Racial disparities and the lack of diversity in the fitness and movement medicine industry.
By training, I’m a yoga instructor, CHEK practitioner (a type of personal trainer), and physical therapist. Movement is my modality of choice. It is literally medicine – preventing many deadly, non-communicable diseases (NCDs) (ex. type 2 diabetes, heart disease, some cancers). But there are racial disparities in who is exercising – Blacks and POC exercise less than Whites (ex https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043172/) (and Americans as a whole exercise less than the recommended minimums for wellness and cardiovascular health).
Studies have examined this exercise disparity between races and suggest many contributors: access to facilities and safe neighborhood to exercise, access to green space for physical activity, barriers to leisure time and transportation and money for exercise, among others. These contributors are social determinants of health – that is, environmental and systems components in which an individual is born, lives, works, and plays that impact an individual’s health. Social determinants of health may contribute more to an individual’s overall health (ex. Zip code may have a greater impact on health than genetic code ex https://pubmed.ncbi.nlm.nih.gov/27513279/).
It is worth noting that racism itself is a social determinant of health. (https://healthequity.globalpolicysolutions.org/wp-content/uploads/2016/12/RacismasSDOH.pdf ) The health consequences of micro aggression and the slow simmering threat of racial harm causes stress leading to mental and physical health consequences, perhaps even PTSD (Ex https://www.psychologytoday.com/us/blog/culturally-speaking/201509/the-link-between-racism-and-ptsd). Racism also impacts medicine, a field built upon the premise of ‘do no harm’ – whether it is implicit bias of the healthcare practitioners, underrepresented racial and ethnic groups as service providers, or systems that limit access to care. Blacks and POC often have poorer health outcomes than Whites (ex https://www.hsph.harvard.edu/news/hsph-in-the-news/health-disparities-between-blacks-and-whites-run-deep/) – in black maternal health, in rates of NCDs, in pain management, in referral and utilization of speciality services (like physical therapy https://www.phillyvoice.com/racial-disparity-post-injury-rehabilitation-services/).
Exercise can’t dismantle racism, but….
Exercise can’t dismantle racism and other systemic oppressions, and I’m not suggesting that. But it can grant individuals greater health (cardiovascular fitness, muscular strength) and resilience against stress (see tweet below; strength to fight racists, to support the energy needed to protest brutality and the prison system day after day, to find pleasure in a body that is marginalized – a particularly fierce tool of self-care, embodiment, and protest). However, when we think of exercise and ‘beach bodies’ and ‘fitspiration’, the images often pushed by social and mass media are white, thin, able-bodied, and young. The bodies we are supposed to want for ourselves severely lack diversity, are unrealistic for many, and miss the full, stunningly beautiful spectrum of what it means to be an embodied human. The world of exercise and fitness would serve all people more fully by focusing on how a person feels while exercising (ex. Pleasure) verses how they look (for the most part, we all fall short and this will keep you busy, less-than, and out of your body).
Further, the professionals of the exercise industry are limited in diversity. For example, only 2.6% of the members of a professional organization of physical therapists are Black (https://ptthinktank.com/2017/06/12/rc-11-17-diversity-in-physical-therapy/ ). A spiritual practice but also a movement modality, yoga is mostly practiced by and taught by whites in the US, though the health benefits are strongly needed by black communities (ex https://seattleyoganews.com/black-yoga-instructor-in-white-yoga-community/ ). There are people and organizations doing the work to diversify fitness for Blacks specifically, including physical therapy and yoga, such as Black Yoga Teachers Alliance (https://blackyogateachersalliance.org ), National Association of Black Physical Therapists, Jessamyn Stanley (http://jessamynstanley.com), Dianne Bondy (https://diannebondyyoga.com ) as well as individuals groups working to diversify how we as society’s view the body in general, such as Health at Every Size (https://haescommunity.com/) and The Body is Not an Apology (. You can support diversity in the fitness and movement industry by seeking out Black owned gyms and yoga studios and Black fitness professionals (ex https://shoppeblack.us/2019/08/14-black-owned-yoga-studios/ and
https://www.self.com/gallery/black-fitness-pros-instagram and @decolonizing_fitness )
Racism is not inherent or unamenable
Racism precedes race. (Biologically & genetically, there is no such thing as race. https://www.nationalgeographic.com/magazine/2018/04/race-genetics-science-africa/ Labeling races was an original tool and justification of colonization – not genes or god. ) This system is man-made, not biological or godly, and it can be man-undone (and it is on all of us to dismantle this inheritance, particularly those of us who are descended from, and benefited by, the oppressors).
Show up how you can, where you can, in your fabulous body nurtured in movement and love to maximize the abilities you have, because racism won’t dismantle itself. And after self-care and maximizing your health, comes community care. Ideas include: support Black and POC gyms and instructors and medical providers. Test your implicit biases (https://implicit.harvard.edu/implicit/ ), including how you view and value bodies and grow as a human and contribute to society by challenging them. Donate to the ACLU (https://www.aclu.org/ ), NAACP (https://www.naacp.org/ ), The Southern Poverty Law Center (https://www.splcenter.org/ ). Think in and utilize a system’s lens – how is racism impacting public health, for example and are there ways that you can help in your own local community (phone calls, protests, art for solidarity, donate to a specific organization, etc).
Questions for the reader:
- Have you noticed the racial disparities in the fitness and medical fields? How? And are there ways that you can work to counter these? (ex supporting black-owned gyms)
- Do you know stories of racism in medicine, such as: gynecologist J. Marion Sims and his experimentation on slaves; or Henrietta Lacks and the unconsented use of her cell line for research; or the Tuskegee syphilis experiment; or the forced sterilization of Native American women in the 1960s and 70s?
- What others are you familiar with?
Written by Dr. Allison Mitch, PT (DPT), and copyright protected.
*This piece is part of my ‘Fitness Friday’ series. It is imperfect but it is a starting point – it is intended to highlight racial disparities in fitness and medicine and ways to correct the problem. I started this piece many times, gave up, attempted it as a podcast, was unsatisfied, and tried to write again. Thanks for reading. My hope is that you gained new wisdom and ideas for application and a more just world.*
For questions or collaboration, please email me at email@example.com