Why Context Matters More Than “Normal”
How health literacy helps prevent harm in care and advocacy
Welcome to The Community Letter, a weekly reflection from the Enhance Black Women’s Health Community. This is where we slow things down, pull up a chair, and talk through what’s shaping Black women’s health with a little more care and a lot more context.
I’m writing this letter on MLK Day, and one quote has been sitting with me all morning: “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
That line hits differently when your work centers Black women’s health. Not because it’s new, but because we keep seeing it play out in quieter, more normalized ways.
It’s been a challenging few years running a community with the words “Black” and “Women” in its title. When I founded the Enhance Black Women’s Health Community in 2023, the political landscape looked very different. There was more openness to nuance. More willingness to talk honestly about how race, gender, and power show up in care.
Although the tides have shifted, the mission has not.
One thing remains true, no matter how uncomfortable it makes people: context matters in health. Context shapes interpretation. Interpretation shapes care. And care shapes outcomes.
Why Context Matters in Care
Whether you’re a clinician, dietitian, health coach, patient, or advocate, context quietly influences decisions long before anyone names it. It affects:
Which labs get ordered
How results are interpreted
What treatment options are offered
What’s labeled “normal” versus “concerning”
When context is ignored, even well-intentioned care can miss the mark. You might prescribe a medication that a patient cannot afford. Design a meal plan that assumes access to ingredients, time, or cultural familiarity that simply isn’t there. Encourage food journaling without recognizing how it might reopen old wounds around control, surveillance, or disordered eating. None of these tools is inherently wrong. But without context, they can cause harm.
What We Mean When We Say “Normal”
Here’s a concrete example. Before becoming the physician and public health leader she is today, Dr. Vanessa Apea was a 21-year-old medical student seeking care for symptoms that felt off. Routine bloodwork showed a low white blood cell count, triggering concerns about leukemia and the possibility of invasive testing.
A second clinician paused. Instead of treating the lab value as universally abnormal, they considered ancestry-related reference ranges and chose observation over immediate intervention. Further evaluation confirmed that Dr. Apea has the Duffy-null genotype, a common and benign genetic variation among people of African and Middle Eastern descent that is frequently misinterpreted in clinical settings.
That pause mattered. Context spared her from unnecessary procedures, including a bone marrow biopsy. This is what health literacy looks like in practice. Not memorizing facts, but knowing when to ask better questions.
Why This Matters Today
Today, I’m opening The Roundtable, where we go deeper. It’s a shared space for reflection and conversation about what’s shaping Black women’s health, especially when the answers are not clean or convenient.
Inside The Roundtable:
Monthly live discussions that break down complex health topics with room for nuance
Space for real questions, not performative hot takes
Ongoing community threads and an archive of past conversations you can return to over time
This kind of space takes intention, care, and yes, time. If you’ve been wanting more room to think out loud, wrestle with complexity, and stay in conversation, this is for you.
Community Prompt
Where have you seen “normal” used in ways that ignored context or caused harm, either in care or advocacy?
Until next week,
Tomesha