Public Health Is Obsessed With Survival—But Ignores How Women Live in Their Bodies
Public health prides itself on saving lives. Mortality rates, disease incidence, life expectancy—these are the metrics that define success. And yet, for many women of color, survival has never been the only issue. The deeper failure lies in how public health refuses to engage with the body as a lived, visible, and socially consequential site of health.
Skin—particularly the skin of women of color—is routinely dismissed as cosmetic. Hyperpigmentation, scarring, chronic inflammation, and barrier damage are framed as aesthetic concerns rather than public health issues. This dismissal is not neutral. It reflects a structural blind spot that treats dignity, embodiment, and long-term bodily harm as peripheral to health outcomes.
For women of color, skin is not superficial. It is medical, social, economic, and psychological. Ignoring it is not merely an oversight—it is a form of neglect embedded in how public health defines what matters.
The Body as an Afterthought
Public health interventions are overwhelmingly oriented toward acute outcomes: preventing death, controlling outbreaks, reducing hospitalizations. These goals are critical. But they also narrow the field of vision. Chronic, non-fatal conditions that shape how people move through the world—how they are perceived, treated, and valued—are consistently deprioritized.
Skin conditions disproportionately affect women of color due to a convergence of factors: chronic stress, hormonal disruption, environmental exposure, inflammatory responses, limited access to culturally competent dermatologic care, and medical bias that minimizes their concerns. Yet these issues rarely appear in public health agendas unless they escalate into something life-threatening.
When hyperpigmentation is dismissed as vanity, when scarring is treated as an inevitable side effect rather than a preventable harm, the message is implicit but clear: as long as you are alive, your body’s condition does not matter.
When “Cosmetic” Becomes Structural
Labeling skin concerns as cosmetic obscures their structural roots. Hyperpigmentation is often the visible outcome of inflammation, injury, or hormonal imbalance. Scarring can reflect delayed treatment, improper care, or systemic barriers to follow-up. Chronic barrier damage is linked to environmental stressors, overexposure to aggressive treatments, and a lack of education around skin health that accounts for melanin-rich skin.
These are not individual failures. They are the downstream effects of systems that were not designed with women of color in mind.
Skin also carries social consequences. It shapes how women are perceived in professional spaces, healthcare settings, and intimate relationships. It influences confidence, economic mobility, and mental health. To ignore this is to pretend that health exists separately from the social world—a fiction public health can no longer afford.
The Erasure of Cultural Knowledge
Public health has also tended to dismiss culturally rooted body-care practices as unscientific or irrelevant. In doing so, it erases generations of preventive knowledge. Across East African, South Asian, and other non-Western traditions, body care has long been understood as integral to health—through ritual cleansing, protective layering, plant-based treatments, and intentional maintenance of the skin barrier.
These practices were not framed as luxury or self-indulgence. They were preventive care.
The refusal to engage seriously with these traditions reflects a broader epistemic bias: what is not produced within Western biomedical frameworks is often excluded from legitimacy, even when it aligns closely with contemporary understandings of inflammation, barrier function, and long-term health maintenance.
Toward a Fuller Definition of Health
Public health must expand its definition of care. Survival is not enough. Health should include how people inhabit their bodies over time—how those bodies heal, age, and are allowed to exist without constant harm or erasure.
Models like Saha Healing emerge precisely because of this gap—not as replacements for public health, but as responses to what institutional frameworks routinely overlook. Rooted in culturally inherited body practices and informed by contemporary understandings of inflammation, barrier repair, and long-term care, Saha Healing treats the body not as an aesthetic project, but as a site of prevention, dignity, and continuity. Its existence is less a brand statement than an indictment: when systems fail to account for how women live in their bodies, people build what they need themselves.
Addressing skin health among women of color is not about aesthetics. It is about recognizing the body as a site where inequality is both produced and experienced. It is about acknowledging that dignity, visibility, and embodied well-being are not optional add-ons to health—they are central to it.
If public health is serious about equity, it must stop treating the body as an afterthought. The question is no longer whether women of color survive, but whether they are allowed to live fully in their bodies.
More about the author!
Hodan Barreh is an epidemiology graduate student and public health writer whose work examines how institutional health frameworks overlook embodiment, skin health, and preventive care for women of color. She is the founder of Saha Healing, a culturally rooted body-care framework responding to gaps in public health’s treatment of the body as a site of dignity, continuity, and long-term health.
