Being Black in America Can Be Hazardous to Your Health

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Being black in America can be hazardous to your health.

On average, black Americans can expect to lose three years from their lives compared to white Americans.

In places like Baltimore with a history of segregation, that life expectancy gap can be as much as 20 years.

What causes this mortality gap?

And what should we be doing about it?

This is Radio Atlantic.

Hello, I'm Matt Thompson, the executive editor of The Atlantic.

With me over there in New York is my esteemed co-host, Alex Wagner.

Hello, Alex.

Hi, Matt.

It is great to hear your voice, as always.

Likewise.

Here in DC, I am delighted to be joined by our staff writer, Van Newkirk.

Hi, Van.

Hey.

And making her Radio Atlantic debut.

Staff writer Olga Chazan.

Hello, Olga.

Hello.

Greetings.

Now, Olga, you've written about science and health for us for years.

And in our latest issue of the magazine, we published a story by you that pulls together what I would say are some of the strands of your reporting over a lot.

of that time.

We gave that story the title, Being Black in America Can Be Hazardous to Your Health.

On average, you write, black Americans live about three years less than white folks.

And in some parts of the country, like Baltimore, where you set this story, black Americans can have lives that are two decades shorter than some of our white counterparts.

What led you to this story?

Yeah, so health disparities and differences in life expectancy have been sort of a big topic of conversation in the health world in recent years.

And so I was really struck by these cities, and there's several of them.

Baltimore is the one that I reported in, but you also have other segregated cities around the country where driving, you know, five miles,

you go from a life expectancy equal to Rwanda to one that's equal to Iceland.

And it's really stark.

And you can see the neighborhood changing, but the main thing you can see is the racial composition of the neighborhood changing, which is that it's it's often African Americans who are left to live in these neighborhoods that are, for all intents and purposes, just profoundly unhealthy.

So I kind of wanted to pull together, like you said,

my reporting on things like ACEs, food deserts, all the stuff that goes into being healthy and kind of show why are these places so much worse off when it comes to life expectancy.

ACEs.

Yes, ACEs, which are adverse childhood experiences.

So these are things that happen to you when you're little that are difficult, they're stressful, and they can actually affect your health in the long term, even as an adult and even with physical conditions, not just mental health conditions.

Olga, when you talk about stress, I think a lot of us hear or think of, you know, the things that we deal with, and I say this as

people who are not, as someone that did not grow up in an economically depressed neighborhood that had institutional racism that drew boundaries around it.

But we think of stress as kind of a workaday thing.

But in your piece, stress is much more pervasive and nefarious.

And it's not an external thing.

It has real internal consequences on the lives of the people living in these neighborhoods.

Tell us a little bit about how the stress is kind of internalized and has an immediate effect on life expectancy.

Yeah, so essentially there's like a few ways that stress can affect you.

The most obvious way is that when you get stressed out, we all know this, you know, big deadline at work or whatever might be happening.

You start to kind of go to the things that might comfort you.

So in these neighborhoods, often that's alcohol and food.

So if you do face a lot of stressors, then you might kind of seek out those things and your behaviors might change as a result.

You might also sleep less and losing sleep is also very bad for your body, your immune system.

But actually there's changes in body chemistry that can happen.

So one thing that occurs is methyl groups can cause genes to turn on or off and set disease patterns in motion.

So different types of stress can cause the methyl groups to be triggered in this way, but including stress from prejudice and discrimination, but definitely other types of just everyday stress that you might be under, like violence or a lack of food.

Going back to that sleep thing, there's so many different facts buried in the corners of the story that just blow your mind.

But you say one of the biggest disparities between black folks and white folks is this sleep gap.

Can you say more about that?

Yeah, so the sleep disparity is a huge contributor to the differences in cardiovascular disease rates.

And we don't totally know exactly why there's this huge sleep difference.

I think it's something like 40 minutes,

which African Americans get 40 minutes less sleep each night.

That could be for a variety of different reasons.

That could be because of conditions like sleep apnea, which make it harder to actually sleep.

But it could also be because of stress, because you're worried about the safety of your neighborhood.

Or you could be taking care of loved ones.

You could be

kind of up all night thinking how you're going to make ends meet.

So we don't know precisely why, but sleep is a huge factor in that disease gap.

Yeah.

All of these, now the talk of methyl groups can make this sound abstract or

medical, but you center your story around this very vivid woman named Kiera Bulware.

What drew you to Kiera?

I met Kiera because I was driving around Baltimore and I went to West Baltimore to this organization called Penn North and it's a recovery center for all sorts of addictions.

And

I was sort of like, hey, do you know anyone who might be interested in participating in an article?

And they introduced me to Kiara.

And kind of right away, I was really struck by the fact that she was very like chipper and upbeat.

Like she was not

like some of the people for obvious reasons are kind of depressed.

She was very like, oh, I've got a total plan.

I've got everything together.

and i was like great um and so one of the things that she told me she was concerned about is that she is 27 years old and she had recently been diagnosed with diabetes and she was really the diabetes are sort of the thing that um triggered her to go on this health journey.

She was approaching, I guess, 380-ish pounds around around the time, but it hadn't really hit home for her until the diabetes happened.

It struck her as this kind of like old fat person disease that she didn't want to deal with.

And so she decided at that point that she was going to try to get healthy.

She was going to try to lose weight and kind of go on this huge health journey.

And I asked if I could join her for that and she said yes.

Yeah.

Tell us about Chiara's home life and the sort of the place where she came from and who raised her.

Yeah, so she was mostly raised by her grandparents, who were,

by her account, wonderful grandparents,

very loving home, very proper home.

Her mom, it seemed like, just wasn't very involved with her kids.

Like, she also lived with the grandparents, but was just not, Kara describes it as there, but not there.

And then the dad is an interesting figure.

He

was in jail a lot during her childhood.

And kind of whenever he was around, he would mostly just kind of terrorize her

in really damaging ways.

So the the thing that I experienced was him calling her

like half a dozen times throughout the day and saying things like, I'm gonna put your head in the dirt.

So

he wasn't really the kind of supportive father figure that you would think of that you would might need.

And then kind of throughout her childhood, you know, she tried.

She was a good student.

She made the honor roll.

She enjoyed kind of reading and writing.

And, you know, she did all the things that you want like a little kid in Baltimore to do.

and and you know but she kind of couldn't catch a break she she got pregnant as a teenager and then unfortunately she got pregnant when she was 12 yes yes

and had the baby at 13 and then actually the the baby died

which was like a crystallizing moment for her it landed her in a psychiatric hospital for kind of a breakdown that she had at that point

and from there things kind of never fully picked back up um steam I would say.

She had got in an abusive relationship with this guy

who physically beat her.

Then later, she was sexually assaulted by a different group of guys.

And then she kind of worked in like Kmart and she became a home health aide, which she didn't super enjoy.

And she just kind of, you know, puttered along.

And it seemed like she never really bounced back from all of those early adversities, the aces that she encountered before she was even in high school.

Yeah,

it's funny how despite all this, Kiera's personality totally leaps off the page.

Like she

seems, I feel her vividness when I'm reading this piece, but when you recount that litany, it is so striking.

I mean,

to have lost a child when you were a child,

to have been abused, to have a father who was in and out of jail, it sounds like, and had a seemingly toxic relationship.

All of these things just really pile up.

How, on a day-to-day level, did she come to cope with that?

So I think

She does have a really strong personality, and I think a lot of it is now she sort of is able to contextualize it and

get help from in positive ways.

But I think in the immediate aftermath, sort of how she came to Penn North North is that she became addicted to pills and to alcohol.

So she describes drinking like,

I don't know how much, but a ton of vodka every day, like wake up and get drunk.

And then,

you know, increasingly as it would, it would affect her.

life and her job.

So she would get in huge fights with her friends.

You know, she would, she was like kind of an angry drunk person, so she would scream at her friends.

Because she worked as a home health aide, she often had to change patients and kind of help them use the toilet and things she left someone on the toilet for something like half an hour because she was drunk um she essentially it was really starting to jeopardize her life um and and sort of so so actually by the time i met her she had uh quit drinking like that was relatively um it seemed not a huge issue for her or or maybe it was but it was it was completely settled by the time i met her uh very quickly in her recovery and and um she i don't think she relapsed the whole time I knew her, which is really impressive, I think.

Yeah.

You spoke with her this week at an Atlantic Live event, and she talked a little bit about why this recovery, after multiple bouts of recovery, why this one stuck.

And that was a really interesting moment.

Can we play that?

Recovery is definitely something that you have to do when you're ready.

Before, I've come before,

because my mom wanted me to come, because my family wanted me to come.

Everybody wanted me to get clean.

This time, I wanted to get clean.

I wanted to live different.

Like, I wanted recovery for myself this time.

So that made the difference.

It sounds though, Olga, like

the toxic substances are not completely gone from her life, though, right?

I mean, her addiction is sort of resurfaces in and around food, which is aided and abetted by the fast food industry and sort of

racist business practices.

Tell us a little bit more about her habits on that front, which is a big health concern.

Yeah, so she, so she did sort of kick the alcoholism, but then she still had, especially when she was stressed out,

she had a tendency to binge eat.

And the stuff that was available to binge on is pretty much the least healthy stuff you can imagine.

So her standard order at McDonald's was a McDouble and a McChicken.

And it was always like two, you know, so basically like two meals.

And, you know, or going to TGI Fridays and getting like the unlimited appetizers and eating like a bunch of mozzarella sticks and quesadillas and things like that.

Because that's what they have in her community kind of all over.

There actually isn't even that much fast food in Baltimore, but to the extent that there is food available, it's all kind of junk food.

So yeah, and that was still a huge issue for her the whole time I was with her and that she was still kind of working on trying to eat less less and eat healthier.

She was considering surgery also.

Talk a little bit about that choice for her.

Yeah.

So when I first, it was interesting, when I first met her and I first started following her,

she really did not seem interested in surgery.

It was one of the first questions I asked her because when you're that heavy, it's really hard.

And especially if you don't have a ton of opportunities to work out and you don't have, I mean, she had some days where she had no money and no food stamps.

So she had no way of getting food.

So you're not going to be making a salad on those days.

So she, she really didn't have a way to like, I mean, lose weight in a healthy way, kind of, I would say.

And or it would, it would just take a really long time.

And plus, once you get that heavy, research shows people tend to gain back the weight.

So surgery, I thought right away kind of seemed like a really good option for her.

And I asked her about it, and she seemed really concerned, like she didn't really trust it, didn't really super know what it was, kind of was a little suspicious.

um and it's interesting i watched her kind of bounce from doctor to doctor and different doctors would try to um i kind of saw like the whole healthcare system like laid bare uh but different doctors would try to get her on things to help her um so one doctor tried this like behavioral health consultant.

Another doctor, this isn't in the story, but they were, there was like a long process of trying to get her a CPAP machine.

And it's like.

She stopped breathing like 48 times an hour, according to one analysis.

Some, yeah.

She basically,

I mean, I don't know if she was exaggerating or not, but she said the doctor told her that she was going to die in her sleep if she didn't get a CPAP.

So this one place tried to get her a CPAP for a really long time, and they kept running into insurance problems where the insurance wouldn't approve the CPAP.

Then it was something like another doctor did actually get her the CPAP, but then she couldn't wear it because it was too uncomfortable and she would like fling it off at night, I guess, in her sleep.

Then I think eventually she did get the CPAP.

But the big kind of C change was that after a few months, a doctor actually came to her and said, have you ever considered bariatric surgery?

And she just said, yes.

Like she decided to sign up on the spot and kind of like before she could change her mind or talk herself out of it or get too scared, she was like, yeah, I'm going to do it.

Yeah.

I think this conversation around, especially

bariatric surgery, the reason why a lot of people don't want to get it is because we've sort of been drilled into our understanding of our eating habits, of our healthy choices, that it's a willpower.

Right.

That you should be able to, in, you know, if you are strong enough, you should be able to do this.

But I think your story sort of gets to the

ways in which your environment, the community around you, all of your surroundings change the way your brain works, the way even we should understand what willpower is.

What is your experience with Kiera?

I told you about that.

And

how has, I guess, her decision to have surgery illustrated those things?

She seems like a person with just this iron will that she gets through everything, right?

Yeah, so I would not say that willpower is Kiara's problem.

And that's something that a couple people have brought up to me after this is published as sort of like, well, all she has to do is make better choices.

But she's not like wishy-washy in her choices.

She kind of knows what she wants.

And I will say that when she chooses to, like, I was with Kiera for entire days where she didn't eat anything because she didn't have any money.

So it's not like she was just obsessed with food and eating non-stop.

But I think it's really hard when you're in this environment.

Like, if you've ever had any kind of compulsion or if you've ever felt like you needed a glass of wine at the end of the night, like

that's what that is, is that feeling of kind of frustration and stress and, you know, a desire to kind of fall back onto something comfortable and reliable.

So I don't know.

I really don't think willpower would do it here, especially since, I mean, just on a broader scale,

once people get this big willpower, even if they lose the weight, they're going to gain it back because of changes to your metabolism.

So willpower is a mood point, kind of.

There's a way that

it sounds in the way that we talk about it.

Like Kira's story in her life is one of just like constant drudgery.

But in fact,

you know, she describes her own,

her grandparents' home as a loving home.

She, you describe her as having the demeanor of a student body president.

She founded a club called Beautiful Beyond Weight, in which she talks about she

puts on fashion shows with friends.

So it does, you know, she also has this rich life.

Yeah.

She doesn't get lost

in this conversation in this story.

So there are questions about sort of like what she herself can do.

And then you frame this in terms of the larger like institutional obstacles, environmental obstacles that are all sort of coalescing in a bid to

basically keep Chiara and people like her down.

I mean, to keep them at the bottom of the income ladder and more urgently, just shave years off of their lives.

Yeah, I mean, one of the most interesting ways that I thought that played out was actually with the

with the fast food element and sort of how, like, why are there so many, when you drive around what you consider quote unquote bad neighborhoods, why are there so many fast food places?

And I had kind of never, I'd thought about it and I didn't really know why.

And that was sort of the extent that I had thought about this

before this.

But so apparently there's been a lot of research into this.

And essentially it's because the government,

starting in about the 1960s,

granted,

I guess, subsidies of various kinds to entrepreneurs who would open up businesses in urban neighborhoods.

And a lot of these entrepreneurs ended up being fast food franchisees.

And so they would open up in urban neighborhoods because they found that that was like a profitable environment for them.

And I think there's even one quote in the piece from a fast food executive where he's like, the ethnic market is a great market for us because the larger families lead to larger checks or something.

So you do have, I mean, it's for a reason.

It's because people, which to their credit, were trying to bring jobs into what they called at the time the quote-unquote ghetto.

And so, but the way of bringing in those jobs was through fast food.

And so now you have all these fast food places and they would sometimes tailor their marketing to where there would be like,

you know, kind of like African inspired uniforms in these stores or like

music that they thought would be appealing to African Americans played in the restaurants

because they were really hoping to capitalize on the fact that like, this is a less expensive meal.

People here don't have as much money.

Why don't we just open a million of these?

So yeah, and that's why those places are like that and why,

you know, those are kind of some of the only options around.

Yeah, all the R ⁇ B commercials.

Yeah.

I do not see Whole Foods advertising itself with like talent and kente cloth, right?

You talk about the flip side of this, Olga, which is supermarkets don't want to go into low-income neighborhoods because they don't want to deal deal with food stamp recipients.

Yes, this is okay.

This was actually a very difficult thing to pin down because there's a debate kind of among scholars as to whether this is real or not.

But the thing supermarkets say when you ask them, hey, why don't you ever open in low-income neighborhoods, is, well, we can't deal with food stamps because they all come at one time of the month and then everyone uses them and then we don't have any customers for the rest of the month.

So we like can't do our stocking the right way or like we can't plan to have the right amount of workers working at the right times.

It's too difficult.

So some people say that's BS.

food policy scholars I talk to don't really buy that.

But the places that have been successful at helping grocery stores stay open and kind of function effectively in lower income neighborhoods have, you know, it's like food policy directors who work with the food stamp people to make the food stamps maybe distributed more evenly throughout the month.

Or, you know, there's ways around this like food stamp issue that they talk about.

So

there's also just the breakdown in people cooking at home and the family meal and fundamentally the family structure.

I mean, you talk about in Kiara's case, there's a sort of absentee father who's in and out of jail.

There's a grandmother who plays a pivotal role as kind of the keeper of the home fire, but she's dealing with multiple mouths to feed.

She has her own life to worry about.

I mean, the idea idea that everybody is going to the supermarket to buy food, to cook it, to have a family meal is just a fantasy in a lot of these households.

I mean, part of the reason fast food has been successful is because families aren't cooking.

I mean, and that has to do with job schedules.

It has to do with, you know, I mean, it's more cost-effective in some ways to just buy fast food, family meals.

It's just part of the 21st century conundrum, but it's also part of the income question in America, right?

And while Chiara has a grandmother who cooks for her, that's in some ways almost an outlier in a lot of communities.

So

it's kind of a vicious cycle, right?

You don't have supermarkets and then you stop cooking and then you get into fast food and the supermarkets say, well, we are not in low-income neighborhoods for X, Y, and Z reasons.

But the long and short of it is you end up with either food deserts or food swamps, which is a distinction you make, Olga, right?

The difference between the two.

Yeah, yeah.

And you're, you're totally right that, um, so Kiara as an adult does not cook very much for for herself or you know, she might cook something like at the beginning of the week and eat it all week.

And but the reason, I mean, that I noticed from her is that

she is just really busy.

Like she really had very little time to herself.

At one point, she was working a daytime job, taking classes, then working a nighttime job.

Oh, my God.

So she literally was like 24 hours at work.

And she would kind of like eat whatever, whenever she had time because she was trying to save up money.

So I think that's, I mean, I met a lot of people who worked way more than 40 hours a week

or who are at least like who are trying to work more actually is like a common thing.

People, even if they're on disability or something, are like trying to make more money to supplement.

So I

find that like the cooking thing is more like a time pressure issue than

instead of like people not wanting to cook per se.

One of the striking things about Kira's story is how many

aspects it touches on.

It's not just food and nutrition, but it's also education and health care and housing and lead.

When we come back, we'll talk about the broader environment that Kira is embedded in and the implications that that has for health.

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So, Van, you have done a ton of reporting on health and health policy.

And I'm curious, from your vantage point, as you were reading Kiara's story, what were some of the areas that struck you as being endemic problems in black neighborhoods?

So especially in the context of minority, especially black neighborhoods, what I've tried to do is tie the idea of environmental justice, the idea that you have an inequitable distribution of environmental risks, of pollution, of things like that, and how that ties to our conception of public health and health policy.

One of the key examples from this story

is people who have asthma.

And asthma, as we are coming to find out in lots of research, in the understanding of the experts who work on asthma every day, it's almost

When we look at the prevalence today, it's almost entirely an environmental disease.

Exposure to pollutants early on, things like

mice droppings, like

insect droppings, infestations of rodents and insects in the home, of allergens, of pollen, of being exposed to the outdoors, smog, things like that, they dramatically increase a child's risk of asthma.

And you extrapolate that, right?

You think about, okay, now we have more kids with asthma.

Then you're going to have, asthma is not usually a life-threatening disease.

Most times, when you have an attack, you can go in and you can get taken care of, right?

But let's say

you go from an average kid doesn't usually see the emergency room at all in any given year.

And say you have now two or three emergency room visits for a family that doesn't have insurance or good insurance.

And now you're paying for two or three emergency room visits a year.

You compile it over a childhood for multiple children.

What we're talking about just the burden of all these things on the outcomes.

And you're paying essentially, you got kids who can't and don't go to college often, and you're basically paying a college tuition for their asthma treatment.

Wow.

It's, it's, what, what strikes me about all of this is that the cascade effect.

Asthma isn't just asthma.

Asthma could then lead to other complicating health factors, which could ultimately compromise your ability to be a fully functioning member of the American workforce, right?

Right.

Right.

All asthma, lots of people with asthma

self-consciously do things to limit their attack.

So they stop working out.

They stop doing heavy physical activity.

They stop taking the groceries inside.

And lots of them become,

they begin to develop obesity and become overweight over time.

And that has its own complications.

And you have folks who have diabetes and they have complications from that.

So all these environmental diseases, all these things with environmental inputs, they basically increase your risk of morbidity and mortality for other diseases.

And so you never see one thing lead to instantly fatal

diseases in poor neighborhoods.

As often, we have these compounding effects.

And that's what happens when people die 20, 15 years earlier.

It's not usually from one sudden thing.

It's a lifetime of these rolling, compounding issues.

And most folks die.

If you die early in a poor minority neighborhood, you're not dying from

just heart disease.

You have lots of different comorbidities.

Yeah.

Van, and just like asthma is tied to other diseases, the onset of asthma is actually tied to other institutional sort of racist practices, which is to say housing policy has created like widely blighted neighborhoods.

Houses are abandoned, rodents, mice move in.

They then create environmental factors that lead to asthma.

Asthma then leads to a cascade of bad health outcomes.

Talk to us a little bit about the beginning of that chain, the housing piece of all of this.

Right.

So if you look at a place like Baltimore, especially, we talk a lot about redlining in Baltimore, which is basically, and now reverse redlining, which are these discriminatory practices that basically price and place black neighborhood dwellers out of healthy and better constructed neighborhoods, end up in blighted housing.

The people in segregated neighborhoods, the housing, it doesn't start off bad, but it usually gets bad over time.

It's not kept up, it's not repaired.

City policy is usually difficult to keep these things up because it's expensive.

And so you have generation after generation of black people, of minorities who live in neighborhoods that become over time less and less well-maintained.

You have peeling lead paint, you have more and more infestations of vermin, of rodents, and just over time, they just become less healthy.

And that's just the case, not just in Baltimore, but in lots of communities of color across the country.

You see this generation, you see asthma rates go up every single generation.

And that's just basically the fact of these communities right now.

One of those factors that you just mentioned, Van, turns out to be pretty material to Kiera's story.

Lead.

Yeah, lead has been kind of a menace in Baltimore for generations.

And interestingly, I just want to point out that any time something goes wrong with the health of black people in Baltimore, people find a way to blame the black people themselves.

So famously the like health and safety guy behind the lead industry who said that it was Baltimore's human rodents who were children, he meant toddlers, who were chewing on surfaces and that's why they were getting lead poisoning.

Of course, the surfaces were covered in lead paint.

And basically, even though we've known since the early 1900s that lead paint is dangerous, it was continued to use in a lot of these homes.

In nicer neighborhoods, they could afford to pay for abatement, so kind of like taking out the lead paint, replacing it.

In less nice areas, in areas where a lot of African-Americans lived,

these landlords would basically paint over it or let it chip or let the dust kind of gather in

little corners.

Of course, kids crawl around and put everything in their mouths.

So basically, you had the majority of kids in some neighborhoods being lead poisoned by the 1990s.

Meanwhile, no one was prosecuting the landlords.

No one was, the city just kind of, the enforcement mechanism that was meant to keep the landlords from doing this and from getting away with it had virtually stopped.

So people like Kiera had several times the level that the CDC sets of lead in their blood.

And that permanently impacts how well you can learn what you're,

you know,

you could be permanently brain damaged and you could have a lower IQ for life because of something like that.

So if you think about it, that's,

and that has so many downstream effects.

So lead is honestly one of the saddest and worst things about the Baltimore health picture to me.

Van, how much of a problem does that remain?

So the one I think, I don't know if it's necessarily a positive takeaway because there's still so many children who are lead poisoned in Baltimore, but a good portion of the worst parts of of lead poisoning in Baltimore have

been fixed.

So actually,

probably the most disconcerting part about lead poisoning in the country is it's extremely easy to deal with.

And it's cost effective.

Basically, all you have to do is paint over.

the peeling paint in places.

It's simply applying a new coat of paint.

You don't have to tear things down.

You don't have to do anything that involves stripping things out.

You just paint.

And all it takes is for the landlords, for the people who run public housing to paint things.

And every dollar you spend painting it, you save about $4 back in terms of long-term health costs for people.

So it's one of the easiest health problems to deal with that we have, but also one of the most pervasive.

So I think it tells you exactly sort of where the alignment of empathy, of our public policy obligations to low-income and people of color, where they failed.

Baltimore is doing much better than it was before, but it's still, you know, something like 10% of all the lead poisoning cases in the country.

It's still not doing great.

It also contributes, sorry, I just have to say, it also contributes to violent behavior and violent impulsivity and violent outbursts.

So when people complain about crime and why is there so much crime, I mean, for a lot of reasons, but

one reason could be lead poisoning.

Aaron Powell, yeah, I've talked pretty extensively to Howard Milke.

He's a researcher who came up with basically the lead crime hypothesis.

And, you know, again, he says this very easily

fixed problem has contributed to generations of, you know, we see crime rates spiking.

We see lots of black male youth, especially who deal with problems with attention span, who end up having problems in school.

He claims that lots of that is just traceable to simple exposure to lead.

The other point that I'd make is that these are generational problems that manifest in long-term consequences.

Kiera herself is only 27, as you point out, Olga, and she was hospitalized for a month

when she was a little kid, yeah.

When she was a little kid because of lead poisoning.

Yeah.

You know how bad lead poisoning has to be to be hospitalized for it?

Gosh.

But also to think about, I mean, again, to bring it back to this woman's life, she's been hospitalized on multiple occasions for a month, once for lead poisoning as a kid, another time for losing a kid

just a few years later.

I mean, that's a lot.

But Kiara, she has seen a way out for herself of a lot of the trouble.

Talk a little bit about the role of education in her life.

Yeah, so education is really important to Kiara.

I feel like I'm speaking for her, but she's said this to me several times.

So she

really is a huge proponent of education.

So her

having not finished college before now, it's not necessarily a reflection of

what she thinks of college.

She's tried college.

She really wanted to go to Spelman.

She didn't ultimately go.

She would kind of enroll and drop out.

Sometimes it was to help with her nieces and nephews.

Sometimes it was just because things would get overwhelming.

So she has a bunch of student loans, a no-college degree.

But she has sort of, I think,

through her recovery and through seeing all the health needs in her community and all the good that people are doing in the community, decided to sort of become a health worker herself.

So she got her community health worker training certificate.

She told me today actually at the at the conference that she was going to be joining Johns Hopkins as a community health worker, which is really great.

Yeah.

So she sees education as a way out.

And I think that will ultimately be the way out for her.

Like the surgery will be really great and will

keep her healthier longer.

But I think think that when she finally exits this world of traumas, I think it'll be because of education.

You know, what strikes me from this reporting, Olga, is this is an ordinary story about black America in many ways, right?

I mean, you wrote this story, not searching for some,

you know, specific heroine.

You just wanted to find a subject, right?

Like, and Van, Kiara's story is a story you've heard over and over again in all of your reporting.

I mean, the lead poisoning piece, which is such a pivotal part of her life story, is a part of so many stories and biographies of black Americans dead and alive in America.

Yeah.

Yeah.

Well, despite its prominence in the Black American story, I will say, Olga, you've achieved an extraordinary piece.

Oh, thank you.

Congratulations.

Thanks.

And I would encourage all of our listeners to read it.

Read all of it.

Read Vans Reporting, too.

Absolutely.

Yes.

I want to turn at the end of our conversation, as I always do, to keepers,

which I ask our listeners and our guests what we've heard, read, watched, experienced recently that we do not want to forget.

First, I want to play a keeper from one of our longtime listeners, a fellow named Jay I.

Before I play his keeper, I want to mention a comment that Jay has made to me, which I think is a very cogent one, which is that we have not yet done a Radio Atlantic episode about Puerto Rico.

And I just wanted to say to Jay, and all, listen, it's coming.

So stay tuned.

Van himself, you have been reporting in Puerto Rico and around the Puerto Rican diaspora.

And I expect to have you on for a conversation about Puerto Rico soon.

Indeed, much more to come.

Let's play Jay as keeper.

My keeper is the quote: endurance isn't a human trait, it is the

human trait by Jennifer Farr Davis, the woman who previously had the record for running the Appalachian Trail.

It was in

one of the Atlantic articles from this June issue ran by Paul.

I'm going to butcher his last name, Paul Bisaglio.

That was such a good job.

He did not butcher Paul's last name at all.

Thank you for that, Jay.

Olga, why don't you go next?

What is your keeper?

Okay, okay, so my keeper, even though it's over and so no one is actually keeping it anymore, is the Americans TV show, which was little.

Oh, man, I just watched the season

series finale last night.

We're still keeping on.

So many people are about to binge the Americans for the first time.

Yes, well, I highly recommend doing that.

It didn't seem to be like one of the most watched shows, but was one of the best, I think, in my recent memory.

And I also have a special connection to it because it's about Russians in America.

Hashtag relevant.

What I am.

what kind of Russian in America are you, Olga?

Wouldn't you like to know?

Van, how about you?

My keeper is Andre 3000's verse, feature verse on the song 16 by Rick Ross.

Specifically the line,

it feels good when the hood pseudo-celebrate.

Hence why every time we dine, we eat until our belly ache.

I think it's actually a really great and i think really profound uh distillation of joy and of pain in the low-income minority neighborhoods um and i have been thinking about it for days

wow all right

andre 3000's verse yes 100 grass is 16 alex What do you want to say?

I always like when I can follow Van and an Andre 3000 reference.

It is, contrary to the tenor of this conversation, which has been important

and one of my favorite Radio Atlantic episodes, it is also summer and it is time for good cheer and light conversation around a bucket of rosé, or maybe not, I don't know.

That's obviously

a bucket of

like a human-sized keg of rosé.

It is summer.

Well, we may not all be drinking rosé, and it is time for dancing and good vibes, and I would recommend to everybody to listen to the dulcet tones of The Mighty Sparrow, one of of Trinidad's finest musicians of the Calypso genre.

And I would start with short little shorts.

That's one of my personal favorite jams.

You will not be sorry that you started off your summer solstice, which is, I think, in a week, with Mighty Sparrow.

Oh, you got me thinking about West Indian Music Keepers.

Just

I'm not going to shout out my West Indian Music Keepers yet because that's a whole episode.

But

My Keeper this week is a Netflix series called The Terror.

I have not heard all that much conversation about the terror, and it's a grisly show.

I've got to warn you in advance.

Really?

With a name like The Terror?

I thought it would be a family-friendly fair.

It is not.

It is about the true life journey to find the Northwest Passage of Sir Francis Crozier and a crew of Britons back in the mid-19th century.

The unsuccessful true life journey.

Those ships, the two ships, the Terror and the Erebus, were lost for many years until just a few years ago.

One of the ships was found in 2014, the other one a couple years later, I believe.

But a few years ago, the author Dan Simmons wrote a novel that speculated about what might have happened to these two ships and to Sir Francis Crozier, this Arctic hero.

The book was interesting.

I'd read the book and it was vivid.

Even though it was quite long, it kept me engaged.

But the series is something else entirely.

The series actually is not only beautifully shot, it's clearly, it's one of those sort of like prestige-y kind of shot television shows, but thematically, the elements of the series start to come into relief, the terror, and what the show means by the terror and what the terror, the terror in this case of, among other things, dying desperate, frozen, and poisoned in the Arctic drives men to do.

Oh, Lord.

We were just talking jams and then he

brought it back to the terror.

But I will say the series strikes me as as cogent in exploration of,

among other things,

the Trump administration, President Trump and his political philosophy,

as anything I've seen.

The last image of the show, the very last shot of the first season of this show,

is one of the images that is going to dwell with me for quite a while.

I'm not going to say too much more about it, but I give it high recommends.

I think I need that keg of rosé now.

Yeah.

You're all invited.

Yes.

Olga, thank you for a tremendous story and for joining us this week.

I look forward to many more.

Thanks for having me.

It was a great story, Olga.

Yes, it was.

Thanks.

Van, thanks again.

Thanks.

And Alex, my esteemed co-host, thanks as always.

Thanks to you, Matt.

We'll see you next week.

That'll do it for this week of Radio Atlantic.

This episode was produced and edited by Kevin Townsend with production support from Kim Lau.

Catherine Wells is the executive producer for Atlantic Podcasts.

Thanks as always to my esteemed co-host, Alex Wagner, and to our colleagues, Olga Hazan and Van Newkirk.

Our theme song is the Battle Hymn of the Republic, interpreted by John Batiste.

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May you live long enough and well enough to find satisfaction one distant day in a life richer and fuller than you'd ever dreamed to hope.

We'll see you next week.