and garments enlisted to inspire the belief that these boys were in firm possession of everything they desired.
We talk about the importance of community, culture, heritage. But we don’t explain what that has to do with how long a person lives. When Coates describes his arrival at Howard University, you can hear what it has to do with survival, and with being able to thrive:
I first witnessed this power out on the Yard, that communal green space in the center of the campus where the students gathered and I saw everything I knew of my black self multiplied out into seemingly endless variations. There were the scions of Nigerian aristocrats in their business suits giving dap to bald-headed Qs in purple windbreakers and tan Timbs. There were the high-yellow progeny of AME preachers debating the clerics of Ausar-Set. There were California girls turned Muslim, born anew, in hijab and long skirt. There were Ponzi schemers and Christian cultists, Tabernacle fanatics and mathematical geniuses. It was like listening to a hundred different renditions of “Redemption Song,” each in a different color and key.
We even talk about toxic stress, and the way that what we call “adverse childhood events” can predict a person’s physical and mental health on a mysteriously wide range of outcomes. It can seem like a kind of sorcery: how can stress experienced in childhood break down an adult body? This is what Coates has to say about carrying his past into his current life:
I am wounded. I am marked by old codes, which shielded me in one world and chained me in the next. I think of your grandmother calling me and noting how you were growing tall and would one day try to “test me.” And I said to her that I would regard that day, should it come, as the total failure of fatherhood because if all I had over you were my hands, then I really had nothing at all. But forgive me, son, I knew what she meant and when you were younger I thought the same. And I am now ashamed of the thought, ashamed of my fear, of the generational chains I tried to clasp onto your wrists. We are entering our last years together, and I wish I had been softer with you.
Those of us who work in health policy don’t write the way Coates does—and not only because we lack his talent. We can’t, because too many of us are white, and don’t have visceral experiences of racism to draw on. We can’t, because it’s an unjust burden to place on our black colleagues to ask them to explain, in depth and repeatedly, what that particular pain feels like. And we don’t, because in a very real way, the problems that Coates explains are not fixable ones. No infusion of cash, no new bike lane or health clinic, no new legislation will fix our history. Coates gives no reprieve, even as he addresses his son:
Never forget that for 250 years black people were born into chains—whole generations followed by more generations who knew nothing but chains.
You must struggle to truly remember this past in all its nuance, error and humanity. You must resist the common urge toward the comforting narrative of divine law, toward fairy tales that imply some irrepressible justice. The enslaved were not bricks in your road, and their lives were not chapters in your redemptive history. They were people turned to fuel for the American machine.
If there’s one thing Coates takes on faith, it’s the value of struggle, and of constant interrogation. He offers us a challenge that is worth taking up—all the more for the fact that we face impossible obstacles.