Art of Medicine
Feb 2021

Black Determinants of Health

Anthony U. Onuzuruike
AMA J Ethics. 2021;23(2):E196-197. doi: 10.1001/amajethics.2021.196.


This graffiti-esque mosaic considers legacies of slavery and segregation as manifested in present-day health inequities. Racist American structures and practices are maintained by social policies and cultural attitudes informed by old stereotypes.


Figure. Black Determinants of Health



Procreate for iPad.


A graffiti-style mosaic invites viewers to consider this 2-sided face as a means of contrasting hope and pessimism about the futures of Black Americans in the United States. The painting offers several color-based contrasts to illuminate possible touchstones for conversation about and exploration of relationships between past and present, between our ancestors and us, and between those among us whose families suffered slavery’s affronts and those among us who are legacy beneficiaries of slavery. Purple-orange and black-white contrasting sites illuminate popular culture and media references that offer yet another layer of interpretation by which viewers might consider these topics. Additionally, viewers can compare blackface and its racist use to portray Black people in entertainment and media (at left) to a caricature of the actor Chadwick Boseman, who played iconic Black figures such as Jackie Robinson, James Brown, Thurgood Marshall, and the fictional character of Marvel’s Black Panther (at right). The left side of the face is scarred and expresses past and present fears of Black people in America. The right side of the face suggests possible sources of Black joy, despite systemic and psychological oppression.

This mosaic suggests numerous ways to interpret relationships among our pasts, our present-day experiences, and health equity. Viewers are invited to reflect upon the historical situatedness of present-day racism as perpetuated by mass incarceration, police violence, and clinician bias in evaluating patient’s health care experiences, for example.


AMA J Ethics. 2021;23(2):E196-197.



Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.