We see the speeches, hearings, press conferences, floor debates, and votes. What is less visible is the institution behind those public moments: the chiefs of staff, legislative directors, committee staff directors, counsels, policy directors, and legislative assistants who help decide which problems receive attention and which solutions become law.

For this post, I will focus on the Senate Democratic Caucus. You can find reports for both chambers of Congress here.

As a former staffer in both the U.S. House of Representatives and the U.S. Senate, I know that congressional staff are not peripheral to policymaking. They are central to it.

They identify emerging issues. They meet with constituents and advocates. They evaluate evidence. They draft legislation, prepare hearings, negotiate amendments, brief members, work with federal agencies, and help determine what is politically and procedurally possible.

That is why the Joint Center for Political and Economic Studies’ latest examination of Senate Democratic staff diversity deserves serious attention.

I congratulate Dr. LaShonda Brenson and the Joint Center for continuing to produce the kind of institutional data Congress should already be collecting, analyzing, and publicly reporting.

The Joint Center’s work asks a simple question:

Do the people advising the Senate reflect the people the Senate governs?

The answer remains uneven.

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The numbers tell two stories

The Senate Democratic Caucus’ 2026 survey provides a snapshot of racial, ethnic, gender, and LGBTQ representation across Democratic personal and committee offices as of June 30, 2026. The Joint Center builds upon that information by ranking offices, comparing staff diversity with state demographics, and identifying offices that improved or declined.

There are offices demonstrating that substantial staff diversity is possible. Senators Schatz, Heinrich, Padilla, Luján, and Ossoff reported that roughly two-thirds or more of their employees identified as non-white. Several offices also reported strong Black staff representation, including those of Senators Alsobrooks, Blunt Rochester, Ossoff, and Warnock.

At the same time, some personal offices reported that fewer than one in four staff members identified as people of color.

Committee offices also varied considerably. The share of staff of color ranged from 14 percent on Armed Services and 17 percent on Aging to 65 percent on Banking. Several committees reported no Black staff members, while others, including Rules and HELP, reported considerably stronger Black representation.

These differences matter. But whole-office percentages tell only part of the story.

Presence is not the same as power

The deeper question is not only who works in an office. It is who holds authority within it.

The Joint Center’s companion report on Senate committee leadership found that people of color make up 42.6 percent of the U.S. population but only 22 percent of Senate committee top staff. Black Americans constitute nearly 12 percent of the population yet hold only 2.7 percent of Senate committee staff director positions. Latino Americans make up more than 19 percent of the population, but there are currently no Latino full-committee staff directors.

Only one of the Senate’s 37 full-committee staff directors was Black.

Among Democratic committee offices, only one Black staff director was identified. Black representation in these leadership positions has remained largely stagnant since the Joint Center’s 2021 analysis.

The report did identify progress. The percentage of policy directors of color increased from 5.6 percent in 2021 to 32 percent in 2026. Yet even this important improvement contained a warning: the Senate moved from having no Black policy directors to having only one.

This is why institutions must look beyond aggregate diversity.

A congressional office may become more diverse overall while the highest levels of authority remain largely unchanged.

Recruitment is not promotion.

Presence is not influence.

Access is not authority.

What congressional staff actually control

Members of Congress make the ultimate decisions. But those decisions are shaped by an institutional process that staff help manage.

Senior staff influence which constituents and organizations receive meetings. They help determine which issues rise to the member’s attention. They recommend hearing topics and witnesses. They decide which proposals merit staff time. They shape legislative language, negotiate with other offices, prepare members for markups, and coordinate with committees, agencies, advocates, and industry.

Committee staff are especially consequential. They possess technical expertise, institutional memory, and influence over legislation, oversight, nominations, and appropriations. The Joint Center rightly emphasizes that committee leaders and top staff help decide which hearings occur and which bills move toward a markup.

Who occupies those positions therefore affects not only workplace diversity, but the substance of democratic governance.

Congressional staff are part of the policy nervous system

I often describe good policy as requiring a healthy policy nervous system.

A nervous system receives signals, interprets them, determines their urgency, and coordinates a response.

Congressional staff perform a similar function. Communities send signals through constituent calls, research, advocacy, testimony, meetings, media coverage, and lived experience. Staff help determine whether those signals are recognized, ignored, misunderstood, or translated into public action.

When the policy nervous system lacks people who understand the lived realities of Black communities, the institution can misinterpret chronic pain as an isolated anecdote. It can treat structural inequity as an individual problem. It can overlook policy consequences that would have been visible to someone with a different body of knowledge or life experience.

Representation does not guarantee good policy. Black staff are not a monolith, and racial identity is not a substitute for policy expertise, sound judgment, or accountability.

But institutions make better decisions when lived experience, technical knowledge, and decision-making authority are not concentrated within a narrow group.

And being specific does not mean being exclusionary.

Naming the particular underrepresentation of Black and Latino staff does not diminish the importance of Asian American, Native American, MENA, multiracial, gender, LGBTQ, disability, socioeconomic, or other forms of representation. Specificity allows institutions to identify where progress is occurring and where exclusion remains deeply embedded.

This is also a health equity issue

My work through Enyia Strategies and the John Henry Institute for Black Men’s Health and Policy Innovation focuses on the political, economic, and social conditions that determine whether Black men and boys can live long, healthy, and flourishing lives.

The John Henry Health Equity Playbook frames political representation and civic participation as health equity tools because government decisions shape access to health care, housing, education, employment, neighborhood investment, environmental protection, violence prevention, and economic opportunity.

Congressional staff sit at the intersection of all these systems.

Consider the reach of Senate committees:

The HELP Committee shapes health, labor, education, public-health, and biomedical-research policy.

The Finance Committee influences Medicare, Medicaid, taxation, and health care financing.

The Appropriations Committee determines whether programs at NIH, CDC, HRSA, SAMHSA, HUD, and other agencies receive the resources necessary to operate.

The Banking Committee shapes housing, lending, community development, and wealth-building policy.

The Judiciary Committee exercises jurisdiction over civil rights, criminal justice, firearms policy, and federal judges.

Veterans’ Affairs, Agriculture, Environment and Public Works, Small Business, and other committees affect the conditions in which Black men and their families live, work, age, and raise children.

These decisions are not separate from health. They are among its upstream causes.

When Black men are underrepresented among the people helping to shape those decisions, the problem is larger than congressional employment. It becomes a question of whether the institution possesses the knowledge and perspective necessary to govern effectively.

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The pipeline cannot end at the doorway

Congress frequently discusses the need to build a more diverse “pipeline.” But a legitimate pipeline must lead somewhere.

An internship without a pathway to a permanent position is not enough.

A junior position without mentorship is not enough.

Mentorship without sponsorship is not enough.

Employment without meaningful portfolio ownership is not enough.

Retention without promotion is not enough.

A serious congressional talent strategy must examine who is hired, how long they remain, what they are paid, which policy portfolios they manage, who supervises staff, who participates in senior meetings, and who advances into leadership.

Otherwise, the pipeline becomes a holding pattern.

What Congress should do next

First, Congress should establish consistent annual workforce reporting across both parties and both chambers. Data should be disaggregated by race, ethnicity, gender, disability, office location, salary band, job function, supervisory status, and seniority, while protecting individual privacy.

Second, Senate offices and committees should publish measurable recruitment, retention, and advancement strategies. Diversity cannot remain an aspiration without ownership, timelines, and accountability.

Third, offices should examine the distribution of power, not merely head counts. Who leads the health, judiciary, tax, appropriations, national security, and economic portfolios? Who briefs the senator? Who sits in negotiations? Who supervises teams? Who is being prepared to become the next legislative director, chief of staff, staff director, or chief counsel?

Fourth, Congress should invest in sponsorship. Mentors offer advice. Sponsors use their institutional credibility to create opportunities. Staff of color need both.

Fifth, philanthropy, universities, HBCUs, professional associations, and advocacy organizations should invest in multiyear pathways that prepare professionals not only to advocate to Congress from the outside, but to shape policy from the inside.

That includes public-health professionals, researchers, physicians, behavioral-health experts, economists, lawyers, data scientists, community leaders, and people with implementation experience.

Congress needs more professionals who know both what communities experience and how federal policy moves.

Representation must become institutional infrastructure

The goal is not to make every congressional office mirror an identical demographic formula. Nor should representation be reduced to a partisan talking point.

The goal is to build a legislative institution capable of hearing the country accurately, interpreting its needs wisely, and translating those needs into equitable policy.

That requires transparency.

It requires intentional hiring.

It requires retention and sponsorship.

It requires leadership pathways.

And it requires recognizing that diversity is not ornamental. It is part of the institution’s governing capacity.

The Joint Center has once again given Congress data it cannot responsibly ignore. The next step is to move from annual disclosure to institutional redesign.

Because the central question is not simply who has a job on Capitol Hill.

It is who has the opportunity, authority, and institutional support to help shape the future of the country.

Elevate,

Dr. Okey K. Enyia

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The report challenges one of the most persistent misconceptions in men’s health: that poor health outcomes are primarily the result of poor individual choices. Instead, it argues that men’s engagement with preventive care, health literacy, symptom recognition, and chronic disease management is shaped by the systems surrounding them. It identifies six priority areas for action:

• Embed men in health policy frameworks

• Strengthen regulation of health risks

• Improve access to male-responsive services

• Enhance health literacy

• Invest in workforce training

• Accelerate research.

This is an important shift.

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For too long, the conversation has centered on changing men’s behaviors without adequately examining the systems that shape their opportunities to be healthy in the first place.

The report also presents sobering realities. Globally, men live approximately five years fewer than women. In the United States, Black men have a life expectancy of approximately 69 years, compared to 75 years for white men and 77 years for Hispanic men. Men experience higher burdens of cardiovascular disease, liver disease, cancer, and suicide, with enormous implications not only for individuals but also for families, communities, employers, health systems, and national economies.

These statistics should concern all of us.

But they should also push us to ask a deeper question.

How do we move from better policy recommendations to better health outcomes?

The report offers six thoughtful recommendations that move the conversation beyond individual responsibility toward systemic change. These are necessary priorities.

But implementation requires something even deeper.

Good policy should strengthen the policy nervous system.

In other words, policy should not simply produce legislation or recommendations. It should strengthen society’s ability to identify emerging health challenges, connect institutions across sectors, coordinate action, translate research into practice, learn from implementation, and continuously improve outcomes. Without that capacity, even the strongest policy recommendations struggle to produce measurable improvements in population health.

This report also resonated with me on a deeply personal level.

Over the past several years, I have intentionally developed what I now describe as a self-care, self-maintenance, and soul care regimen. It was not created in response to a single event. It was shaped through seasons of professional leadership, caregiving, fatherhood, entrepreneurship, unemployment, disappointment, healing, and spiritual formation. Like many men, I spent years believing that strength meant pushing through. Over time, I came to understand that true strength is found in stewardship.

That journey transformed how I define health.

Self-care became much more than annual checkups or exercise. It became learning to regulate my emotions rather than simply managing stress. It became creating rhythms of rest instead of glorifying busyness. It became establishing healthy boundaries, investing in meaningful relationships, cultivating my spiritual life, embracing reflection and continual personal growth, and intentionally protecting time with my wife and son. Perhaps the greatest lesson was moving from proving my worth to stewarding the life God has entrusted to me.

Perhaps most importantly, it taught me that resilience should never become an excuse for systems to remain unchanged.

Individual responsibility matters. Every person has a role to play in caring for their health. But my own experience reinforced what this report makes clear: our ability to practice self-care is shaped by the environments we inhabit, the communities that support us, the institutions we trust, and the policies that either expand or constrain our opportunities to flourish.

That realization has profoundly shaped both my research and my professional work.

Through Enyia Strategies, I partner with healthcare organizations, nonprofit organizations, academic institutions, philanthropic organizations, and public sector leaders to translate research, policy, and population health evidence into practical implementation strategies that improve health outcomes.

Through The John Henry Institute, we convene healthcare organizations, researchers, advocates, policymakers, funders, employers, and community-based organizations to design systems-level solutions that improve the health and well-being of Black men. Together with The John Henry Health Equity Playbook, these efforts are focused on strengthening the infrastructure that moves evidence into action.

This report reinforces many of the principles that have guided my work over the past several years.

It recognizes that men’s health is not solely a healthcare issue. It is influenced by policy, health systems, culture, workforce development, access to care, and social conditions. I would simply take that conversation one step further.

Self-care is downstream.

Policy is upstream.

And policy itself must be supported by implementation infrastructure.

That is especially true for Black men.

While the report appropriately highlights racial differences in life expectancy and acknowledges that men experience health differently across race, income, and geography, the next step is ensuring those differences shape implementation strategies. Being specific does not mean being exclusionary. In public health, targeted approaches often strengthen systems for everyone because they address the greatest barriers to health.

This is why I continue to advocate for approaches grounded in the social drivers of health, the political determinants of health, targeted universalism, and population health. These frameworks recognize that housing, education, employment, economic opportunity, civic engagement, healthcare access, transportation, environmental quality, and community conditions are not separate from men’s health. They are the conditions that make health possible.

They also remind us that implementation matters just as much as innovation.

From Reflection to Action

The encouraging news is that the field of men’s health continues to mature.

Reports like this demonstrate growing recognition that improving men’s health requires structural thinking rather than simplistic narratives about personal responsibility.

For that, Peter Baker and the entire GAMH team deserve congratulations.

Their work is helping move the field forward.

Now comes the next challenge.

Not simply producing better reports.

Not simply producing better policies.

But building stronger systems capable of translating those policies into measurable improvements in people’s lives.

Because good policy should strengthen the policy nervous system.

When our policies improve how communities communicate, how institutions coordinate, how research informs practice, and how lived experience shapes decision-making, we move beyond isolated interventions toward healthier, more responsive systems.

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Policy Recommendations

If we are serious about advancing men’s health, I believe the next generation of policy should prioritize five areas.

1. Develop comprehensive men’s health strategies at every level of government.
Federal, state, local, Tribal, and territorial governments should intentionally integrate men’s health into public health planning and accountability frameworks. Dedicated men’s health offices, interagency coordination, and measurable performance indicators can sustain progress beyond election cycles.

2. Recognize civic engagement as an upstream civic determinant of health.
Communities that participate in shaping public policy are better positioned to influence the conditions that affect health, including healthcare access, housing, education, workforce development, environmental quality, transportation, and economic opportunity.

3. Invest in implementation infrastructure alongside research and innovation.
Funding should support implementation science, evaluation, technical assistance, and cross-sector coordination so that promising ideas become scalable and sustainable solutions.

4. Improve population-specific data collection and reporting.
More granular data on Black men and other historically underserved populations is essential for designing interventions that reflect lived realities. Being specific does not mean being exclusionary. It strengthens the effectiveness of population health strategies.

5. Incentivize cross-sector collaboration.
Healthcare systems, public health agencies, academic institutions, philanthropy, employers, and community organizations should be encouraged to align around shared outcomes, shared measurement, and long-term partnership.

Practice Recommendations

Policy creates opportunity.

Practice creates impact.

Healthcare organizations should redesign care delivery around how men actually engage with the healthcare system while building stronger partnerships with trusted community organizations.

Public health agencies should embed men’s health into community health assessments, prevention strategies, and population health improvement plans.

Academic institutions should expand community-engaged research and implementation science that evaluates what works, why it works, and how successful models can be replicated.

Community-based organizations should be recognized as equal implementation partners because they possess the trust, cultural competence, and lived experience necessary to reach populations that traditional systems often struggle to engage.

Philanthropic organizations should invest not only in innovative programs but also in the connective infrastructure that allows partnerships to grow, data to be shared responsibly, and successful models to scale.

Researchers, healthcare leaders, policymakers, and community organizations should intentionally strengthen what I describe as the policy nervous system by improving communication, coordination, accountability, learning, and continuous improvement across sectors.

A Call to Action

Improving men’s health is not the responsibility of any single sector.

It requires healthcare organizations willing to redesign care.

Researchers willing to move beyond describing disparities toward evaluating solutions.

Policymakers willing to invest in long-term systems change.

Community organizations willing to continue serving as trusted partners.

Funders willing to invest in collaboration as much as innovation.

And men willing to embrace self-care, self-maintenance, and soul care as acts of stewardship rather than signs of weakness.

At Enyia Strategies, I help organizations bridge the gap between research, policy, and implementation by designing practical, evidence-informed strategies that improve population health and advance health equity.

Through The John Henry Institute, we are building a national platform that convenes leaders across sectors to advance systems-level solutions for Black men’s health while creating models that can strengthen health systems for everyone.

If this report challenges your thinking, don’t let it end as another document on your bookshelf.

Read it.

Discuss it with your colleagues.

Share it with your organization.

Ask how your institution is contributing to a stronger policy nervous system.

And if your organization is ready to move from conversation to implementation, let’s connect. Whether through strategic consulting, partnerships, research translation, policy development, or systems redesign, we have an opportunity to build healthier communities by intentionally aligning policy, practice, and people.

The future of men’s health will not be determined by better reports alone.

It will be determined by what we build together.

Because healthier men require healthier systems.

And healthier systems require all of us.

Elevate,

Dr. Okey K. Enyia

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The report provides a comprehensive snapshot of the economic conditions shaping the lives of Black men and boys across the United States. Drawing on federal data and community engagement, it examines the continuum from early literacy and postsecondary education to employment, earnings, wealth, and intergenerational mobility. It concludes with six institutional priorities focused on improving educational persistence, strengthening workforce pathways, investing in literacy, addressing long-term unemployment, and mobilizing action across government, higher education, employers, and community organizations. As the first in what will become an annual series, it establishes an important benchmark against which progress can be measured.

One of the report’s greatest strengths is its commitment to disaggregation. As Dr. Bellamy writes, this is “not a competition with Black women” but rather “a discipline.” I would add one more thought:

Being specific does not mean being exclusionary.

In public health, specificity is how we identify inequities, allocate resources, design interventions, and evaluate outcomes. Every population has unique strengths, challenges, and lived experiences that deserve to be understood on their own terms. Centering Black men and boys in this report does not diminish the experiences of anyone else. Rather, it strengthens our collective ability to advance equity through precision instead of assumption.

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The data presented throughout the report are both compelling and concerning.

There are approximately 22.7 million Black men and boys living in the United States. The Black unemployment rate stands at 6.6 percent, the highest among the four major racial and ethnic groups reported by the Bureau of Labor Statistics. Black men working full time earn a median of $1,039 per week, or just 77 cents for every dollar earned by white men. Households with a Black householder hold a median transaction account balance of only $2,200, compared with $10,000 for white households, while homeownership remains 43 percent, compared with 73 percent among white households.

The educational pipeline tells a similarly important story.

Only 17 percent of Black fourth graders perform at or above proficiency in reading. Black male enrollment in postsecondary education has declined by approximately 22 percent since 2010. At historically Black colleges and universities, Black men’s share of enrollment has fallen from 38 percent in 1976 to 26 percent in 2022. At the same time, Black men were the only major race-by-gender group to experience a measurable decline in their employment-to-population ratio between 2025 and 2026, and nearly 30 percent of unemployed Black men had been searching for work for at least 27 weeks.

These statistics should capture our attention.

But as I read the report, I kept returning to one central thought:

This is an outstanding diagnosis. The next challenge is implementation.

How do we redesign the systems producing these outcomes?

That question has shaped much of my own work over the past several years.

Through my doctoral research, The John Henry Health Equity Playbook, and now the work of the John Henry Institute, I have sought to answer a complementary question: How do we move from documenting disparities to redesigning the systems that produce them?

While this report powerfully documents the economic realities facing Black men, my work expands that conversation by examining how those realities interact with health.

Employment influences access to health insurance.

Health insurance influences preventive care.

Preventive care influences chronic disease.

Chronic disease influences workforce participation.

Workforce participation shapes household wealth.

Wealth affects housing stability, educational opportunity, neighborhood conditions, civic participation, and ultimately life expectancy.

These are not separate policy conversations.

They are interconnected population health systems.

That systems perspective is at the heart of The John Henry Health Equity Playbook. Rather than focusing solely on documenting disparities, the playbook offers a four-year policy agenda that integrates healthcare, housing, education, economic stability, civic engagement, violence prevention, and fatherhood into a comprehensive population health strategy for Black men. It also outlines implementation pathways for healthcare organizations, community-based organizations, advocacy organizations, policymakers, and academic institutions to translate evidence into action.

This is why I increasingly describe my work as population health architecture.

Diagnosis matters.

Data matter.

Measurement matters.

But sustainable change requires institutions that are intentionally designed to produce healthier outcomes.

Healthcare systems.

Public health agencies.

Schools and universities.

Employers.

Community-based organizations.

Philanthropy.

Government.

Each has a role to play, and none can solve these challenges alone.

Reports like this one provide an essential foundation for that work by helping us understand where we are.

The next phase is designing where we are going.

The future of Black men’s health will not be determined by economic indicators alone. It will be shaped by our collective willingness to connect research, policy, practice, and community into systems that consistently produce better outcomes.

For those of us committed to advancing Black men’s health and well-being, this report is more than a collection of statistics.

It is an invitation to build.

Elevate,

Dr. Okey K. Enyia

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What the HIT Strategies Report Gets Right—and Where We Go from Here

“If institutions want to earn Black men’s trust, they must move beyond asking how to communicate with Black men and begin asking how to govern with them.”

Introduction

The newly released Seen, Not Spoken To report by HIT Strategies is one of the most important studies published this year on young Black men and civic engagement. It challenges long-held assumptions about why many Black men have become increasingly skeptical of institutions and political leaders, demonstrating that the issue is not ideology as much as it is trust.

The report deserves recognition because it reframes the conversation. Rather than asking why Black men are disengaging, it asks what institutions have failed to understand about them.

That is an important shift.

Yet I believe the next question is even more important.

What happens after understanding?

Communication alone cannot solve structural problems.

Through my work with Enyia Strategies, I partner with healthcare organizations, nonprofits, philanthropy, associations, academic institutions, and public sector leaders to translate evidence into actionable policy and systems change.

Through The John Henry Institute for Black Men's Health and Policy Innovation, I work to build the broader infrastructure needed to advance research, civic engagement, and cross-sector collaboration for Black men and boys.

Institutions must earn trust through sustained investment, accountability, shared governance, and measurable improvements in people’s lives.

That is where my work begins.

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Figure 1

The Trust-to-Prosperity Framework

The framework illustrates a simple but powerful proposition.

Investment creates trust.

Trust increases civic participation.

Civic participation influences public policy.

Public policy shapes health outcomes.

Health creates human capital.

Human capital fuels economic mobility.

Economic mobility creates market power.

And market power strengthens national prosperity.

This systems perspective extends beyond campaign messaging into long-term governance.

The Wrong Question

For years the national conversation has focused on one question:

“How do we persuade Black men?”

The HIT report suggests a different question:

“How do we rebuild trust?”

I would go one step further.

The question should become:

How do institutions become worthy of Black men’s trust?

That distinction matters.

Trust cannot be marketed.

It must be earned.

Figure 2

Moving Beyond Messaging Toward Systems Change

Communication matters.

Representation matters.

But governance matters more.

Institutions ultimately earn legitimacy through outcomes rather than slogans.

That includes healthcare systems, employers, schools, philanthropy, government agencies, and nonprofit organizations.

This transition from messaging to systems change is the work I increasingly help organizations navigate. Whether advising executive leadership, facilitating strategy sessions, or designing policy frameworks, the challenge is rarely a lack of ideas. More often, it is translating evidence into implementation.

Civic Health Is Public Health

One of the most overlooked insights in public health is that civic engagement is itself a health intervention.

My John Henry Health Equity Playbook argues that civic engagement belongs alongside housing, education, employment, and healthcare as a core social driver of health. It proposes institutionalizing voting and civic engagement as health equity tools because communities with stronger civic participation are better positioned to influence the policies that shape health outcomes.

Healthy People 2030’s recognition of voter participation as a civic objective reinforces this connection.

Communities that participate in democracy are often better able to secure investments in schools, transportation, healthcare, housing, and public safety.

Those investments ultimately affect life expectancy.

Figure 5

Civic Health Is Public Health

This framework demonstrates the reinforcing cycle between:

• Trust

• Representation

• Policy

• Resources

• Community conditions

• Health outcomes

Healthy democracies create healthier communities.

The John Henry Institute was created to help fill this gap by developing practical resources, fostering civic leadership, and supporting community-informed approaches that strengthen both civic participation and health equity. The goal is not simply to increase engagement during election years, but to build long-term civic infrastructure that improves community well-being.

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Black Men’s Health Is an Economic Strategy

One reason I increasingly describe this work through the lens of market power is because health is not simply a moral issue.

It is an economic one.

Research estimates that racial and ethnic health inequities cost the U.S. economy more than $421 billion annually, while inequities associated with educational disparities approach $940 billion each year.

Those costs affect every American.

When Black men experience preventable illness, premature mortality, unemployment, educational barriers, or underinvestment, the nation loses workers, entrepreneurs, taxpayers, caregivers, innovators, and civic leaders.

Improving Black men’s health should therefore be viewed not only as an equity strategy but as a national competitiveness strategy.

Figure 3

Black Men’s Health Is an Economic Strategy

Health influences:

• workforce participation

• entrepreneurship

• educational attainment

• family stability

• innovation

• economic growth

The return on investment extends far beyond healthcare.

Elections Create Policy Windows

Much discussion surrounding the 2026 election understandably focuses on campaigns and candidates.

As a policy professional, I see something different.

I see a policy window.

Elections determine who governs.

Policy windows determine what becomes possible.

Regardless of which party governs, institutions must be prepared with evidence-based solutions that improve health, strengthen communities, and build trust.

That is precisely why The John Henry Health Equity Playbook was written as a four-year policy agenda designed to be adapted across administrations. It intentionally presents a roadmap that can be tailored regardless of political leadership while emphasizing that advancing Black men’s health requires long-term, bipartisan commitment.

Figure 4

The Policy Window Framework

Leadership changes create opportunities.

Prepared institutions convert those opportunities into measurable outcomes.

Building Institutional Trust

Perhaps the most important lesson from the HIT report is that trust cannot be restored through better messaging alone.

Trust grows through repeated institutional behavior.

Organizations build trust when they:

• listen before acting

• share decision-making power

• invest consistently

• measure outcomes

• remain accountable over time

Figure 6

The John Henry Framework for Institutional Trust

This framework offers six principles for institutions seeking lasting relationships with Black men and their communities.

Trust is not communication.

Trust is institutional behavior.

At Enyia Strategies, institutional trust is not treated as an abstract concept. It is operationalized through strategic planning, stakeholder engagement, policy analysis, implementation support, and measurable accountability. Organizations increasingly recognize that trust has become a strategic asset, particularly when serving communities that have historically experienced underinvestment and exclusion.

From Investment to Market Power

For too long discussions about Black men’s health have centered almost exclusively on disparities.

Disparities describe problems.

Investment creates solutions.

Strategic investment produces healthier communities, stronger workforces, increased entrepreneurship, greater civic participation, and stronger economies.

That is market power.

Figure 7

From Investment to Market Power

This framework demonstrates how sustained investment generates:

• human capital

• institutional trust

• economic strength

• innovation

• national competitiveness

One of the central ideas I continue to advance through both Enyia Strategies and The John Henry Institute is that improving Black men's health should be viewed as an investment strategy rather than solely a disparity reduction strategy.

Healthy communities strengthen labor markets, expand entrepreneurship, improve educational attainment, increase civic participation, and generate long-term economic returns that benefit the entire nation.

Where My Work Begins

The HIT report diagnoses a communications challenge.

My work focuses on implementation.

The John Henry Health Equity Playbook was intentionally designed as a four-year roadmap organized around three pillars—physical and mental health, economic stability, and community empowerment through civic engagement—supported by evidence, policy recommendations, implementation strategies, and evaluation metrics.

Understanding is essential.

Implementation is transformational.

Figure 8

Where My Work Begins

This figure summarizes my approach:

• identifying structural barriers

• applying systems thinking

• translating research into policy

• partnering across sectors

• measuring impact

• sustaining long-term change

A Call to Action

The next chapter of Black men’s health will not be written by institutions that simply recognize the problem.

It will be written by those willing to redesign systems, share power, and invest for the long term.

If you are:

• a policymaker, use this moment to build bipartisan, evidence-informed solutions;

• a healthcare leader, embed Black men’s health into your strategic priorities;

• a philanthropist, invest in infrastructure, not just programs;

• a researcher, produce knowledge that communities can use;

• a business leader, recognize that investing in Black men’s health is an investment in workforce resilience and economic growth;

• a community leader, continue building trust from the ground up.

The future of Black men’s health is not simply about being seen.

It is about being heard, valued, invested in, and empowered.

Because when Black men thrive, families thrive.

When families thrive, communities thrive.

And when communities thrive, America becomes healthier, stronger, and more prosperous.

Let’s Build the Next Generation of Black Men’s Health Leadership

If your organization is asking:

• How do we better engage Black men?

• How do we operationalize health equity?

• How do we build institutional trust?

• How do we translate research into policy and practice?

• How do we measure our impact?

• How do we position investments in Black men’s health as drivers of economic growth and community prosperity?

Let’s work together.

Enyia Strategies partners with organizations to design evidence-informed policy, strategy, implementation, and stakeholder engagement solutions that improve measurable outcomes.

The John Henry Institute for Black Men’s Health and Policy Innovation serves as a convener, catalyst, and resource hub, advancing research, policy innovation, civic engagement, and cross-sector partnerships that improve the lives of Black men and boys.

Together, we can move beyond conversation and build systems that produce lasting change.

Elevate,

Dr. Okey K. Enyia

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For decades, conversations about Black men and boys have too often begun with crisis.

We discuss life expectancy gaps, educational disparities, unemployment, violence, mental health, healthcare access, incarceration, and underrepresentation. We document the ways Black men and boys are being failed by systems and institutions.

Those realities must be confronted.

But the framing matters.

Black men and boys should not be understood primarily as a population in need of rescue, remediation, or charity. They should be understood as a vital source of human capital, leadership, entrepreneurship, innovation, family stability, civic capacity, and economic growth.

The question is not only what inequities cost Black men and their families.

We must also ask:

What do our institutions, communities, and economy lose when the potential of Black men and boys is not adequately supported, developed, and financed?

That is why investing in Black men and boys’ health should be viewed not only as a moral obligation or philanthropic priority.

It should be understood as an economic development strategy.

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Health Is Economic Infrastructure

We typically think about infrastructure in physical terms.

Roads. Bridges. Hospitals. Housing. Broadband. Energy systems. Transportation.

But health is also infrastructure.

A healthy population creates the foundation for a strong workforce, stable families, productive institutions, and resilient local economies.

A person’s health influences whether he can learn, work, lead, parent, create, build wealth, start a business, participate in civic life, and contribute consistently to his community.

When Black men experience higher rates of chronic disease, untreated mental health needs, inadequate insurance coverage, violence exposure, limited access to preventive care, and premature mortality, the consequences extend far beyond the healthcare system.

They affect workforce participation.

They affect productivity and employee retention.

They affect family income and household wealth.

They affect entrepreneurship and business formation.

They affect educational attainment.

They affect public spending and tax revenue.

They affect the development of future leaders.

These are not isolated outcomes. They compound across generations, families, communities, and institutions.

The Economic Cost of Inequity

The economic scale of inequity should command the attention of every major funder, employer, health system, university, government agency, professional association, and philanthropic institution in the country.

Estimates included in The John Henry Health Equity Playbook suggest that racial and ethnic health inequities cost the United States approximately $421 billion to $451 billion annually.

Health inequities associated with educational disparities are estimated to cost approximately $940 billion to $978 billion.

Those figures are staggering, but they are not merely abstract national totals.

They reflect:

• preventable healthcare expenditures

• reduced workforce productivity

• diminished earnings

• disability and absenteeism

• premature death

• lost educational opportunity

• caregiver burdens

• unrealized human potential

They also reveal a truth we do not state often enough:

Inequity is economically inefficient.

When institutions fail to invest in populations with substantial untapped capacity, they are not merely neglecting a social responsibility.

They are making a poor economic decision.

From Deficit to Investment

The conventional narrative often treats Black men and boys as a collection of problems to solve.

An investment framework begins from a different premise.

Black men and boys are assets.

They are current and future workers, fathers, entrepreneurs, students, researchers, clinicians, educators, public servants, consumers, inventors, organizers, and community leaders.

The challenge is not an absence of talent.

It is the persistent undercapitalization of that talent.

Too many discussions begin with what Black men lack rather than examining what institutions have failed to provide.

Who receives early educational support?

Who has access to safe neighborhoods and quality healthcare?

Who is recruited into high-growth professions?

Who receives business capital and technical assistance?

Who is included in clinical research?

Who has access to mentors, sponsors, and professional networks?

Who is supported before a crisis rather than after one?

Who is funded to build institutions that can last?

These are questions about health.

They are also questions about capital, institutional priorities, public policy, and power.

The Multiplier Effect of Investment

Investing in Black men and boys produces value across multiple systems at once.

An investment in hypertension prevention can reduce emergency care, disability, missed workdays, and premature death.

An investment in culturally responsive mental health services can improve educational persistence, family stability, workplace retention, and community well-being.

An investment in Black boys’ education can increase lifetime earnings, labor-force participation, health insurance coverage, and long-term health.

An investment in violence prevention can reduce trauma, hospitalization, justice-system involvement, and neighborhood instability.

An investment in Black fathers can strengthen children, families, and communities.

An investment in Black male entrepreneurship can create jobs, increase household income, expand local procurement, and generate community wealth.

The return is not singular.

It is a health return.

A workforce return.

A fiscal return.

A family return.

A community return.

An institutional return.

This is why Black men and boys’ health should not be confined to a narrow public health portfolio.

It belongs within economic development, education policy, workforce strategy, corporate strategy, philanthropy, community investment, and regional growth planning.

Why Education Belongs in the Investment Case

The estimated cost of education-related health inequities is especially important because it demonstrates that health and education cannot be separated.

Education affects employment, earnings, insurance coverage, occupational conditions, housing opportunity, civic participation, and access to healthcare.

Health, in turn, affects attendance, concentration, academic performance, persistence, and graduation.

For Black boys, early underinvestment can produce cumulative disadvantage.

Inadequate educational support can narrow employment options. Limited employment opportunities can restrict access to stable income and health insurance. Economic stress can worsen physical and mental health. Poor health can then further constrain educational and economic mobility.

This is not a series of disconnected failures.

It is a reinforcing system.

That is why an investment in Black boys’ educational development is also an investment in public health, workforce readiness, and economic competitiveness.

A scholarship is not only an education intervention.

A mentorship program is not only a youth intervention.

A workforce pathway is not only an employment intervention.

Each can also become a long-term health and wealth intervention.

Market Power Is the Missing Link

This is where the concept of market power becomes essential.

Market power is the ability of people, communities, organizations, and institutions to influence how resources, capital, opportunities, and investments are allocated.

Communities with market power help shape the decisions that affect them.

Communities without market power are often forced to react to decisions that have already been made.

They fight to keep hospitals open.

They fight for schools to be adequately funded.

They fight for transportation, broadband, and economic development.

They fight for research funding.

They fight for business capital.

They fight to be included in policy conversations.

The goal should not be to keep Black communities in a permanent state of advocacy for basic consideration.

The goal should be to build enough economic, institutional, civic, and political capacity that Black men and boys are consistently considered in the design of systems, not merely addressed after those systems fail them.

Health equity without market power is difficult to sustain.

A temporary program may close a gap for a year.

A strong institution can shape a field for a generation.

A grant may support an initiative.

Ownership can create durable influence.

A campaign may raise awareness.

Data, capital, policy capacity, organizational infrastructure, and leadership pipelines can change how decisions are made.

This is why investments in Black men and boys must go beyond short-term programming.

We must build:

• human capital

• economic capital

• social capital

• civic and political capital

• institutional capital

That means investing in leadership development, community-based organizations, research infrastructure, data systems, policy capacity, entrepreneurship, mental health services, education, workforce pathways, and long-term implementation.

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A New Investment Thesis

The case can be stated plainly:

Black men and boys are not a social liability to be managed. They are a national asset that has been systematically undercapitalized.

Strategic investments in their health, education, economic stability, family well-being, and civic participation can reduce preventable costs while expanding workforce capacity, household wealth, entrepreneurship, institutional trust, and community prosperity.

This is the foundation of the Investment Prospectus included in The John Henry Health Equity Playbook.

The purpose of the prospectus is not simply to ask institutions to fund another program.

It is to help them understand:

• where value can be created

• how returns can be measured

• where institutional resources can be aligned

• why investing in Black men and boys strengthens the broader economy

The playbook connects physical and mental health with housing, education, economic stability, civic engagement, violence prevention, and fatherhood. It recognizes that Black men’s health is shaped by social, political, and economic conditions, not only by what happens inside a clinic.

The broader initiative behind the playbook has also emphasized multidisciplinary collaboration, community-informed strategies, measurable implementation, and policy innovation.
The next step is to convert that framework into a clear and actionable investment agenda.

What Different Institutions Can Do

Funders and philanthropies should move beyond episodic grants and invest in durable community capacity.

Employers should treat Black men’s health as a workforce, leadership, retention, productivity, and competitiveness issue.

Health systems should invest in prevention, trust-building, culturally responsive care, community health infrastructure, and stronger referral pathways.

Universities should develop educational, professional, and research pipelines for Black men and boys.

Professional associations should invest in recruitment, mentorship, leadership development, representation, and membership pathways.

Government agencies should connect public health investments to workforce development, education, housing, economic mobility, and community stability.

Corporations should examine procurement, entrepreneurship, supplier diversity, employee wellness, leadership development, and community investment through the lens of Black men and boys’ health.

Most importantly, institutions should not make these investments without sharing power.

Black men and the organizations closest to their communities must have meaningful roles in identifying priorities, designing strategies, governing resources, interpreting data, and defining success.

Investment without shared decision-making can reproduce the same inequities it claims to address.

Measuring the Return

The return on investment should be measured broadly.

Relevant outcomes may include reductions in:

• preventable disease

• emergency care

• absenteeism

• disability

• violence exposure

• premature mortality

They may also include increases in:

• graduation and credential completion

• employment and earnings

• workforce retention

• business ownership

• professional representation

• homeownership

• father involvement

• civic participation

• community trust

Some returns will be financial.

Some will be institutional.

Some will be social.

Some will be intergenerational.

Not every return can or should be reduced to a single dollar amount. But that does not mean it should go unmeasured.

Institutions should establish baselines, identify meaningful indicators, track outcomes over time, and remain accountable to the communities their investments are intended to serve.

How Enyia Strategies and The John Henry Institute Advance This Work

Through Enyia Strategies, I help institutions connect health equity, public policy, organizational strategy, stakeholder engagement, and economic value.

The goal is to help leaders move from broad commitments to actionable and investable strategies.

That includes helping organizations understand the policy environment, identify strategic opportunities, build partnerships, develop compelling narratives, and design approaches that produce measurable value.

Through The John Henry Institute, we are building a community-centered platform for research, policy, convening, innovation, and implementation focused on Black men and boys.

The Institute’s work is grounded in the belief that communities should not merely receive programs.

They should possess the knowledge, infrastructure, relationships, data, and policy capacity necessary to shape their own futures.

Enyia Strategies helps institutions design and execute strategy.

The John Henry Institute helps develop, test, and advance public-benefit solutions rooted in the lived experiences, priorities, and aspirations of Black men and boys.

Together, this work seeks to shift the conversation:

From disparity to investment.

From reaction to institution-building.

From temporary intervention to durable capacity.

From overlooked potential to market power.

A Call to Action

Every institution should ask itself a series of difficult questions.

Where are we currently investing in Black men and boys?

Where are we not investing?

Who shapes our priorities?

Who receives our capital?

Who benefits from our decisions?

Who is represented in our data?

Who participates in governance?

What outcomes are we measuring?

Are our investments temporary, or are they building lasting capacity?

The next generation of health equity work must move beyond documenting inequity.

We must finance solutions.

We must build institutions.

We must strengthen leadership.

We must expand ownership.

We must create pathways to health, wealth, influence, and economic power.

We must invest in Black men and boys not only because inequity is unjust, but because their health and success are central to the strength of families, institutions, communities, and the American economy.

The question is no longer whether we can afford to invest in Black men and boys.

The evidence suggests that we cannot afford not to.

Elevate,

Dr. Okey K. Enyia

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The August 2026 issue of the American Journal of Public Health represents an important moment for the field of men’s health. Taken together, the articles move the conversation beyond simplistic explanations of men’s health behavior and toward a more sophisticated understanding of how masculinities, race, work, family, public policy, digital environments, and institutional structures shape men’s opportunities to live healthy and meaningful lives.

I want to begin by thanking the authors, researchers, editors, community partners, and participants whose work made this collection possible. Men’s health has too often occupied an uncertain position within public health. It is frequently discussed through mortality statistics, individual risk behaviors, or cultural stereotypes, but less often treated as a serious interdisciplinary field requiring sustained research, policy infrastructure, public investment, and community-informed implementation.

This issue helps change that.

At the same time, the collection raises an essential question:

Where do we go from here?

The answer cannot be a return to generalized “men are in crisis” narratives. Nor can the answer be to dismiss the real challenges facing men because some of those narratives have been manipulated by reactionary political movements. We must hold two truths simultaneously.

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First, masculinity is neither inherently pathological nor singular. Masculinities are socially constructed, historically situated, racially differentiated, economically conditioned, and expressed differently across communities and stages of life.

Second, many boys and men are experiencing measurable and preventable harms. These harms include premature mortality, suicide, chronic disease, social isolation, occupational injury, educational disconnection, digital exploitation, inadequate access to preventive care, and policies that fail to account for men as fathers, caregivers, workers, patients, and community members.

The public health challenge is therefore not to decide whether men are “in crisis.” It is to identify which men are experiencing which harms, through which pathways, under which institutional conditions, and what policy and practice responses will allow them to thrive.

Moving Beyond the Recurring “Crisis of Masculinity”

Professor Steven Roberts’ thoughtful historical reflection, “The Crisis That Always Is, but Never Was,” warns us that declarations of a crisis of masculinity have appeared repeatedly for more than 150 years. Industrialization, urbanization, women’s political and economic advancement, shifting family arrangements, educational changes, and evolving gender expectations have all produced recurring claims that men are losing their place, purpose, or power.

Roberts rightly challenges the tendency to treat boys and men as a homogeneous group. Broad claims that “boys are falling behind,” for example, can obscure the profound differences between boys who are economically secure and those navigating poverty, racial discrimination, neighborhood disinvestment, disability, immigration, family instability, or under-resourced schools. Educational disadvantage is not distributed evenly across all boys. It is structured by race, class, geography, disability, and institutional opportunity.

His analysis also exposes the danger of framing gender progress as a zero-sum contest. Women’s educational, political, or economic advancement does not inherently produce men’s decline. When male distress is framed primarily as the result of feminism or women’s progress, legitimate concerns about men’s health can be redirected toward resentment, grievance, misogyny, and reactionary politics.

This is an important warning. But it also creates an opportunity to make a critical distinction:

The “crisis of masculinity” may be an overstated and historically recurring narrative, while crises affecting particular populations of men remain very real.

The fact that “crisis talk” can be misused does not mean that policymakers should ignore male suicide, preventable chronic disease, firearm mortality, occupational death, fatherhood-related stress, loneliness, or racialized health inequities. The solution is not less attention to men. The solution is more precise, intersectional, evidence-informed, and accountable attention.

Masculinities Are Social Determinants of Health

Several articles in the AJPH collection advance a significant conceptual shift. Rather than treating masculinity as an individual personality trait, they examine masculinities as social determinants of health.

“Masculinities as a Social Determinant of Chronic Illness” positions gender expectations as part of the social environment through which health risks, health behaviors, and access to resources are produced.

Similarly, Kemmel Palmer’s “Rethinking Masculinity as a Social Determinant of Mental and Behavioral Health” calls attention to the ways that norms surrounding emotional control, strength, self-reliance, vulnerability, and help-seeking can shape mental health across men’s lives.

This is more than a semantic change.

A social determinants approach shifts the question from:

“Why will men not take better care of themselves?”

to:

“What social conditions, institutions, expectations, incentives, and constraints shape men’s ability to care for themselves and others?”

That shift matters because an exclusive focus on individual behavior can easily become blame. Men are told to eat better, exercise more, seek therapy, reduce stress, attend medical appointments, be more emotionally expressive, become more involved fathers, and build stronger social networks.

These may all be worthwhile goals. But they cannot be separated from whether men have health insurance, paid leave, predictable work schedules, transportation, safe neighborhoods, culturally responsive providers, economic security, supportive relationships, or workplaces that permit care-seeking without financial or professional penalty.

Masculinity does not operate outside structure. It is developed, rewarded, constrained, and sometimes weaponized within institutions.

Race, Masculinity, and the Limits of Universal Narratives

One of the collection’s greatest strengths is its recognition that there is no single male experience.

Pedro Serrano’s “Beyond the Illusion of Machismo” calls for critical and intersectional frameworks in understanding Latino men’s health rather than relying on reductive cultural stereotypes.

Caroline Efird and Derek Griffith’s analysis of structural advantage and White men’s health complicates assumptions that social privilege automatically produces optimal physical and mental well-being. Their work suggests that social position, economic change, masculine expectations, and institutional advantage can interact in complex ways.

Orlando Wright and Walker Tisdale’s examination of middle-aged African American men is especially consequential. They argue that the health experiences of Black men cannot be understood by separating masculinity from structural racism, medical mistrust, economic pressure, chronic stress, and racialized expectations. They also demonstrate that masculinity can function both as a barrier to self-care and as a source of health-promoting identity. Responsibility, family protection, community leadership, and stewardship can become pathways to healthier behavior when they are affirmed rather than pathologized.

This finding closely aligns with my own body of work.

The John Henry Health Equity Playbook begins with the understanding that Black men are often hyper-visible in punitive systems and invisible in health policy, research, preventive care, and institutional investment. It connects the experiences of Black men to healthcare access, mental health, housing, education, economic stability, civic participation, violence prevention, and fatherhood.

The playbook’s use of John Henry is intentional. John Henry symbolizes strength, labor, endurance, racialized economic extraction, and the physical costs of repeatedly having to outperform systems that were not designed for one’s well-being.

That is one of the central policy lessons emerging from this AJPH collection:

Strength should not require self-destruction.

We should not ask men to abandon strength, responsibility, courage, provision, protection, or perseverance. We should expand what those qualities mean. Strength can include seeking help. Provision can include emotional presence. Protection can include preventive care. Leadership can include rest. Responsibility can include therapy, medical appointments, community participation, and making space for others to thrive.

Fatherhood Is a Public Health Institution

The collection’s attention to fatherhood is particularly important.

The CARDIA study examining fatherhood, race, and cardiovascular health found that the relationships among fatherhood, health, and race are complex rather than uniformly protective or harmful. The findings suggest that fatherhood may be associated with protective health patterns for some Black men while younger fathers may face distinct health risks and pressures.

Other studies address paid paternal leave, leave utilization, and fathers’ mental health. Research from Ohio found associations between paternity leave status and mental health symptoms among fathers. A study in Sweden found that longer paternal leave was associated with a lower risk of depressive symptoms. Research in a Los Angeles public hospital setting examined male partners’ expectations and actual use of paternity leave, illustrating the gap that can exist between wanting to be present and having the practical or institutional ability to do so.

These findings reinforce a foundational principle:

Father engagement is not merely a private family matter. It is shaped by public policy.

A father cannot fully use leave that does not exist, is unpaid, is culturally discouraged, threatens his employment, or is inaccessible to contract, hourly, low-wage, or precariously employed workers.

Public health systems should therefore treat fathers as an integral part of maternal, infant, child, and family health. Fathers should be welcomed into prenatal care, screened for depression and anxiety, included in health education, connected to economic and legal supports, and recognized as caregivers rather than treated as peripheral visitors.

This is especially important for Black fathers, who continue to be burdened by stereotypes that conflict with evidence of substantial involvement in their children’s lives. The John Henry Health Equity Playbook deliberately includes fatherhood as a health equity domain because supporting fathers strengthens children, families, and communities.

Paid family leave is therefore not only a labor benefit. It is mental health policy, cardiovascular health policy, child development policy, maternal health policy, and racial equity policy.

Work Is a Health Exposure

The article examining all-cause mortality among working-age men by occupation highlights another essential point: men’s health cannot be separated from how men work.

Men are disproportionately concentrated in many physically dangerous occupations and may be exposed to injury, toxic substances, extreme temperatures, irregular schedules, long work hours, job insecurity, and cultures that discourage acknowledgment of pain or vulnerability.

Yet occupational risk is often framed as an unfortunate consequence of men’s choices rather than a preventable public health issue shaped by labor standards, employer practices, union power, economic opportunity, regulatory enforcement, and access to healthcare.

A robust men’s health agenda must therefore include:

• Stronger occupational safety standards and enforcement.

• Heat and environmental exposure protections.

• Predictable scheduling and adequate rest.

• Mental health and suicide-prevention protocols within high-risk industries.

• Disability protection and return-to-work support.

• Paid sick leave and family leave.

• Access to preventive healthcare without wage loss.

• Economic development strategies that expand pathways to safe, stable, well-compensated work.

This also illustrates why men’s health cannot be confined to the healthcare system. Some of the most significant men’s health interventions will occur through labor policy, housing policy, education policy, transportation policy, environmental regulation, and economic development.

Digital Environments Are Public Health Environments

The digital environment is another recurring theme.

“Beyond the Manosphere: Supporting Boys’ and Men’s Health in Online Spaces” asks how public health can engage digital spaces without abandoning boys and men to influencers who monetize resentment, anxiety, and identity insecurity.

A related national study of more than 46,000 college students found that online harassment was associated with suicidal ideation across gender groups, while the relationship between time spent online and suicidal thoughts was especially strong among cisgender men.

This evidence complicates two common narratives.

The first is that the Internet merely reflects preexisting male grievance. As Roberts has argued elsewhere, some online environments actively manufacture and monetize insecurity by recoding ordinary disappointment, uncertainty, or isolation as proof that men are victims of social dispossession.

The second is that the solution is simply to tell boys to spend less time online. Digital spaces now function as environments for identity development, social connection, education, entertainment, political formation, and health information. Public health cannot withdraw from these spaces and expect healthier narratives to emerge on their own.

We need a digital public health strategy for boys and men that includes:

• Media literacy and algorithmic literacy.

• Suicide prevention and referral systems embedded in digital platforms.

• Stronger protections against online harassment.

• Investment in credible male health messengers.

• Positive online communities that do not depend on misogyny or grievance.

• Research that disaggregates digital risks by race, gender identity, sexual orientation, disability, age, and socioeconomic status.

• Accountability for business models that profit from polarization, insecurity, and social isolation.

Suicide and Firearm Policy Cannot Be Separated

The study of Medicaid expansion and firearm suicide mortality further underscores the relationship between social policy and men’s survival.

Men’s suicide is often presented primarily as a problem of emotional suppression or reluctance to seek therapy. Those issues matter, but they are incomplete.

Suicide risk is also shaped by insurance coverage, access to behavioral healthcare, financial strain, job loss, social isolation, substance use, firearm access, geographic proximity to care, and whether a person can obtain treatment before reaching a point of crisis.

This means suicide prevention must include clinical services, but it must also include:

• Medicaid expansion and continuity of coverage.

• Mental health parity enforcement.

• Crisis response systems that are accessible and trusted.

• Lethal-means counseling and safe-storage initiatives.

• Firearm suicide prevention tailored to men and firearm-owning communities.

• Workplace-based prevention.

• Post-discharge follow-up after emergency or psychiatric care.

• Community-based supports that engage men before crisis.

• Economic and housing stabilization.

We should resist the tendency to choose between cultural and structural explanations. Effective prevention requires both.

Men’s Reproductive Health Must Move Beyond Silence

The AJPH article examining masculinity and vasectomy utilization adds an important reproductive health dimension.

Reproductive health policy has often treated men as either absent from reproductive decision-making or as obstacles within it. A more constructive approach recognizes men as partners with responsibilities, information needs, bodily autonomy, and legitimate questions about contraception, fertility, sexual health, and family planning.

Healthcare providers should be prepared to discuss vasectomy and other reproductive health issues without relying on stereotypes about manhood, sexuality, virility, or control. Public health messaging should frame reproductive responsibility as consistent with care, partnership, and mature masculinity.

At the same time, reproductive health engagement must preserve women’s autonomy and avoid turning male inclusion into control over women’s decisions. Men’s health and women’s health should not be placed in competition. Healthy families and communities require equitable investment in everyone.

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What the Collection Gets Right

Across these articles, several major insights emerge.

1. Masculinity is plural.

There is no single masculinity and no universal male health experience. Masculinities vary across race, ethnicity, age, sexuality, class, geography, religion, disability, occupation, family role, and historical context.

2. Masculinity can harm and heal.

Norms of emotional restriction, invulnerability, dominance, and extreme self-reliance can undermine health. Yet responsibility, discipline, protection, service, fatherhood, community leadership, and resilience can also support healthy behavior when interpreted constructively.

3. Men’s health is structurally produced.

Healthcare access, paid leave, employment conditions, economic security, educational opportunity, neighborhood conditions, digital environments, firearm availability, and public policy all shape outcomes.

4. Fatherhood is a major but underdeveloped public health domain.

Supporting fathers can improve paternal mental and physical health while strengthening maternal health, child development, family stability, and community well-being.

5. Gender equity must not be zero-sum.

We can address men’s needs without minimizing violence against women, discrimination against women, or gender inequities. Similarly, recognizing women’s inequality should not require ignoring preventable suffering among boys and men.

6. Interventions must be culturally and structurally responsive.

Programs designed for an abstract universal man will continue to miss the men at greatest risk.

Important Gaps That Remain

The collection advances the field, but it also reveals several gaps requiring further attention.

Black Men Need More Than Periodic Inclusion

Black men appear meaningfully within parts of the collection, but their health must become a sustained national research and policy priority rather than a recurring special topic.

Black men’s health is shaped by the intersection of race and gender, but also by geography, disability, age, incarceration exposure, immigration, educational opportunity, labor-market position, neighborhood conditions, and health insurance access.

My dissertation research on Affordable Care Act implementation found that, during the post-ACA period studied, Black men ages 18 to 64 continued to experience substantially higher uninsurance and lack of a usual source of care than white men. Those gaps remind us that expanding coverage overall does not automatically eliminate inequity within specific populations.

Research must move beyond documenting disparities to testing and scaling interventions specifically designed with Black men.

Policy Infrastructure Remains Inadequate

The United States lacks a sufficiently coordinated governmental infrastructure for men’s health. Important work occurs across federal agencies, health systems, universities, community organizations, and professional associations, but responsibility is fragmented.

A federal Office of Men’s Health could coordinate research, surveillance, policy development, cross-agency collaboration, public education, and accountability. State and local offices or commissions could translate that work into geographically specific strategies.

This should not be an office built around grievance or competition with women’s health. It should be grounded in public health, gender equity, intersectionality, evidence, and partnership.

I also appreciate the state-level analysis that Dr. Dominick Shattuck developed to bring more clarity to the opportunities present to advance the policy ecosystem.

Relational Ground

Mapping Boys’ and Men’s Health Policy Activity Across the United States (2015–2026)

Introduction…

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2 months ago · 5 likes · 4 comments · Dominick Shattuck, PhD

Community-Based Organizations Need Sustainable Financing

Barbershops, faith communities, fraternities, fatherhood organizations, civic organizations, violence-intervention programs, schools, and community health workers are frequently asked to reach men whom formal systems have failed to engage.

Too often, these organizations are treated as volunteer outreach channels rather than essential parts of the public health infrastructure.

Community engagement without funding, authority, data access, and decision-making power is not equity. It is extraction.

We Need Better Disaggregated Data

“Men” is too broad a category for effective policy.

Data should be routinely disaggregated by race, ethnicity, age, geography, disability, income, education, sexual orientation, gender identity, occupation, veteran status, insurance status, fatherhood status, and incarceration exposure.

Public dashboards should allow communities to identify where inequities are concentrated and track whether interventions are working.

Boys and Men Must Be Engaged Across the Life Course

The articles address college students, working-age men, middle-aged men, and fathers, but a comprehensive strategy must connect the life course.

Early childhood conditions shape educational engagement. Educational engagement shapes employment. Employment shapes insurance, income, housing, and family formation. These factors shape chronic disease, mental health, and life expectancy.

We need an integrated continuum rather than disconnected programs.

Where Do We Go From Here?

The next phase of men’s health must move from description to infrastructure, from isolated programs to systems change, and from generalized narratives to targeted implementation.

I propose seven priorities.

1. Establish a National Men’s Health Strategy

The federal government should develop a national strategy with measurable objectives for physical health, mental health, suicide prevention, occupational health, fatherhood, preventive care, digital well-being, reproductive health, and social connection.

The strategy should include targeted approaches for groups of men experiencing distinct barriers, including Black men, Latino men, Indigenous men, rural men, LGBTQ+ men, men with disabilities, veterans, justice-involved men, and men in high-risk occupations.

2. Build Federal, State, and Local Men’s Health Infrastructure

Congress and the Department of Health and Human Services should establish a federal Office of Men’s Health or comparable coordinating entity.

States and local jurisdictions should be supported in creating men’s health offices, commissions, advisory councils, or interagency task forces. These bodies should include researchers, clinicians, policymakers, labor representatives, educators, fathers, youth, and community organizations.

3. Make Paid Family and Medical Leave Universal

Paid leave should cover fathers and other caregivers regardless of income, employer size, or employment classification.

Leave policy should be accompanied by workplace protections, culturally relevant education, and health-system practices that actively include fathers in perinatal and pediatric care.

4. Treat Men’s Mental Health as a Population Health Priority

Mental health strategies should be designed around where men live, work, learn, worship, socialize, parent, and spend time online.

Public health systems should fund community-based services, peer support, behavioral health integration, workplace programs, digital interventions, mobile services, and culturally responsive providers.

5. Integrate Men’s Health Into Policies Beyond Healthcare

Every major policy proposal involving labor, housing, education, criminal justice, transportation, environmental health, technology, or family policy should assess its implications for men’s health across race and socioeconomic position.

This is the political determinants of health in practice. Laws and budgets are health interventions.

6. Fund Community-Led Research and Implementation

Men and communities should not merely be recruited as research participants after the questions have already been decided.

They should help define research priorities, interpret data, design interventions, govern information, and determine how findings are translated into policy and practice.

7. Create Accountability Through Data and Evaluation

A national men’s health agenda should include measurable goals, public reporting, implementation timelines, and independent evaluation.

Metrics should extend beyond mortality to include preventive-care utilization, mental health access, insurance coverage, paternal leave, educational connection, social isolation, occupational injury, housing stability, civic participation, and trust in institutions.

How My Work Contributes to the Next Phase

The John Henry Health Equity Playbook was created to help move Black men’s health from episodic attention to an actionable policy agenda. Its three pillars address physical and mental health, housing and economic stability, and community empowerment through civic engagement, violence prevention, and fatherhood.

The working-group process behind the playbook was also designed to bring together expertise from medicine, dentistry, mental health, public health, policy, advocacy, and technology while developing practical initiatives and building the case for durable men’s health infrastructure. That work is now being advanced through two complementary institutions.

Enyia Strategies helps governments, organizations, coalitions, funders, and community leaders translate evidence into policy strategy, advocacy, organizational change, and implementation.

The John Henry Institute for Black Men’s Health and Policy Innovation serves as a nonprofit research, policy, innovation, and civic-action platform focused on advancing community-informed solutions for Black men and boys. Its role is to convene, develop knowledge, build partnerships, test solutions, strengthen policy capacity, and ensure that Black men’s lived experiences are not an afterthought in decisions that shape their health.

The firm and the Institute occupy different but complementary lanes. One supports strategy, policy translation, and institutional implementation. The other builds public-interest infrastructure, community partnership, research, and advocacy with a focus on Black men and boys.

Together, they reflect the inside-outside strategy required for lasting systems change.

A Call to Action

I am grateful to the authors of these articles for strengthening the intellectual and empirical foundation of men’s health. Their work moves us toward a more honest and nuanced conversation.

But publication cannot be the endpoint.

Researchers must design the next generation of intervention and implementation studies.

Funders must treat men’s health as a sustained portfolio rather than a temporary theme.

Health systems must redesign care so that men are engaged before crisis.

Employers must recognize that work conditions, paid leave, scheduling, and organizational culture affect men’s health.

Schools must support boys without blaming girls or abandoning gender justice.

Technology companies must be held accountable for digital environments that intensify despair, harassment, grievance, and social isolation.

Policymakers must create infrastructure, appropriate resources, establish measurable goals, and evaluate outcomes.

Community organizations must be resourced as partners, not used as unpaid distribution networks.

Men must also be invited to participate not merely as patients or problems, but as fathers, caregivers, advocates, mentors, workers, scholars, leaders, and architects of healthier communities.

The question is not whether masculinity is in crisis.

The more consequential questions are:

Which men are being harmed?

What systems are producing or preventing that harm?

What strengths already exist within men, families, and communities?

Who has the authority and resources to act?

And what are we prepared to build together?

The next era of men’s health must be neither reactionary nor dismissive. It must be rigorous, intersectional, non-zero-sum, community-informed, policy-oriented, and grounded in the belief that supporting men and boys strengthens families and communities without diminishing anyone else.

We have more evidence.

We have better frameworks.

We have clearer warnings.

Now we need the infrastructure, political will, investment, and collective action to move from awareness to implementation.

The work before us is not to restore an idealized past.

It is to reimagine the conditions under which men, women, children, families, and communities can thrive together.

Elevate,

Dr. Okey K. Enyia

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Behind the sticky notes, I found a bigger lesson about belonging, civic engagement, and why reimagining requires us to build systems where people can see themselves.

There was one exercise during the summit that I haven’t been able to stop thinking about.

We were standing around sheets of paper covered in sticky notes.

One read:

“Young People Say...”

Another read:

“School / Program / Workplace: Where Seen?.”

The responses weren’t complicated.

They wanted to be heard.

They wanted to feel welcome.

They wanted adults to listen.

They wanted mentors.

They wanted mental health support.

They wanted to know they mattered.

As I stood there reading those notes, I realized something.

We weren’t just talking about schools.

We were fundamentally talking about belonging.

I want to shout out my fraternity brother, Dr. Terrell Strayhorn and his work on belonging as a reference.

That reminder stayed with me throughout the inaugural Black Boys and Men Mental Health and Well-Being Summit, where leaders from psychology, psychiatry, public health, education, social work, government, advocacy, philanthropy, and community organizations came together around a shared purpose: advancing the mental health and well-being of Black boys and men.

The summit was organized and hosted by the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness, the National Association of Social Workers, the American Public Health Association, and the 100 Black Men of Prince George’s County (Maryland chapter).

The summit intentionally organized participants into workgroups on Caregiving, Fathers, and Relationship Development; Communities, Culture, and Faith; Education and Workforce; Healthcare Systems, Policy, and Advocacy; Coping, Healing, Help-Seeking, and Accessibility; and Advocacy, reiterating a simple truth: mental health is shaped across many systems, not just one.

I participated in the Education & Workforce workgroup alongside educators, psychologists, researchers, and practitioners from across the country.

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As our conversation unfolded, we talked about identity.

Belonging.

Psychological safety.

Representation.

Black male educators.

Trauma-informed environments.

Community.

Social-emotional development.

Systems change.

One exercise invited us to consider what it means for schools, programs, and workplaces to be places “where people are seen.” Another centered the voices of young people themselves. Their requests were strikingly simple: listen to us, help us feel loved, support our mental health, understand our interests, and create spaces where we can express ourselves.

Those aren’t just educational priorities.

They’re public health priorities.

They’re leadership priorities.

They’re civic priorities.

They’re human priorities.

Belonging is a public health strategy

During our discussion, I shared The John Henry Health Equity Playbook and introduced the work of The John Henry Institute. What encouraged me wasn’t simply having the opportunity to share my work as an invited participant. It was realizing how naturally the conversation aligned with the framework I’ve been building over the past several years.

Health is more than healthcare.

Mental health is more than treatment.

Education is more than academics.

Civic engagement is more than voting.

They’re all shaped by the systems we build—and by whether people can see themselves within those systems.

That may have been my biggest takeaway from the summit.

People rarely participate in systems where they cannot see themselves.

That is true in classrooms.

It is true in workplaces.

It is true in healthcare.

It is true in civic life.

It is true in public policy.

Before people believe they can influence a system, they have to believe they belong in it.

Civic engagement begins long before Election Day

People often think civic engagement begins at the ballot box.

I don’t.

Civic engagement begins when someone believes:

“My voice matters here.”

It begins when a young person sees someone who looks like them teaching in a classroom.

When a father feels welcomed rather than judged.

When a community member is invited into the policymaking process before decisions are made.

When people understand that policy isn’t something that simply happens to them—it is something they can help shape.

Helping people see themselves in the civic and policymaking process isn’t just good engagement strategy.

It’s essential to building healthier communities.

That’s one of the reasons I founded Enyia Strategies. We help organizations move from policy to practice by making civic engagement more meaningful, accessible, and actionable among other services.

It’s also why I founded The John Henry Institute.

The Institute exists to connect research, policy, civic engagement, and implementation so that evidence doesn’t stop at publication—it improves lives.

Workforce Is More Than an Economic Issue

One reality has been difficult to ignore this year.

According to recent reporting based on U.S. Bureau of Labor Statistics data, an estimated 567,000 Black men lost their jobs between November 2025 and February 2026. Behind every statistic is a person, a family, a career interrupted, and a community affected.

When we talk about workforce development, we often reduce the conversation to employment rates or job creation.

But work is about much more than a paycheck.

Work provides purpose.

It shapes identity.

It creates routine, relationships, and opportunities for growth.

For many families, it provides access to healthcare, retirement savings, and the financial stability needed to invest in the next generation.

When employment becomes unstable, the effects ripple far beyond the labor market. They influence mental health, family stability, civic participation, educational opportunity, and long-term community well-being.

That’s why I believe workforce policy is health policy.

Our conversations during the Education & Workforce workgroup reinforced that preparing Black boys and men for meaningful careers cannot begin when they are looking for a job. It begins much earlier—with high-quality schools, caring mentors, strong mental health supports, pathways into postsecondary education and apprenticeships, exposure to entrepreneurship, and workplaces where people feel seen, valued, and able to grow.

This is also where reconstruction and reimagination become practical.

Reconstruction asks how we strengthen existing workforce systems.

Reimagination asks a more transformative question:

What would it look like to build workforce ecosystems where Black boys and men are not simply prepared for jobs, but equipped to create opportunity for themselves and their communities?

That means investing in entrepreneurship.

Building stronger pipelines into healthcare, education, public service, skilled trades, and technology.

Expanding apprenticeships and paid internships.

Connecting civic engagement with economic mobility.

Supporting Black-owned businesses that create jobs in their own neighborhoods.

And ensuring that Black men are not only represented in the workforce, but also in the rooms where workforce policy is designed.

Belonging Requires More Than Good Intentions

One concept that surfaced during our discussion was Targeted Universalism, a framework developed by Dr. john a. powell and colleagues that begins with a universal goal while recognizing that different communities face different barriers to reaching it. Rather than treating everyone identically, it encourages us to design targeted strategies that enable everyone to achieve the same shared outcome.

I appreciated the opportunity to discuss this framework because it closely aligns with the philosophy behind The John Henry Health Equity Playbook.

The universal goal is simple:

We are not a monolith. Every Black boy and man should have the opportunity to live a healthy, thriving life.

But reaching that goal requires understanding that the barriers facing a young Black boy in a rural community may differ from those facing a father navigating unemployment, a veteran returning to civilian life, or a college student struggling with belonging.

Targeted universalism reminds us that equity is not about lowering expectations.

It is about designing systems that give everyone a fair opportunity to reach the same destination.

Reconstruction is necessary. Reimagination is essential.

As I reflected on the summit, another thought kept returning.

We spend a great deal of time talking about improving existing systems.

We should.

But an equally important question is this:

How do we build our own systems?

How do we cultivate more Black educators?

How do we strengthen community-based organizations?

How do we build research agendas that begin with community wisdom?

How do we prepare the next generation of clinicians, researchers, entrepreneurs, and policymakers?

How do we create spaces where people don’t have to wait to be invited before they can contribute?

Reconstruction asks us to repair what has been broken.

Reimagination asks us to design systems that produce different outcomes from the start.

That shift—from repair to redesign—may be one of the most important leadership challenges of our time.

From Problems to Possibilities

One conversation I especially enjoyed during the summit was introducing what I describe as an Investment Prospectus for Black Men’s Health from my book.

Too often, discussions about Black men’s health begin and end with disparities, deficits, and unmet needs. Those realities are important, and they deserve our attention. But they cannot be the end of the conversation.

An investment prospectus reframes the discussion.

Instead of asking:

“What problems do we need to solve?”

It asks:

“Where should we strategically invest to create the greatest long-term return for Black boys, Black men, their families, and their communities?”

That shift matters.

It moves us from scarcity to stewardship.

From reacting to crises to intentionally building opportunity.

From funding isolated programs to investing in sustainable ecosystems.

An investment agenda for Black men’s health should include more than healthcare. It should prioritize:

• Education and lifelong learning

• Workforce development and career pathways

• Entrepreneurship and Black-owned businesses

• Mental and behavioral health

• Community-based organizations

• Research and data infrastructure

• Civic leadership and civic engagement

• Technology and innovation

• Fatherhood and family strengthening

• Cross-sector partnerships that connect these investments rather than treating them as separate initiatives

This conversation also reinforced something I’ve been thinking about for some time.

We often ask how we can improve existing systems.

That’s an important question.

Again, an equally important question is:

How do we build our own systems?

How do we cultivate the next generation of Black educators, clinicians, researchers, entrepreneurs, and policymakers?

How do we create community institutions that are sustainable, trusted, and designed with—not just for—the communities they serve?

How do we ensure that Black boys and men are not simply recipients of investment, but architects of the systems that shape their futures?

Reconstruction asks us to repair what has been broken.

Reimagination challenges us to ask something even bigger:

If we were designing these systems today, knowing what we know now, what would we build?

For me, that’s where the Investment Prospectus fits.

It provides a roadmap for moving from ideas to implementation.

From vision to investment.

From policy to measurable impact.

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So what can we do now?

As we move toward the midterm elections and beyond, it’s easy to think our role begins and ends with voting.

Voting matters.

But democracy requires much more.

Here are six actions we can all take today:

1. Help someone see themselves in the process. Invite a young person, neighbor, or colleague into a conversation about issues that affect their community. Representation starts with relationships.

2. Learn who makes decisions locally. School boards, city councils, county commissions, and state legislatures often make decisions that shape education, behavioral health, workforce development, and community investment.

3. Show up before decisions are made. Attend a public meeting, participate in a listening session, or submit comments on proposed policies. Influence is built before votes are cast.

4. Invest in community organizations. Mentor, volunteer, donate, or partner with organizations already creating spaces where Black boys and men feel seen, heard, and supported.

5. Ask systems-level questions. Instead of asking, “How do we fix this program?” ask, “What conditions created this outcome, and how do we redesign the system?”

6. Build something. Whether it’s a mentoring initiative, a neighborhood coalition, a research partnership, or a civic education workshop, don’t wait for the perfect invitation. Create opportunities for others to belong.

The work continues

As I left the summit, I realized those sticky notes weren’t simply describing what young people need.

They were describing what all of us need.

To be seen.

To be heard.

To belong.

To believe our experiences matter.

Better mental health begins there.

Better education begins there.

Better civic engagement begins there.

Better public policy begins there.

Because when people can see themselves in the systems around them, they begin to believe they can shape those systems for the generations that follow.

Let’s build together

If you’re working in education, public health, behavioral health, philanthropy, healthcare, workforce development, civic engagement, or public policy, I’d love to connect.

At Enyia Strategies, we help people see themselves shaping the policy-making process across all levels of government.

At The John Henry Institute, we’re building a national platform that advances Black men’s health through research, policy, partnerships, and community-driven implementation.

Together, we can build systems where more people are seen, more voices are valued, and more communities have the opportunity to thrive.

Elevate,

Dr. Okey K. Enyia

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Every generation inherits moments that invite us to rethink what is possible.

I believe we are living through one of those moments.

Across the country, conversations about healthcare, education, workforce development, civic participation, economic mobility, artificial intelligence, institutional trust, and the future of our democracy are converging in ways they rarely have before.

To me, this is more than a policy moment.

It is a political and policy window of opportunity.

An opportunity to intentionally reconstruct and reimagine the systems that shape health.

Over the past several weeks, I reviewed a series of studies examining Black men’s health, life expectancy, health equity, and the economic costs of health disparities. Individually, each study offers an important insight. Together, they point to a conclusion that I believe should reshape how we think about health equity in America.

The research is giving us more than evidence of disparities.

It is giving us direction.

For decades, conversations about health equity have largely centered on healthcare.

Expand insurance coverage.

Increase access to care.

Improve quality.

Encourage healthier behaviors.

These investments matter.

But after synthesizing this body of evidence, I have become increasingly convinced that we may be asking the wrong question.

Instead of asking,

“How do we improve healthcare?”

perhaps we should ask,

“Where can we make the greatest impact?”

The evidence increasingly suggests one answer.

Black men’s health is one of the greatest untapped opportunities to advance health equity in America.

And if we fail to invest accordingly, we are not only perpetuating preventable inequities. We are also leaving billions of dollars in human potential, economic productivity, and community leadership unrealized.

My perspective on this issue has been shaped by experiences across research, public health practice, congressional policymaking, federal advocacy, and community engagement. Those experiences have convinced me that meaningful change requires connecting evidence to policy, policy to practice, and practice back to the communities we seek to serve.

That perspective also shaped The John Henry Health Equity Playbook, where I argue that Black men’s health should not be viewed solely through the lens of healthcare. It should be understood as an interconnected challenge involving physical and mental health, economic stability, civic engagement, and the systems that influence opportunity throughout the life course.

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We Have Been Asking the Wrong Question

A recent analysis examining differences in life expectancy between Black and white Americans found that Black men continue to experience substantially shorter life expectancy than white men. Importantly, the disparity is not driven by a single disease. Rather, it reflects the cumulative effects of cardiovascular disease, cancer, homicide, injuries, and other preventable causes of death occurring across the life course. The study also found that deaths among young and middle-aged Black men disproportionately widen the life expectancy gap because they represent decades of potential life lost instead of deaths occurring later in life.¹

A second study reinforces this point.

Within the high-risk population they examined, Cai and colleagues found that Black men experienced a substantially larger racial life expectancy gap than Black women. Among Black men, heart disease, homicide, and cancer accounted for much of the difference.²

These studies do not tell us that Black men account for a specific percentage of the overall Black-white health gap.

That calculation has not been made.

What they do tell us is something equally important.

Black men bear one of the largest burdens of premature mortality in the United States.

Because many of these deaths are preventable, and because they occur earlier in life, improving Black men’s health represents one of the greatest opportunities to reduce racial disparities in longevity.

That distinction matters.

Too often, conversations about Black men’s health begin and end with documenting disparities.

Documentation is necessary.

But documentation alone does not improve health outcomes.

The more important question is:

What do these findings invite us to do differently?

For me, they invite us to think differently about where strategic investments can create the greatest return.

Beyond Closing the Gap

As I reflected on these studies, another question came to mind.

Nearly every analysis compares Black men to white men.

There are valid methodological reasons for doing this. Historically, white populations have often served as the reference group because they have generally experienced greater social, economic, and political advantage than historically marginalized populations.⁶

But a reference group is a methodological choice.

It is not a definition of optimal health.

That distinction matters.

Increasingly, health equity scholars are encouraging us to think differently about what success should look like.

Rather than asking,

“How do we help Black men achieve the same outcomes as white men?”

perhaps we should ask,

“What is the highest attainable level of health for Black men?”

Those are fundamentally different questions.

The first measures progress against historical averages.

The second challenges us to imagine what becomes possible when structural barriers are removed and opportunities are expanded.

It also reminds us that non-Hispanic white populations do not universally represent the healthiest benchmark. Several Asian American populations and the well-documented Hispanic mortality advantage demonstrate that longer life expectancy is possible under different social and demographic circumstances.

The goal, therefore, should not be to make Black men “more like white men.”

The goal should be to ensure that every community has the opportunity to achieve its highest attainable level of health.

That is precisely the vision behind Targeted Universalism, a framework that establishes a universal goal while recognizing that different communities face different barriers and therefore require different strategies to reach the same destination.⁷

It is also one of the foundational principles underlying The John Henry Health Equity Playbook.

Specificity Does Not Mean Being Exclusionary

Whenever I advocate for Black men’s health, I occasionally hear a familiar question.

“Why focus specifically on Black men?”

It is a fair question.

My answer is simple.

Specificity does not mean being exclusionary.

Public health has always relied on specificity.

We have dedicated initiatives for maternal health.

Veterans’ health.

Children’s health.

Rural health.

Alzheimer’s disease.

Cancer survivorship.

HIV prevention.

No one assumes these efforts imply that other populations are unimportant.

Instead, they recognize a basic truth.

Different populations experience different barriers.

Evidence-based solutions require evidence-based specificity.

Black men are no exception.

The research demonstrates that Black men experience one of the largest racial life expectancy disadvantages in America and bear a disproportionate burden of premature mortality from preventable causes.¹ ²

Recognizing that reality is not exclusionary.

It is evidence-based.

More importantly, improving Black men’s health benefits far more than Black men themselves.

Healthier fathers strengthen families.

Healthier workers strengthen the economy.

Healthier entrepreneurs create jobs.

Healthier community leaders strengthen neighborhoods.

Healthier voters strengthen democracy.

When Black men thrive, everyone benefits.

This is the essence of Targeted Universalism.

We pursue a universal goal while using targeted strategies to address the distinct barriers different populations face.

Specificity is not about excluding others.

It is about being precise enough to solve the problem.

From Health Disparities to an Investment Strategy

As I was writing The John Henry Health Equity Playbook, I kept returning to one question:

If Black men’s health is one of America’s greatest untapped opportunities, what would it actually look like to invest in it?

That question fundamentally changed how I approached the book.

Most policy reports conclude with recommendations.

I wanted to conclude with an invitation.

That is why The John Henry Health Equity Playbook ends with an Investment Prospectus.

I intentionally chose the language of investment because it changes the conversation.

Too often, Black men’s health is discussed primarily in terms of deficits, disparities, and costs.

Those realities are important.

But they are not the whole story.

An investment perspective asks a different set of questions.

Instead of asking,

“How much will improving Black men’s health cost?”

it asks,

“What returns can we generate if we invest intentionally?”

That is a fundamentally different way of thinking about public policy.

It challenges us to move beyond documenting disparities and toward mobilizing resources.

It encourages us to think like investors, not just analysts.

It asks policymakers, healthcare leaders, employers, philanthropic organizations, insurers, researchers, and community organizations to consider not only the cost of action, but also the cost of inaction.

Because every investment carries an opportunity cost.

The question is no longer whether we will invest.

The question is where we will invest.

Health Equity Is Also an Economic Strategy

There is another reason Black men’s health deserves greater national attention.

It is not only a public health imperative.

It is an economic one.

Researchers at the Johns Hopkins Bloomberg School of Public Health estimated that health disparities among Black and Hispanic men cost the United States economy more than $450 billion over a four-year period. Black men alone accounted for $341.8 billion of those losses. Much of that burden resulted from premature death, representing the loss of workers, entrepreneurs, fathers, taxpayers, mentors, and community leaders.³

The story does not end there.

A more recent national analysis estimated that racial and ethnic health inequities cost the United States between $421 billion and $451 billion in 2018 alone, with most of the burden attributable to the poor health of the Black population.⁴

Think about what that means.

Every preventable heart attack.

Every delayed cancer diagnosis.

Every homicide.

Every unmanaged chronic disease.

Every premature death.

These are not simply personal tragedies.

They are lost human capital.

Lost innovation.

Lost productivity.

Lost entrepreneurship.

Lost civic leadership.

Lost tax revenue.

Lost economic growth.

Viewed through this lens, improving Black men’s health is not simply about reducing disparities.

It is about expanding opportunity.

It is about strengthening our workforce.

It is about improving economic competitiveness.

It is about increasing the return on investments we have already made in education, workforce development, and community development.

In other words, health equity is not merely a healthcare strategy.

It is an economic development strategy.

Healthcare Cannot Solve What Systems Create

One of my favorite observations comes from the Advisory Board, which summarized decades of public health research with a simple but profound insight.

Medical care accounts for only one portion of what determines health outcomes.

The conditions in which people are born, grow, live, learn, work, worship, and age often exert an even greater influence.⁵

Healthcare matters.

So do:

• Education

• Employment

• Housing

• Transportation

• Neighborhood safety

• Environmental quality

• Civic participation

• Economic opportunity

Healthcare treats illness.

Systems produce health.

That insight reinforces something I have come to believe throughout my career.

Health is more than healthcare.

It is shaped by the policies we enact.

The neighborhoods we build.

The schools we fund.

The jobs we create.

The transportation systems we design.

The environmental conditions we tolerate.

The civic institutions we strengthen.

Or fail to strengthen.

This is precisely why The John Henry Health Equity Playbook intentionally extends beyond healthcare.

The Playbook is organized around three interconnected pillars:

• Physical and Mental Health

• Economic Stability

• Civic Engagement

Those pillars are intentionally connected because life is interconnected.

Educational attainment influences employment.

Employment influences income.

Income influences housing.

Housing influences stress.

Stress influences chronic disease.

Chronic disease influences life expectancy.

These are not separate conversations.

They are parts of the same system.

A Political and Policy Window of Opportunity

As I reflect on this body of research, I also find myself reflecting on the current sociopolitical landscape.

Periods of significant policy discussion invite us to ask bigger questions than how to improve individual programs.

They invite us to consider how we might reconstruct and reimagine the systems that shape people’s lives.

I believe we are in one of those moments.

Whether the issue is healthcare, education, workforce development, housing, artificial intelligence, economic mobility, or civic participation, there is growing recognition that many of our institutions were designed for a different era.

Some continue to serve us well.

Others require thoughtful redesign.

That reality presents a unique opportunity.

Not simply to reform existing systems.

But to intentionally improve them.

For me, this is where Black men’s health becomes much more than a healthcare conversation.

It becomes a conversation about institution building.

About how we design systems that create opportunity.

About how we remove barriers that prevent people from reaching their full potential.

About how we ensure that health equity is reflected not only in our aspirations, but also in our policies, investments, and partnerships.

The research discussed throughout this essay reinforces that improving Black men’s health will require coordinated action across multiple sectors.

That is not a weakness of the challenge.

It is an invitation to think differently.

To move beyond fragmented solutions.

To strengthen partnerships across sectors.

To align policy with evidence.

To align investment with opportunity.

And to intentionally build institutions that are better equipped to meet the needs of the communities they serve.

To me, that is what reconstruction and reimagining look like.

Not returning to what existed before.

But intentionally building something better.

Not because change is fashionable.

But because the evidence demands it.

Not because Black men are the only population experiencing disparities.

But because the evidence suggests that strategic investments in Black men’s health can generate benefits that extend far beyond Black men themselves.

That is exactly what systems thinking teaches us.

A Systems Thinking Perspective

Systems scientists often talk about leverage points, places within a complex system where relatively focused interventions can produce disproportionately large improvements across the entire system.

I believe Black men’s health represents one of those leverage points.

Viewed through this lens, Black men’s health is not a niche issue competing for attention.

It is a strategic opportunity capable of generating broad societal returns.

Improving Black men’s health strengthens families.

It strengthens the workforce.

It strengthens communities.

It strengthens civic participation.

It strengthens economic productivity.

It strengthens population health.

That is why I believe Black men’s health should not be viewed as a competing priority within health equity.

It should be viewed as one of the ways we advance health equity.

Focusing on Black men does not narrow the health equity agenda.

It strengthens it.

Specificity does not mean being exclusionary.

It means directing our attention, our partnerships, our policies, and our investments toward the places where the evidence suggests they can produce the greatest impact.

That is what systems thinking teaches us.

When you strengthen a leverage point, you strengthen the entire system.

From Research to Action

One lesson has become increasingly clear to me throughout my career.

Research is essential.

Policy is essential.

Practice is essential.

But none of them, by themselves, are enough.

Real progress happens when evidence informs policy, policy informs investment, investment strengthens institutions, and institutions improve people’s lives.

That is the journey I hoped to capture in The John Henry Health Equity Playbook and operationalizing through my non-profit the John Henry Institute for Black Men’s Health and Policy Innovation.

The Playbook is not simply a collection of policy recommendations.

It is a framework for translating research into action.

For connecting healthcare with economic stability.

For connecting civic engagement with health outcomes.

For helping policymakers, healthcare leaders, employers, philanthropic organizations, insurers, researchers, and community organizations see themselves as partners in improving Black men’s health.

This is also why I concluded the Playbook with an Investment Prospectus.

Rather than ending with another list of recommendations, I wanted to invite readers to think differently.

The Investment Prospectus asks us to move beyond asking,

“What will this cost?”

and instead ask,

“What becomes possible when we invest intentionally?”

What becomes possible when more Black men have access to preventive care?

What becomes possible when communities are safer?

When educational attainment improves?

When employment opportunities expand?

When trust in institutions grows?

When civic participation increases?

Those are not simply health questions.

They are questions about America’s future.

The Investment Prospectus is an invitation to move beyond documenting disparities.

It is an invitation to finance solutions.

It is an invitation to align public policy, private capital, philanthropy, healthcare, research, and community leadership around one shared objective.

Helping every Black man achieve his highest attainable level of health.

Because when Black men thrive, the returns extend far beyond Black men themselves.

An Invitation

Every generation inherits opportunities to strengthen the institutions it leaves behind.

I believe this is one of those moments.

The research is giving us more than evidence of disparities.

It is giving us direction.

A direction that challenges us to reconstruct and reimagine the systems that shape health.

A direction that challenges us to move beyond fragmented approaches and toward coordinated investment.

A direction that challenges us to recognize that health equity is not only about healthcare.

It is about opportunity.

It is about institutions.

It is about partnership.

It is about leadership.

And it is about intentional investment.

That is why I believe Black men’s health is one of America’s greatest untapped opportunities.

Not because Black men matter more than anyone else.

But because investing where the evidence points has the potential to strengthen the entire system.

The challenge before us is not choosing between universalism and specificity.

It is learning how to use specificity in service of universal progress.

Specificity does not mean being exclusionary.

It means being intentional.

It means being evidence-driven.

It means recognizing where investments can create the greatest return for individuals, families, communities, and our nation.

If we embrace that mindset, improving Black men’s health becomes much more than a public health priority.

It becomes an opportunity to strengthen America’s human capital.

To expand economic opportunity.

To improve community well-being.

To build institutions that serve all of us more effectively.

That is the invitation behind The John Henry Health Equity Playbook.

It is an invitation to reconstruct and reimagine.

To move from documenting disparities to designing solutions.

To move from identifying problems to financing progress.

To move from awareness to intentional investment.

The question is no longer whether Black men’s health deserves our attention.

The evidence has answered that.

The question is whether we are willing to invest with the intentionality this moment requires.

Because investing in Black men’s health is not simply an investment in Black men.

It is an investment in America’s future.

Elevate,

Dr. Okey K. Enyia

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Author’s Note

The ideas in this essay informed the development of The John Henry Health Equity Playbook, a policy framework that examines Black men’s health through the interconnected lenses of physical and mental health, economic stability, and civic engagement. The Playbook concludes with an Investment Prospectus, inviting policymakers, healthcare leaders, philanthropic organizations, employers, insurers, researchers, and community partners to view Black men’s health not simply as a health disparity, but as a strategic opportunity to improve health equity, strengthen communities, and build a more prosperous nation.

If this essay resonated with you, I invite you to subscribe to this newsletter, share it with your network, and join the conversation. Advancing Black men’s health will require all of us working together across sectors, disciplines, and communities.

References

1. Harper S, et al. Life Expectancy Differences Between Black and White Americans by Cause of Death. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11258794/

2. Cai B, et al. Racial Differences in Life Expectancy and Causes of Death. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7453009/

3. Johns Hopkins Bloomberg School of Public Health. Health disparities among U.S. African-American and Hispanic men cost economy more than $450 billion over four years. https://publichealth.jhu.edu/2014/health-disparities-among-us-african-american-and-hispanic-men-cost-economy-more-than-450-billion-over-four-years

4. LaVeist TA, Gaskin DJ, Richard P, et al. The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the United States. Health Affairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01394

5. Advisory Board. The factors that influence health. https://www.advisory.com/daily-briefing/2020/02/18/racial-health-outcomes

6. State Health & Value Strategies. Health Equity Measurement: Considerations for Selecting a Benchmark. https://www.shvs.org/wp-content/uploads/2023/09/SHVS_Health-Equity-Measurement-Considerations-for-Selecting-a-Benchmark.pdf

7. Othering & Belonging Institute at UC Berkeley. Targeted Universalism. https://belonging.berkeley.edu/targeted-universalism

8. Enyia OK. The John Henry Health Equity Playbook: A Four-Year Health Policy Agenda for Black Men.

Why improving Black men and boys health may be one of the highest-return investments we can make for health equity, economic growth, and stronger communities.

Over the past several weeks, I reviewed a series of studies examining Black men’s health, life expectancy, health equity, and the economic costs of health disparities. Individually, each study offers an important insight. Together, they point to a conclusion that I believe should reshape how we think about health equity in America.

For decades, conversations about health equity have largely centered on healthcare.

Expand insurance coverage.

Increase access to care.

Improve quality.

Encourage healthier behaviors.

Those investments matter.

But after examining this body of evidence together, I have become increasingly convinced that we may be asking the wrong question.

Instead of asking only,

“How do we improve healthcare?”

perhaps we should ask,

“Where can we make the greatest impact?”

The evidence increasingly suggests one answer.

Black men’s health is one of the greatest opportunities to advance health equity in America.

And if we fail to invest accordingly, we are not only perpetuating preventable inequities. We are also leaving billions of dollars in human and economic potential unrealized.

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The Data Tell a Bigger Story

A recent analysis of the Black-White life expectancy gap found that Black men continue to experience substantially shorter life expectancy than white men. Importantly, the disparity is not driven by a single disease. Rather, it reflects the cumulative effects of cardiovascular disease, cancer, homicide, injuries, and other preventable causes of death occurring across the life course. The study also found that deaths among young and middle-aged Black men disproportionately widen the life expectancy gap because they result in decades of potential life lost instead of deaths occurring later in life (Harper et al., 2024).¹

A second study reinforces this point.

Within the high-risk population they studied, Cai and colleagues found that Black men experienced a substantially larger racial life expectancy gap than Black women. Among Black men, heart disease, homicide, and cancer were the largest contributors to the disparity (Cai et al., 2020).²

These studies do not tell us that Black men account for a specific percentage of the overall Black-white health gap.

That calculation has not been made.

What they do tell us is something equally important.

Black men bear one of the largest burdens of premature mortality in the United States.

Because many of these deaths are preventable, and because they occur earlier in life, improving Black men’s health represents one of the greatest opportunities to reduce racial disparities in longevity.

Beyond Closing the Gap: Rethinking the Benchmark

Reading these studies also led me to another question.

Nearly every analysis compares Black men to white men.

There are valid methodological reasons for doing this. Historically, white populations have often served as the reference group because they have generally experienced greater social, economic, and political advantage than historically marginalized populations (State Health & Value Strategies, 2023).⁶

But a reference group is a methodological choice.

It is not a definition of optimal health.

That distinction matters.

Increasingly, health equity scholars are encouraging us to think differently about what success should look like.

Rather than asking,

“How do we help Black men achieve the same outcomes as White men?”

perhaps we should ask,

“What is the highest attainable level of health for Black men?”

Those are fundamentally different questions.

The first measures progress against historical averages.

The second challenges us to imagine what becomes possible when structural barriers are removed and opportunities are expanded.

It also reminds us that non-Hispanic white populations do not universally represent the healthiest benchmark. Several Asian American populations and the well-documented Hispanic mortality advantage demonstrate that longer life expectancy is possible under different social and demographic circumstances. The goal, therefore, should not be to make Black men “more like white men.”

The goal should be to ensure that every community has the opportunity to achieve its highest attainable level of health.

That is precisely the vision behind Targeted Universalism, a framework that establishes a universal goal while recognizing that different communities require different strategies to reach it (Powell).⁷

It is also a foundational principle of The John Henry Health Equity Playbook and my non-profit the John Henry Institute for Black Men’s Health and Policy Innovation.

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Specificity Does Not Mean Being Exclusionary

Whenever I advocate for Black men’s health, I occasionally hear a familiar question.

“Why focus specifically on Black men?”

It is a fair question.

My answer is simple.

Specificity does not mean being exclusionary.

Public health has always relied on specificity.

We have dedicated initiatives for maternal health.

Veterans’ health.

Children’s health.

Rural health.

Alzheimer’s disease.

Cancer survivorship.

HIV prevention.

No one assumes these efforts imply that other populations are unimportant.

Instead, they recognize a basic truth.

Different populations experience different barriers.

Evidence-based solutions require evidence-based specificity.

Black men are no exception.

The research demonstrates that Black men experience one of the largest racial life expectancy disadvantages in America and bear a disproportionate burden of premature mortality from preventable causes (Harper et al., 2024; Cai et al., 2020).¹²

Recognizing that reality is not exclusionary.

It is evidence-based.

More importantly, improving Black men’s health benefits far more than Black men.

Healthier fathers strengthen families.

Healthier workers strengthen the economy.

Healthier entrepreneurs create jobs.

Healthier community leaders strengthen neighborhoods.

Healthier voters strengthen democracy.

When Black men thrive, everyone benefits.

This is the essence of Targeted Universalism.

We pursue a universal goal while using targeted strategies to address the distinct barriers different populations face.

Specificity is not about excluding others.

It is about being precise enough to solve the problem.

Health Equity Is Also an Economic Strategy

There is another reason Black men’s health deserves greater national attention.

It is not only a public health imperative.

It is an economic one.

For too long, we have discussed health disparities primarily through the lens of social justice.

They are certainly a social justice issue.

But they are also an enormous economic liability.

Researchers at the Johns Hopkins Bloomberg School of Public Health estimated that health disparities among African American and Hispanic men cost the U.S. economy more than $450 billion over a four-year period. African American men alone accounted for $341.8 billion of those losses. The largest contributor was not medical spending. It was premature death, representing the loss of workers, entrepreneurs, fathers, taxpayers, mentors, and community leaders.³

The story does not end there.

A more recent national analysis estimated that racial and ethnic health inequities cost the United States between $421 billion and $451 billion in 2018 alone, with most of the burden attributable to the poor health of the Black population (LaVeist et al., 2022).⁴

Think about what this means.

Every preventable heart attack.

Every delayed cancer diagnosis.

Every homicide.

Every unmanaged chronic disease.

Every premature death.

These are not simply personal tragedies.

They represent lost productivity.

Lost innovation.

Lost leadership.

Lost opportunity.

Health inequities are not simply costing lives.

They are costing America economic growth.

Viewed through this lens, Black men’s health is not merely a healthcare expenditure.

It is one of the highest-return investments we can make.

Healthcare Cannot Solve What Systems Create

One of my favorite observations comes from the Advisory Board, which summarized decades of public health research with a simple but profound insight.

Medical care accounts for only one portion of what determines health outcomes.

The conditions in which people are born, grow, live, learn, work, worship, and age often exert an even greater influence.⁵

Healthcare matters.

So do:

• Education

• Employment

• Housing

• Transportation

• Neighborhood safety

• Environmental quality

• Civic participation

• Economic opportunity

Healthcare treats illness.

Systems produce health.

That understanding is why The John Henry Health Equity Playbook intentionally extends beyond healthcare into economic stability and civic engagement.

A Systems Thinking Perspective

Systems scientists often talk about leverage points, which are places within a complex system where relatively focused investments can produce disproportionately large improvements.

Viewed through this lens, Black men’s health is not a niche issue competing for attention.

It is a strategic investment capable of generating broad societal returns.

Focusing on Black men does not narrow the health equity agenda.

It strengthens it.

Specificity does not mean being exclusionary.

It means directing our attention, resources, and policies toward the places where the evidence suggests they can produce the greatest impact.

That is what systems thinking teaches us.

When you identify a leverage point, you do not ignore the rest of the system.

You strengthen the entire system by investing where change can create the greatest ripple effects.

Final Thoughts

The question should no longer just be whether Black men’s health deserves greater attention.

The evidence has already been well-established.

But the evidence also challenges us to rethink how we define health equity.

If our benchmark is simply reducing the distance between Black men and White men, we risk aiming too low.

If our strategies are so broad that they overlook populations experiencing the greatest burdens, we risk making too little progress.

The challenge before us is not choosing between universalism and specificity.

It is learning how to use specificity in service of universal progress.

Specificity does not mean being exclusionary.

It means being intentional.

It means being evidence-driven.

It means recognizing where investments can create the greatest return for individuals, families, communities, and our nation.

That is why I believe Black men’s health is one of America’s greatest untapped opportunities.

Not because Black men matter more than anyone else.

But because every community deserves the opportunity to achieve its highest attainable level of health. Sometimes achieving that universal goal requires targeted strategies for those facing the greatest barriers.

The question is no longer whether we can afford to invest in Black men’s health.

The evidence increasingly suggests we cannot afford not to.

Elevate,

Dr. Okey K. Enyia

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References

1. Harper S, et al. (2024). Life Expectancy Differences Between Black and White Americans by Cause of Death. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11258794/

2. Cai B, et al. (2020). Racial Differences in Life Expectancy and Causes of Death. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7453009/

3. Johns Hopkins Bloomberg School of Public Health. (2014). Health disparities among U.S. African-American and Hispanic men cost economy more than $450 billion over four years. https://publichealth.jhu.edu/2014/health-disparities-among-us-african-american-and-hispanic-men-cost-economy-more-than-450-billion-over-four-years

4. LaVeist TA, Gaskin DJ, Richard P, et al. (2022). The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the United States. Health Affairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01394

5. Advisory Board. (2020). The factors that influence health. https://www.advisory.com/daily-briefing/2020/02/18/racial-health-outcomes

6. State Health & Value Strategies. (2023). Health Equity Measurement: Considerations for Selecting a Benchmark. https://www.shvs.org/wp-content/uploads/2023/09/SHVS_Health-Equity-Measurement-Considerations-for-Selecting-a-Benchmark.pdf

7. Othering & Belonging Institute. Targeted Universalism. https://belonging.berkeley.edu/targeted-universalism

8. The John Henry Health Equity Playbook: A Four-Year Health Policy Agenda for Black Men.

Next month, I will join roughly 125 leaders from across the country for the Black Boys and Men Summit, a national convening bringing together community elders, youth, clinicians, researchers, educators, faith leaders, policymakers, funders, advocates, and men with lived experience to help shape a national blueprint for the mental health and well-being of Black boys and men.

I am looking forward to participating, not simply because mental health is an important issue, but because this summit reflects a growing recognition that Black boys and men deserve more than conversations about crisis. We deserve conversations about thriving.

That distinction matters.

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For too long, national discussions about Black men have been framed through deficits, disparities, and dysfunction. While it is important to acknowledge the very real challenges Black boys and men face, it is equally important to recognize what the summit organizers have intentionally centered: resilience, faith, creativity, intergenerational wisdom, community, and the countless strengths that have sustained Black communities across generations.

As the summit materials note, the goal is not simply to identify problems. The goal is to move from conversation to co-creation and leave with concrete commitments that can shape a national agenda.

That is exactly the type of conversation we need.

Mental Health Is About More Than Healthcare

One of the most important findings from the summit’s preliminary work is that Black boys and men consistently described mental health as an integrated state of mind, body, and spirit. Participants spoke about purpose, joy, belonging, self-awareness, faith, family, and connection rather than simply the absence of illness.

This aligns closely with a central argument I make in The John Henry Health Equity Playbook: health is about far more than healthcare and my non-profit mission.

Health is shaped by where people live, learn, work, worship, play, and age. Housing, education, economic opportunity, civic engagement, family stability, and community connection all influence whether individuals and communities can thrive.

If we want to improve mental health outcomes for Black boys and men, we cannot limit our thinking to therapists, clinics, and hospitals.

We must also think about fathers, mentors, coaches, barbers, pastors, teachers, employers, fraternities, and community organizations.

In many ways, these institutions represent the first line of care long before someone enters a healthcare system.

The Cost of Carrying More

One theme from the summit materials resonated deeply with me: the discussion of John Henryism. Participants described the pressure many Black men feel to constantly prove themselves, overcome barriers, and outwork systems that were never designed with them in mind.

Last year, while writing The John Henry Health Equity Playbook, I had the privilege of interviewing Dr. Sherman James, the researcher who coined the John Henryism Hypothesis.

His work challenged us to consider what happens when resilience becomes a survival strategy.

John Henryism is not a character flaw. It is an adaptive response to chronic stress, systemic barriers, discrimination, and the belief that one must work twice as hard to achieve the same outcomes.

The challenge is that even adaptive strategies can come at a cost.

Research has linked chronic stress and sustained high-effort coping to adverse physical and mental health outcomes. The very qualities that help many Black men survive can, over time, undermine their health and well-being.

That reality raises an important question:

How do we create systems that no longer require Black men to carry disproportionate burdens simply to access opportunity, care, and dignity?

Community Strength Cannot Substitute for System Responsibility

One of the most important statements in the summit materials is this:

Community strength should never be asked to substitute for systemic responsibility.

I could not agree more.

Black communities have always created support systems where formal institutions fell short.

Churches have provided counseling before counseling was accessible.

Barbershops have served as trusted spaces for healing and connection.

Fraternities and mentoring organizations have developed leaders, built networks, and fostered belonging.

Families and caregivers have carried enormous responsibility with limited resources.

These institutions are invaluable. But they should not be expected to solve structural challenges on their own.

We must ask ourselves:

• How do we expand access to culturally affirming care?

• How do we build and sustain a more diverse and culturally responsive workforce?

• How do we translate research into community-relevant and fundable practice?

• How do we align public policy with lived experience?

These are not just healthcare questions.

They are systems questions.

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From Programs to Institutions

As I prepare for this summit, I keep returning to a question that has increasingly shaped my work:

Are we building programs or are we building institutions?

Programs can be valuable.

But programs often depend on temporary funding cycles, individual champions, or shifting political priorities.

Institutions endure.

Institutions create accountability.

Institutions shape culture.

Institutions survive leadership transitions.

If we are serious about improving the mental health and well-being of Black boys and men, we must think beyond short-term interventions and toward long-term infrastructure.

That means investing in workforce development.

That means strengthening community-based organizations.

That means supporting research.

That means building sustainable partnerships between healthcare systems and trusted community institutions.

That means ensuring that Black boys and men are visible in the policy-making process.

A Blueprint for the Future

The summit organizers have framed this effort around a powerful vision:

Every Black boy and man can be well, be whole, and thrive.

I believe that vision is achievable.

But achieving it will require us to move beyond fragmented solutions and toward a coordinated strategy that connects policy, research, community engagement, workforce development, and lived experience.

It will require us to move from reactive interventions to intentional systems design.

And it will require all of us to ask a fundamental question:

What would it look like to build a society where Black boys and men are not merely surviving, but truly thriving?

I look forward to joining this important conversation and contributing insights from my research, policy, advocacy, and community engagement work through The John Henry Health Equity Playbook and The John Henry Institute.

The work ahead is significant.

So is the opportunity.

The time to build is now.

Elevate,

Dr. Okey K. Enyia

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What Life Expectancy Reveals About Washington, DC

Place matters. As a social driver of health, zipcode shapes life expectancy.

In Washington, DC, residents of Ward 3 can expect to live approximately 89 years. Residents of Ward 8 can expect to live approximately 71 years.

That is an 18-year difference.

The gap is one of the starkest reminders that health outcomes are not produced solely in hospitals and clinics. They are shaped by the conditions in which people are born, grow, learn, work, worship, and age.

For me, that statistic is more than a number. It is a window into a larger story about healthcare access, economic opportunity, civic engagement, and the systems that influence whether people have the opportunity to live long and healthy lives.

Recent data on men’s cardiovascular health in Washington, DC, combined with my own research on healthcare access among Black men, have reinforced a conclusion I have come to believe throughout my career:

The path to longer lives begins long before disease appears.

The Data Tell a Powerful Story

Heart disease remains the leading cause of death among men in Washington, DC.

At the same time, significant disparities persist in healthcare access, hypertension prevalence, and life expectancy.

Ward 3 (affluent Georgetown area); Ward 8 (predominantly Black residents)

An 18-year life expectancy gap exists within the same city.

Health outcomes are shaped by more than healthcare. They reflect differences in opportunity, environment, resources, investment, and access.

These numbers are alarming.

But they are also predictable.

Health outcomes rarely emerge in isolation. They reflect years of accumulated experiences and opportunities.

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My Research Reached a Similar Conclusion

Several years ago, I completed doctoral research examining healthcare access among Black and White men following implementation of the Affordable Care Act.

The findings were encouraging and concerning at the same time.

The ACA significantly reduced uninsured rates for both groups.

However, disparities persisted.

Black men had:

• 30% greater odds of being uninsured

• 25% lower odds of having a usual source of care

In other words, coverage improved, but access gaps remained.

That distinction matters.

Insurance coverage is important.

Meaningful engagement with care is what ultimately helps improve health outcomes.

Today, local data tell a similar story.

Black male Medicaid beneficiaries in Washington, DC continue to engage with primary care at lower rates than the citywide average.

Coverage increased. Engagement gaps persist.

This finding resonated deeply with me because it mirrors what I found in my research.

The challenge is not simply obtaining coverage.

The challenge is sustaining engagement with care.

The Problem Starts Earlier Than We Think

One of the most important lessons from men’s health research is that many disparities begin long before adulthood.

Young men are less likely to engage with preventive healthcare than young women.

Many lose regular contact with the healthcare system during the transition from adolescence to adulthood.

By the time chronic disease emerges, opportunities for prevention may already have been missed.

This is why I increasingly believe we need a life-course approach to men’s health.

Healthy men begin as healthy boys.

The goal should not simply be treating disease.

The goal should be creating conditions that allow boys and men to thrive throughout their lives.

A Life-Course Approach to Health Equity

Too often, our healthcare system is organized around illness.

We wait until disease appears.

We wait until blood pressure rises.

We wait until a heart attack occurs.

We wait until a crisis emerges.

A life-course approach asks a different question:

What would it look like to create healthy trajectories before disease develops?

Healthy Boys → Healthcare Engagement → Civic Awareness → Educational Opportunity → Young Adult Access to Care → Usual Source of Care → Primary Care Engagement → Hypertension Detection → Blood Pressure Control → Economic Mobility → Community Leadership → Longer Life Expectancy

Health outcomes are cumulative.

Healthy boys become healthy men when systems support engagement, opportunity, prevention, and leadership throughout life.

Hypertension Remains a Critical Opportunity

One of the most actionable opportunities for improving men’s health is hypertension prevention and control.

DC Health data demonstrate substantial disparities.

Black residents experience hypertension at rates more than twice those of White and Hispanic residents.

Hypertension remains one of the leading contributors to cardiovascular disease, stroke, disability, and premature mortality.

The good news is that hypertension is both detectable and manageable.

The challenge is ensuring that people remain connected to care long enough to benefit.

The Cost of Waiting

Poor health has consequences beyond healthcare.

Research estimates:

• $421 billion annual burden associated with racial and ethnic health inequities

• $940 billion annual burden associated with educational health inequities

• Hundreds of billions of dollars in direct and indirect costs associated with disparities affecting Black and Hispanic men

Health inequities are not only a public health challenge.

They are also an economic challenge.

Poor health affects:

• Workforce participation

• Productivity

• Disability

• Family stability

• Economic mobility

Improving Black men’s health is not simply a public health strategy.

It is also an economic development strategy.

Health equity is an investment in human capital.

Civic Engagement Is a Health Intervention

One of the central ideas in The John Henry Health Equity Playbook is that civic engagement influences health outcomes.

Consider the issues that shape health:

• Medicaid coverage

• Public health funding

• Housing

• Education

• Transportation

• Workforce development

• Violence prevention

None of these are accidental.

They are the result of policy decisions.

And policy decisions are influenced by civic participation.

This is why I often say:

Civic health influences public policy. Public policy influences health outcomes.

Health outcomes are shaped not only in clinics and hospitals.

They are also shaped in city halls, school boards, state legislatures, Congress, and communities.

Meeting Men Where They Are

Improving outcomes requires more than asking men to navigate increasingly complex healthcare systems.

It requires meeting men where they already are.

One idea I continue to explore is the creation of a National Black Barbershop Network.

Barbershops are among the most trusted institutions in many Black communities.

They are places where relationships are built, information is exchanged, and communities gather.

Imagine a network capable of connecting men to:

• Primary care

• Blood pressure screening

• Mental health resources

• Health insurance enrollment

• Workforce development opportunities

• Civic engagement opportunities

Not as a one-time initiative.

As infrastructure.

Not as a program.

As a trusted community asset capable of improving health outcomes across generations.

A Different Vision for Men’s Health

The future of men’s health cannot begin at diagnosis.

It must begin much earlier.

It begins with healthy boys.

It continues through healthcare engagement, educational opportunity, economic mobility, and civic participation.

It requires partnerships among healthcare systems, schools, employers, policymakers, faith institutions, community organizations, and trusted neighborhood leaders.

Most importantly, it requires us to see men’s health as more than a healthcare issue.

It is a health equity issue.

It is an economic issue.

It is a civic issue.

It is a life-course issue.

And if we are serious about improving outcomes, we must be willing to address all of those dimensions together.

The Real Meaning of an 18-Year Difference

An 18-year difference in life expectancy should not be accepted as inevitable.

It should challenge us to ask harder questions about access, opportunity, prevention, and accountability.

The real lesson of this gap is not simply that some people live longer than others.

It is that life expectancy reflects the cumulative impact of the policies, investments, institutions, and opportunities that shape people’s lives.

If we are serious about improving health outcomes, we must think beyond healthcare alone.

Because what life expectancy reveals about Washington, DC is ultimately a story about what is possible when communities have the resources and opportunities they need to thrive.

The path to longer lives begins long before disease appears.

It begins with building systems that allow boys and men to thrive at every stage of life.

Elevate,

Dr. Okey K. Enyia

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Sources

• DC Health Mortality Data

• DC Health Men’s Health Blood Pressure Control Strategic Initiative

• DC Medicaid Primary Care Engagement Data

• Medical Expenditure Panel Survey (MEPS)

• LaVeist et al. (2023)

• Thorpe et al. (2013)

• The John Henry Health Equity Playbook

This week, I attended the Congressional Men’s Health Caucus Men’s Health Conference on Capitol Hill.

The conference convened policymakers, advocates, researchers, healthcare professionals, and community leaders to discuss the health and well-being of men and boys in the United States. At a time when life expectancy gaps, chronic disease burdens, mental health challenges, workforce shortages, and barriers to care continue to affect millions of Americans, it was encouraging to see bipartisan attention focused on men’s health.

Several legislative efforts were highlighted throughout the conference, including:

• H.R. 7602 – State of Men’s Health Act

• H.R. 7787 – Bipartisan Mental Health Workforce Act

• H.R. 1300 – PSA Screening for HIM Act

• Congressional resolutions recognizing National Men’s Health Week, Men’s Health Month, and Prostate Cancer Awareness Month

For those of us who have spent years working at the intersection of public health, health policy, and men’s health advocacy, the growing momentum is encouraging.

Yet as I listened to the discussions throughout the day, I found myself reflecting on a question that sits at the heart of effective policymaking:

How Do We Move from Legislation to Impact?

Should these legislative efforts advance, how would they ultimately be operationalized and sustained?

In health policy, authorizing legislation is an important step. It establishes priorities, creates frameworks, and signals congressional intent. But authorization is only one part of the policymaking process.

Implementation matters.

Funding matters.

Workforce capacity matters.

Data and evaluation matter.

Community partnerships matter.

Whether the discussion is a Federal Office of Men’s Health, expanding the mental health workforce, or increasing access to preventive screenings, long-term success depends on the ability to translate policy goals into measurable outcomes.

This is not a commentary on the likelihood of passage. Rather, it reflects an important reality of policymaking: effective implementation requires thoughtful planning long before a bill reaches the President’s desk.

The strongest policy conversations often ask two questions simultaneously:

1. Should we do this?

2. If we do this, how will we make it work?

Both questions deserve our attention.

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Beyond Healthcare

One of the recurring themes in my work has been that men’s health is about much more than healthcare.

Health outcomes are shaped by access to care, housing stability, educational opportunity, economic mobility, mental health, fatherhood, civic engagement, and safe communities.

These same themes are reflected throughout The John Henry Health Equity Playbook, which frames health equity through three interconnected pillars: physical and mental health, economic stability, and civic empowerment.

The playbook also argues that civic engagement itself is a health equity strategy because public policy influences nearly every condition that shapes health and well-being.

That is why conferences like this matter.

They help elevate men’s health as a policy issue worthy of serious attention and bipartisan collaboration. They create opportunities to build coalitions, identify common ground, and explore solutions that improve the lives of men and boys across communities.

Moving from Policy to Impact

As these conversations continue, I hope we begin asking not only what policies should be enacted, but also:

• How would success be measured?

• What resources would be required?

• How would communities be engaged?

• What role could public-private partnerships play?

• How would sustainability be achieved across administrations and political cycles?

These implementation questions may not generate headlines, but they often determine whether a policy ultimately succeeds.

As someone who recently launched The John Henry Institute and authored The John Henry Health Equity Playbook, I believe the next chapter of the men’s health movement must focus not only on awareness and advocacy, but also on implementation, sustainability, and measurable outcomes.

The question is not simply whether men’s health deserves attention.

The question is how we build the infrastructure, partnerships, and accountability mechanisms necessary to improve the lives of men and boys over the long term.

Legislation can create opportunity.

Impact requires execution.

The work continues.

Elevate,

Dr. Okey K. Enyia

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Why This Matters

What if one of the most overlooked public health indicators in America is not blood pressure, obesity, or diabetes—but employment?

A recent report from the Center for Economic and Policy Research (CEPR) found that Black men continue to experience significantly lower employment rates than White men, even when educational attainment is taken into account. The findings challenge a familiar narrative that places responsibility solely on individuals and raises a more fundamental question:

What if the issue is not the resume, but the system evaluating it?

This question sits at the heart of health equity.

To be clear, you should absolutely ensure that your resume is optimized.

Too often, conversations about Black men’s health focus on downstream outcomes such as chronic disease, mental health, substance use, or life expectancy. While these outcomes matter, they are often symptoms of deeper structural conditions that shape opportunity long before someone walks into a doctor’s office.

Employment is one of those conditions.

And if we are serious about improving health outcomes for Black men, we must be equally serious about understanding the policies, systems, and institutions that influence economic opportunity.

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The Data Tell a Different Story

For decades, Americans have been told that education is the pathway to economic mobility.

There is truth in that statement.

But the CEPR report demonstrates that education alone does not fully explain employment disparities experienced by Black men.

In fact, Black men experience lower employment rates than White men across educational levels. The report also notes that Black men have higher educational attainment than some other demographic groups that nonetheless experience higher employment rates.

In other words, the relationship between education and employment is not as straightforward as many assume.

The findings suggest that something more is happening.

When disparities persist despite educational achievement, it becomes increasingly difficult to explain them solely through individual effort, skills, or qualifications.

The resume is not the whole story.

Employment Is a Health Equity Issue

Public health professionals often discuss the social drivers of health—the conditions in which people are born, live, learn, work, worship, and age.

Employment sits at the center of many of these conditions.

A stable job influences:

• Access to health insurance

• Housing stability

• Food security

• Transportation

• Wealth accumulation

• Mental health

• Family stability

• Community investment

Employment is not simply about earning a paycheck.

It is about access to opportunity.

When employment opportunities are constrained, the consequences extend far beyond economics. They appear in emergency rooms, mental health clinics, schools, neighborhoods, and households.

This is one reason why my research, writing, and advocacy have consistently emphasized that health is shaped by much more than healthcare.

Healthcare matters.

But health begins long before someone sees a physician.

The Political Determinants of Employment

Dr. Daniel Dawes introduced the concept of the Political Determinants of Health to help explain how policy decisions shape health outcomes.

Employment disparities provide a clear example.

Labor markets do not operate in a vacuum.

Employment outcomes are influenced by:

• Workforce development investments

• Educational policy

• Transportation infrastructure

• Housing policy

• Criminal justice policy

• Anti-discrimination enforcement

• Economic development strategies

• Access to capital and entrepreneurship

These are political decisions.

The opportunities available to individuals are often shaped by choices made in city halls, state legislatures, Congress, school boards, workforce agencies, and corporate boardrooms.

When viewed through this lens, employment is not simply a workforce issue.

It is a policy issue.

And because it affects health, it is also a public health issue.

The Modern John Henry Dilemma

The findings of the CEPR report also remind me of the legend of John Henry.

John Henry is remembered for his extraordinary strength and determination. He worked harder, pushed farther, and ultimately outperformed the machine.

But the story also contains a warning.

His victory came at tremendous personal cost.

Dr. Sherman James later developed the John Henryism Hypothesis, which explored how prolonged high-effort coping with structural barriers can contribute to adverse health outcomes among Black Americans.

Today, many Black men are told that success requires working harder, obtaining more credentials, building larger networks, and continually proving themselves.

Effort matters.

Education matters.

Preparation matters.

But when disparities persist even after these investments have been made, we must ask difficult questions about the structures that continue to shape outcomes.

The lesson is not that effort is unnecessary.

The lesson is that effort alone cannot overcome every structural barrier.

What This Means for Policy and Practice

If employment is a public health issue, then improving employment outcomes should be viewed as a health intervention.

That means expanding our definition of health policy.

Health policy should include conversations about:

• Apprenticeships and workforce development

• Career and technical education

• Entrepreneurship and access to capital

• Fair hiring practices

• Transportation access

• Housing stability

• Reentry programs

• Economic mobility

These are not separate conversations.

They are health conversations.

A workforce development program can improve health outcomes.

An apprenticeship can reduce health disparities.

A small business grant can improve community well-being.

An equitable hiring practice can help strengthen families.

The boundaries between economic policy and health policy are far more porous than many realize.

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Moving Beyond Individual Blame

One of the most persistent challenges in health equity work is the tendency to focus on individual behavior while overlooking structural conditions.

It is easier to ask individuals to change than it is to reform systems.

But meaningful progress requires both.

We should absolutely encourage educational attainment, workforce readiness, and entrepreneurship.

At the same time, we must be willing to examine whether systems are creating equitable pathways for people who have already done what was asked of them.

The question is not whether Black men should pursue education and employment opportunities.

The question is whether our institutions are creating fair opportunities for those investments to translate into equitable outcomes.

A Different Vision of Health Equity

Health equity is not simply about helping people survive.

It is about creating conditions where people can thrive.

The CEPR report offers an important reminder that employment is not just an economic indicator.

It is a reflection of opportunity.

It is a reflection of policy.

And it is a reflection of health.

If we want to improve health outcomes for Black men, we cannot limit our focus to hospitals, clinics, and insurance coverage.

We must also examine the systems that influence who gets hired, who gets promoted, who builds wealth, and who has access to opportunity.

Because sometimes the problem is not the resume.

Sometimes the problem is the environment in which the resume is being evaluated.

And until we address that reality, health equity will remain out of reach for far too many Black men.

Question for readers:
How should policymakers, employers, educational institutions, and community organizations work together to close employment gaps and improve health outcomes for Black men? Share your thoughts in the comments.

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Elevate,

Dr. Okey K. Enyia

Why This Matters

Every June, organizations across the country recognize Men’s Health Month by encouraging men to schedule annual checkups, exercise more, eat healthier foods, and prioritize their well-being.

Those efforts matter.

But if we are serious about improving men’s health—and particularly the health of Black men—we must also ask a deeper question:

What if the greatest barriers to health are not simply individual behaviors, but the systems that shape our lives?

Health does not begin in a doctor’s office.

Health begins where people live, learn, work, worship, play, and age.

Health is shaped by housing policies, educational opportunities, economic mobility, community safety, civic engagement, access to care, and whether people have a voice in the decisions that affect their lives.

That realization is why I am proud to officially launch the John Henry Institute for Black Men’s Health & Policy Innovation (JHI) during Men’s Health Month.

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Why the John Henry Institute?

Let me be very clear: specificity does not mean being exclusionary. This is not a zero-sum game where centering one group of individuals is intended to take away from any other group. That is part of the goal of structural racism — to create false binaries.

I am intentional about taking a dialectical (both/and) approach to ensuring that entire communities flourish and I unapologetically argue that Black men and boys should be the barometer.

Throughout my career, I have worked at the intersection of public health, health policy, government affairs, research, and advocacy.

I have served in Congress, state government, national nonprofit organizations, and academic research settings.

I have studied health disparities.

I have helped shape policy.

I have engaged communities.

Yet one reality became increasingly clear.

Black men are often visible in conversations about problems but invisible in conversations about solutions.

We are overrepresented in statistics related to chronic disease, premature mortality, violence, and economic instability.

Yet we remain underrepresented in research agendas, policy conversations, funding priorities, and decision-making spaces designed to address those very challenges.

The more I studied the evidence, the more I recognized that the issue was not simply healthcare.

The issue was infrastructure.

The systems influencing health outcomes were rarely designed with Black men intentionally in mind.

The Story Behind the Name

The Institute draws inspiration from the legendary figure John Henry. However, what I discovered while doing the research on my book, was that there were actually two real-life John Henrys.

Many know the story of John Henry as a tale of extraordinary strength.

I see it as a warning.

John Henry defeated the machine but died from exhaustion.

His story reflects a reality many Black men know all too well: being asked to work harder, carry more, endure more, and overcome more while receiving fewer structural supports.

For decades, researchers have examined this phenomenon through what became known as the John Henryism Hypothesis, which explores the health consequences of prolonged high-effort coping in the face of persistent social and economic adversity.

The lesson is simple.

Black men are the barometer.

Black men should not have to sacrifice their health in order to survive.

Thriving should not require exhaustion.

Success should not require suffering.

And equity should not depend on extraordinary resilience.

Our Vision

The John Henry Institute exists to build systems—not simply programs.

Our mission is to advance evidence-based policy, research, advocacy, and community-driven solutions that improve health, educational, and economic outcomes for Black men and boys.

We believe that improving Black men’s health requires more than treating disease.

Our work is to be the Chief Architect and Convener of systems-level policy and practice solutions, leading and partnering to advance community-informed strategies that improve outcomes for Black men and boys.

It requires addressing the conditions that produce health in the first place.

That means focusing on:

• Physical and mental health

• Housing and economic mobility

• Education and workforce development

• Civic engagement and political participation

• Violence prevention and community safety

• Fatherhood and family stability

• Data equity and community-centered innovation

A Different Approach

Too often, conversations about Black men focus exclusively on deficits.

We focus on what is wrong.

What is broken.

What is missing.

JHI will take a different approach.

We recognize challenges while also elevating strengths.

Black men are fathers.

Black men are caregivers.

Black men are entrepreneurs.

Black men are veterans.

Black men are faith leaders.

Black men are educators.

Black men are policymakers.

Black men are researchers.

Black men are innovators.

Black men are community builders.

Our work will center both the challenges Black men face and the tremendous assets Black men bring to our communities.

From Playbook to Action

The launch of JHI builds upon the foundation established through The John Henry Health Equity Playbook: A Four-Year Health Policy Agenda for Black Men.

The Playbook outlined a comprehensive vision grounded in three interconnected pillars:

1. Physical and Mental Health

2. Housing, Education, and Economic Stability

3. Civic Empowerment and Community Well-Being

The Institute now represents the next chapter.

Moving from ideas to implementation.

Moving from recommendations to action.

Moving from awareness to measurable impact.

What Success Looks Like

Success is not simply another report sitting on a shelf.

Success is:

• More Black men with a usual source of healthcare.

• More Black men accessing mental health services.

• More Black men graduating from college and workforce training programs.

• More Black men becoming homeowners.

• More Black men starting and scaling businesses.

• More Black men participating in civic life.

• More Black fathers receiving support and resources.

• More communities equipped to address violence before it occurs.

• More policymakers making decisions informed by evidence and community voice.

Success means building systems that allow Black men to thrive.

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An Invitation

The challenges facing Black men cannot be solved by any one organization.

They require collaboration across sectors and disciplines.

Researchers.

Healthcare providers.

Policymakers.

Community organizations.

Faith leaders.

Advocates.

Philanthropy.

Business leaders.

Educators.

And most importantly, Black men themselves.

As we enter Men’s Health Month, I invite you to join us.

The work ahead is ambitious.

But so is the opportunity.

Together, we can build a future where Black men’s health is not an afterthought, but a priority.

A future where Black men are not merely surviving systems, but helping shape them.

A future where health equity is not an aspiration, but a reality.

The John Henry Institute was created for that purpose.

And today, the work officially begins.

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Elevate,

Dr. Okey K. Enyia

Founder & CEO
John Henry Institute for Black Men's Health & Policy Innovation

Why this matters:

One of the most important questions in Black men’s health today is not whether policymakers are beginning to pay attention. It is whether we are building the infrastructure necessary to sustain that attention over time.

Recently, my colleague Dr. Dominick Shattuck published an analysis examining more than 225 policy actions related to boys’ and men’s health across all 50 states between 2015 and 2026. His central finding was both encouraging and cautionary: activity is increasing, but much of it remains fragmented, disconnected, and insufficiently institutionalized.

As I read the article, I found myself returning to a central premise of The John Henry Health Equity Playbook:

Health equity does not happen because policymakers suddenly become interested in an issue. Health equity happens when communities build enough civic power to make their priorities impossible to ignore.

This is precisely why the John Henry Institute for Black Men’s Health & Policy Innovation (JHI) exists.

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The Missing Link: Governance Infrastructure

The conversation around Black men’s health often focuses on individual programs:

• Mental health initiatives

• Violence prevention programs

• Fatherhood initiatives

• Workforce development efforts

• Chronic disease prevention campaigns

All of these matter.

However, programs without infrastructure often disappear when leadership changes, funding dries up, or political priorities shift.

Shattuck’s analysis suggests that many states are experimenting with policies related to boys and men but have not yet built durable governance systems capable of coordinating these efforts over time.

This observation aligns directly with one of the major recommendations within the John Henry Health Equity Playbook: the creation of permanent structures such as Offices of Men’s Health, cross-sector task forces, and institutionalized approaches to civic engagement and accountability.

The question is no longer:

“Do Black men face disparities?”

The evidence is overwhelming.

The question is:

“What systems are we building to address them?”

Health Is Political Whether We Like It or Not

One of the foundational frameworks in the Playbook is the Political Determinants of Health framework developed by Daniel Dawes. The framework reminds us that policies shape access to healthcare, housing, education, transportation, employment, and environmental conditions. These factors ultimately determine who lives longer and healthier lives.

In other words:

Policy is a health intervention.

The budget is a health intervention.

Voting is a health intervention.

Civic engagement is a health intervention.

Healthy People 2030 formally recognizes voter participation as a public health objective because communities that participate politically often experience better health outcomes and greater influence over resource allocation.

This is why JHI places civic engagement alongside physical health, mental health, economic stability, and fatherhood.

Moving From Awareness to Action

Many people care deeply about Black men’s health but are unsure where to start.

The good news is that civic engagement exists on a continuum.

Not everyone needs to run for office.

Not everyone needs to become a policy expert.

But everyone can do something.

Build Relationships

Policy change is fundamentally relational.

Develop relationships with:

• City council members

• State legislators

• Members of Congress

• School board members

• Public health officials

• Community leaders

The best time to introduce yourself to an elected official is before you need something.

Track Legislation

Policy moves quickly.

Set up alerts using legislative tracking platforms and monitor bills related to:

• Men’s health

• Mental health

• Medicaid

• Workforce development

• Education

• Violence prevention

• Fatherhood

The Playbook specifically encourages monitoring legislation and understanding the policy landscape before crises emerge.

Submit Testimony

One of the most underutilized tools in advocacy is public testimony.

Whether at the local, state, or federal level, testimony helps place lived experience into the public record.

Data tells policymakers what is happening.

Stories help policymakers understand why it matters.

Monitor Regulations

Many important decisions happen after legislation passes.

Agencies write regulations that determine how laws are implemented.

Public comment periods create opportunities for advocates, researchers, clinicians, and community members to shape implementation.

Contact Elected Officials

Calls and emails still matter.

Legislative offices track constituent engagement.

A consistent stream of communication can influence priorities, hearing topics, and legislative action.

Use Social Media Strategically

Social media should not replace civic engagement.

It should amplify it.

Share:

• Research

• Community stories

• Policy analyses

• Calls to action

• Public health resources

Awareness without action has limited impact.

Awareness paired with organizing can change systems.

Attend Town Halls and Public Meetings

Many important decisions occur in spaces where few people show up.

Attend:

• Town halls

• School board meetings

• Health commission meetings

• City council hearings

• State legislative forums

Visibility matters.

Schedule Quarterly Meetings With Policymakers

One meeting is advocacy.

Repeated meetings are relationship-building.

JHI’s long-term vision requires sustained engagement, not episodic engagement.

Create a Voting Plan

Voting should be intentional.

Vote:

• Up and down the ballot

• In primary elections

• In local elections

• In off-year elections

Many decisions affecting health occur at the state and local level.

Think Critically About Information

Information literacy is civic infrastructure.

Before sharing information:

• Verify sources

• Examine incentives

• Understand context

• Seek evidence

Healthy democracies require informed citizens.

Serve as a Poll Worker, Poll Judge, or Poll Watcher

Elections require infrastructure.

Serving in these roles helps protect the integrity and accessibility of the democratic process.

Volunteer for Civic Campaigns

Phone banking and canvassing remain among the most effective methods for increasing voter participation.

Participation builds political efficacy.

Political efficacy builds civic power.

Support Organizations Doing the Work

Not everyone has time to organize.

Many can support organizations through:

• Donations

• Membership

• Volunteering

• Fundraising

• Strategic partnerships

Work on a Campaign

Campaigns provide a practical education in how policy change occurs.

Skills learned include:

• Messaging

• Coalition-building

• Community outreach

• Data analysis

• Relationship management

These skills transfer directly into public health advocacy.

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What This Means for JHI

For the John Henry Institute, Shattuck’s analysis reinforces three priorities:

1. Build Infrastructure, Not Just Programs

Programs matter.

Institutions endure.

Our focus must include sustainable structures such as Offices of Men’s Health, policy coalitions, research networks, and community accountability systems.

2. Develop Civic Capacity

Health equity requires civic engagement.

Communities cannot outsource advocacy to experts alone.

We must build a culture where Black men understand how policy is made and how to influence it.

3. Create Long-Term Governance Solutions

Countries such as Ireland and England have increasingly recognized men’s health as a distinct area of public policy requiring dedicated strategies and accountability structures.

The United States has an opportunity to do the same.

The question is whether we are willing to build the systems necessary to support it.

Final Thought

The legend of John Henry teaches us about strength.

The future of Black men’s health requires something more.

It requires strategy.

It requires institutions.

It requires civic power.

Most importantly, it requires ordinary people taking extraordinary responsibility for the communities they love.

As I wrote in The John Henry Health Equity Playbook:

“If you choose not to participate in civic engagement and the political process, you only make it easier for people to make decisions for you.”

The future of Black men’s health will not be determined solely in hospitals, clinics, or research centers.

It will also be determined in city halls, state capitols, congressional offices, school board meetings, voting booths, and community organizations.

Health equity is not simply a health issue.

It is a civic issue.

And civic engagement is one of the most powerful public health interventions available to us.

Elevate,

Dr. Okey K. Enyia

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A recent article from Capital B News explored an important and evolving political reality: Black men are not politically monolithic, increasingly skeptical of both parties, and deeply concerned about whether the political system is materially improving their lives.

That skepticism did not emerge in a vacuum.

For decades, Black men have been asked to continuously navigate systems that were often never intentionally designed with our realities, health outcomes, economic conditions, or lived experiences in mind. We are consistently encouraged to vote, engage, trust institutions, seek care, participate civically, and “do our part,” while the burden of adaptation remains disproportionately on us.

But what if we reframed the question?

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What if the responsibility shifted from asking Black men to continuously navigate broken systems toward requiring political institutions, policymakers, healthcare systems, and civic structures to meaningfully and sustainably meet Black men where we already are?

That is the deeper challenge heading into the 2026 midterm elections.

As I wrote in The John Henry Health Equity Playbook, civic engagement is not separate from health equity. It is one of its core determinants. “A civically engaged community is a healthy community.”

The issue before us is not simply whether Black men will vote.

The issue is whether the political apparatus is prepared to build the kind of long-term civic infrastructure, accountability systems, and material investments necessary to earn sustained trust.

The Five Questions Framework

As we approach 2026 and beyond, I believe Black men, policymakers, institutions, philanthropies, advocates, and civic leaders must grapple with five strategic questions.

1. What is broken — and irreparable?

Some systems were not built to fully account for Black men’s humanity, complexity, or long-term well-being.

We see this across:

• healthcare access

• mental health systems

• workforce pipelines

• educational attainment

• housing policy

• research prioritization

• civic representation

• economic opportunity structures

The question is not whether disparities exist.

The question is whether some institutional models are so deeply rooted in inequity that incremental reform alone will never produce transformational outcomes.

Some systems may not merely require improvement.

They may require redesign.

2. What is broken — and can be fixed?

Not every institution is irredeemable.

Some systems suffer from fragmentation, underinvestment, weak accountability, poor implementation, or failure to build trust.

This is where meaningful governance matters.

There are practical opportunities to improve:

• culturally responsive mental health services

• Black male workforce development pathways

• Medicaid access

• fatherhood support initiatives

• violence prevention ecosystems

• community health infrastructure

• voter engagement systems

• educational and technical training pipelines

Local and state governments already possess many of the tools necessary to operationalize these solutions.

The question is whether there is sustained political will to prioritize them.

3. What is broken — and must be fixed differently?

This may be the most important question.

Too often, Black men are approached primarily through deficit-based narratives:

• violence

• pathology

• disengagement

• absenteeism

• criminalization

• risk

But Black men are also:

• fathers

• caregivers

• entrepreneurs

• veterans

• faith leaders

• organizers

• healthcare professionals

• educators

• mentors

• innovators

• community stabilizers

We cannot continue using outdated frameworks to solve modern problems.

The future requires ecosystem thinking instead of siloed interventions.

Meeting Black men where we are means building around trusted institutions and existing community ecosystems:

• barbershops

• fraternities

• faith institutions

• recreation centers

• community colleges

• mentorship organizations

• neighborhood leaders

• culturally competent providers

The political apparatus should stop asking:

“How do we get Black men to trust systems?”

And start asking:

“Why aren’t systems investing in the places and relationships Black men already trust?”

That is a fundamentally different governance philosophy.

4. What survives — and needs to be broken?

Not everything that survives deserves preservation.

Some political behaviors survive because they are institutionally convenient:

• election-year engagement without long-term investment

• symbolic visibility without structural accountability

• temporary outreach without permanent infrastructure

• fragmented programming without measurable outcomes

• rhetoric without material investment

Black men do not simply need more awareness campaigns.

We need durable civic architecture.

That means:

• sustained funding

• measurable accountability

• policy implementation tracking

• long-term institution building

• cross-sector coordination

• public dashboards and evaluation systems

Without accountability, Black men remain rhetorically visible while operationally invisible.

5. What survives — and must be sustained?

Despite every structural challenge, Black men continue building:

• families

• businesses

• mentorship pipelines

• civic organizations

• faith communities

• social movements

• cultural institutions

• prevention ecosystems

That resilience matters.

But resilience should never become the policy strategy.

What must be sustained includes:

• intergenerational leadership development

• civic engagement infrastructure

• culturally grounded wellness practices

• trusted community institutions

• fatherhood and mentorship ecosystems

• educational advancement

• economic mobility pathways

• coalition-building across sectors

Most importantly, we must sustain belief in our collective ability to shape systems instead of merely surviving them.

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The Political Apparatus Must Evolve

The responsibility cannot rest solely on Black men to “engage harder.”

The sociopolitical governance structure itself must provide tangible, meaningful, and sustainable reasons for Black men to participate civically and electorally.

That means moving beyond transactional election-cycle outreach and demonstrating:

• measurable improvements in community conditions

• sustained investment in Black communities

• transparent accountability

• responsive governance

• culturally grounded policy implementation

• visible pathways to economic mobility, health, safety, and opportunity

Black men should not be expected to participate based solely on symbolism, partisan loyalty, fear, or rhetoric.

Participation deepens when people can clearly see that governance structures are materially connected to improving their lived realities.

Trust cannot simply be requested.

It must be earned through consistency, accountability, and outcomes.

That means:

• local governments funding trusted-community prevention ecosystems

• states institutionalizing Black male health equity metrics

• healthcare systems investing in culturally responsive care

• federal agencies coordinating long-term men’s health strategies

• philanthropies funding infrastructure instead of one-off programming

• policymakers tying civic engagement to tangible material outcomes

Because politics is not abstract.

Politics determines:

• healthcare access

• public safety

• housing quality

• transportation systems

• school funding

• workforce opportunities

• environmental exposure

• mental health infrastructure

• neighborhood investment

In other words:
policy shapes daily life.

Why This Matters Beyond Black Men

Black men are often early indicators of broader systemic instability.

When systems fail Black men, those failures frequently foreshadow larger societal fractures:

• labor market instability

• healthcare inequities

• educational exclusion

• civic distrust

• public health crises

• violence exposure

• economic displacement

Which means:
if systems become responsive enough to meaningfully support Black men, those systems often become better for everyone.

That is targeted universalism in practice.

Call to Action

As we move toward the 2026 midterms, Black men must continue organizing, building, voting, mentoring, advocating, and leading.

But institutions must also evolve beyond symbolic engagement.

We should demand:

• measurable accountability

• sustained investment

• permanent civic infrastructure

• culturally grounded prevention ecosystems

• long-term policy commitments

• meaningful partnership in governance and implementation

Black men should not merely be treated as populations needing intervention.

We should be recognized as:

• governance stakeholders

• civic infrastructure partners

• policy co-designers

• prevention ecosystem leaders

• trusted messengers

• democratic assets

The future of Black men’s health is not simply about healthcare.

It is about power.

Political power.
Economic power.
Narrative power.
Institutional power.
Community power.

And the question before us is not simply whether Black men will participate.

The question is whether America is prepared to build systems worthy of that participation.

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Elevate,

Dr. Okey K. Enyia

A recent policy brief developed by the Alpha Political Action Committee (Alpha PAC) helped sharpen my thinking around the Supreme Court’s decision in Louisiana v. Callais. What resonated with me was its willingness to move beyond surface-level legal analysis and wrestle with a deeper question: what does it mean for America to claim racial progress while systems continue producing racially inequitable outcomes? That question sits at the heart of health equity work and directly connects to themes explored throughout The John Henry Health Equity Playbook.

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One of the most revealing lines in The Policy Pulse following the Supreme Court’s decision in Louisiana v. Callais argued:

“There may be an argument that we are post-racial. There is no argument — none supported by evidence — that we have achieved anything we could honestly call post-racist.”

At first glance, that framing sounds intellectually balanced and politically moderate.

But the more I sat with it, the more I realized something important:

I would argue that America is not becoming more post-racial.

What we are witnessing is not the disappearance of race.
It is the evolution of how race operates.

Race has not become less relevant.
It continues to become more structurally embedded, politically coded, legally sanitized, economically adaptive, and rhetorically disguised.

In many ways, America did not move beyond race.
America simply became more sophisticated at managing the appearance of racial progress while preserving many of the underlying inequitable outcomes.

And that distinction matters tremendously for Black men’s health, political power, and long-term well-being.

The Problem With “Post-Racial”

The phrase “post-racial” suggests that race no longer meaningfully structures opportunity, vulnerability, power, or outcomes.

But nearly every major social indicator contradicts that claim.

Black men continue to experience:

• lower life expectancy

• higher chronic disease burdens

• disproportionate homicide rates

• higher rates of uninsured status

• lower access to mental health services

• lower representation in medicine and research

• persistent wealth gaps

• disproportionate incarceration

• environmental inequities

• educational disparities

The John Henry Health Equity Playbook was written precisely because these disparities remain systemic, measurable, and deeply entrenched.

If race no longer mattered structurally, these outcomes would not remain so predictably racialized across generation after generation.

What Changed Was The Language

What often gets interpreted as “post-racial” is frequently just a shift in public language, branding, and presentation.

America became more comfortable condemning explicit racism while becoming increasingly uncomfortable discussing structural racism.

The result is a society where:

• diversity can be celebrated while inequity persists

• representation can increase while power remains concentrated

• symbolic inclusion can coexist with material exclusion

• racial progress can be marketed while racial disparities remain operational

That is not post-racialism.

That is reputational adaptation.

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Louisiana v. Callais Reveals The Reality

The Supreme Court’s ruling in Louisiana v. Callais exposed how fragile many racial protections still are.

According to The Policy Pulse, the Court weakened the enforceability of Section 2 of the Voting Rights Act while formally leaving it intact.

Then almost immediately:

• Louisiana suspended a primary election midstream after thousands had already voted

• Tennessee moved against its only majority-Black congressional district

• Florida advanced maps expected to consolidate additional political power

• Alabama and South Carolina initiated new legal and legislative maneuvers tied to the ruling

The Policy Pulse report summarized the moment bluntly:

“The 2026 midterms are being redrawn in real time.”

This is not abstract constitutional theory.

This is structural power moving at operational speed.

And these decisions do not happen in isolation. They occur within a broader ecosystem of voter suppression tactics that continue shaping political participation across the country:

• restrictive voter ID laws

• voter roll purges

• polling place closures

• reduced early voting periods

• limits on mail-in voting

• long lines and excessive wait times

• weakened judicial protections for voters

When these barriers accumulate simultaneously, they disproportionately burden communities already navigating structural inequities in healthcare, transportation, employment, housing, and education.

The Court Saw Progress and Mistook It for Transformation

One of the strongest parts of The Policy Pulse analysis was its critique of the Court’s logic.

The report argued the Court made three critical errors:

1. It saw progress and confused it with arrival.

2. It misread the underlying voter participation data.

3. It used evidence produced by the Voting Rights Act itself as justification for weakening the Act.

The publication’s levee analogy captured this perfectly:

“You don’t dismantle the levee because the city stayed dry during the last storm.”

That may also describe how America often approaches racial equity more broadly.

We point to visible examples of progress while ignoring the systems still producing unequal outcomes underneath the surface.

“Color-Blind” Systems Often Produce Predictably Unequal Outcomes

One of the most important sections of The Policy Pulse dismantled the myth that “color-blind” policymaking automatically produces fairness.

Louisiana’s Black population is approximately 33%, yet Black voters initially received only one out of six congressional districts — roughly 17% representation.

The report responded directly to the idea that race-conscious districting itself is discriminatory:

“Refusing to see race doesn’t make racism disappear. It makes racism uncontestable.”

That principle extends far beyond voting rights.

We see similar patterns across:

• healthcare access

• maternal mortality

• educational funding

• home appraisals

• AI bias

• environmental exposures

• lending practices

• workforce representation

• criminal justice

The systems may no longer always announce racial intent explicitly.

But outcomes continue to distribute risk, burden, opportunity, and protection along racial lines with remarkable consistency.

Why This Matters for Black Men’s Health

In The John Henry Health Equity Playbook, I argued that civic engagement is not peripheral to health equity. It is central to it.

Voting shapes:

• healthcare access

• Medicaid expansion

• violence prevention funding

• environmental protections

• housing policy

• educational opportunity

• economic investment

• public health infrastructure

The Political Determinants of Health framework reminds us that policy decisions shape the conditions in which people live, work, learn, worship, and age.

When political representation weakens, communities often lose influence over the very systems shaping their survival.

That matters because Black men already experience disproportionately poor outcomes across multiple domains:

• chronic disease

• homicide

• mental health

• insurance coverage

• educational attainment

• economic stability

Those disparities are not disconnected from political power.

They are deeply connected to it.

America Did Not Become Post-Racial. Race Became More Institutional.

This may be the more honest framing.

Race today often operates less through overt declarations and more through:

• institutional design

• legal interpretation

• political geography

• economic distribution

• zoning decisions

• healthcare infrastructure

• educational stratification

• algorithmic bias

• policy omission

The language evolved.
The systems adapted.
The outcomes persisted.

That is not evidence of a post-racist society.

It is evidence that inequity evolved faster than many people’s frameworks for recognizing it.

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What Must Happen Next

This moment requires more than outrage.

It requires infrastructure, strategy, organization, and sustained civic engagement.

That means:

• building authentic relationships with elected officials at the local, state, and federal levels

• setting up bill tracking alerts and monitoring legislation in real time

• tracking regulatory guidelines and agency actions

• submitting written testimony and testifying before elected officials and public bodies

• calling and emailing elected officials consistently, not just during election cycles

• attending town halls, public hearings, and rallies

• posting credible information on social media platforms

• thinking critically about the information we consume and share

• creating a voting plan that focuses up and down the ballot

• serving as poll watchers or poll judges

• phone banking and canvassing

• working on campaigns

• coordinating community fundraisers

• donating to civic and advocacy organizations advancing equity and democratic participation

• scheduling quarterly meetings with elected officials to maintain accountability and relationships over time

These are not separate from health equity work.

They are health equity work.

As I wrote in The John Henry Health Equity Playbook:

“If you are not at the decision-making table, you are on the menu.”

The challenge before us is not whether race still matters.

The data already answered that question.

The real challenge is whether we are willing to confront how modern systems continue reproducing racial inequity while simultaneously insisting that race is becoming less relevant.

That contradiction may be one of the defining public health and policy crises of our time.

Elevate,

Dr. Okey K. Enyia

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Why this matters

The Supreme Court’s latest decision in Louisiana v. Callais is being framed as a redistricting case.

Not in its totality.

It is a decision about power.
And power determines policy.
And policy determines health.

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What the Court Did

In a 6–3 decision, the Court struck down Louisiana’s congressional map that included a second majority-Black district.

According to coverage from SCOTUSblog, the Court ruled that even when states attempt to comply with the Voting Rights Act, race cannot be the predominant factor in drawing districts. It also raised the legal bar for future claims, requiring plaintiffs to prove intentional discrimination, not just unequal outcomes.

In practice, that is a much harder standard to meet.

What This Really Means

This decision does not eliminate the Voting Rights Act.

But it fundamentally changes how it works.

It shifts the burden:

• From outcomes → to intent

• From structure → to proof

• From access → to litigation strategy

And that shift matters.

Because intent is difficult to prove.
And structure is where inequity often lives.

The Representation Gap (Data That Matters)

Let’s be clear about what is at stake.

• Black Americans make up 13.6% of the U.S. population, according to the U.S. Census Bureau.

• There are currently 62 Black members of the U.S. House, many elected from majority-Black districts, as tracked by the Congressional Black Caucus.

• In Louisiana, Black residents make up roughly one-third of the population, based on Census data.

That is the core issue:

District lines determine whether population translates into representation.

The Scale of the Impact

Analysis from Fair Fight Action and Black Voters Matter Fund projects:

• Up to 19 U.S. House seats could shift directly due to weakened Voting Rights Act protections

• As many as 27 seats total when combined with mid-decade redistricting efforts

• 13–16 members of the Congressional Black Caucus could be at risk

• Approximately 191 state legislative seats—many held by Black lawmakers—could be eliminated across the South

At the state level:

• Black-majority legislative districts in the South could drop from 273 to 146

• That is nearly half of all Black-majority districts

These are not abstract numbers.

They represent a generational shift in representation.

Why Representation Matters Beyond Politics

Representation is not just about who holds office.

It is about what gets prioritized.

Research consistently shows that Black elected officials are more likely to advance legislation on:

• voting rights

• economic equity

• education funding

• criminal justice reform

• and health disparities

When representation declines, so does attention to these issues.

____________________________________________________________________________

The Health Connection Most People Are Missing

This is not just a democracy issue.

It is a public health issue.

Because policy decisions directly shape health outcomes:

• Medicaid covers over 80 million Americans, according to the Centers for Medicare & Medicaid Services.

• Black adults are more likely to rely on Medicaid for coverage, as shown by the Kaiser Family Foundation.

• Medicaid expansion has been associated with:

  • Lower uninsured rates

  • Increased access to preventive care

  • Improved chronic disease management, as summarized by KFF research.

At the same time:

• Black men have a life expectancy of about 72.8 years compared to 77.5 years for White men, according to the CDC.

• Black Americans experience higher mortality from heart disease, cancer, and diabetes, as documented by the CDC’s health disparities data.

• Black communities face higher exposure to environmental hazards and underinvestment, as reported by the Environmental Protection Agency.

These outcomes are not random.

They are policy-driven.

Civic Engagement and Health Outcomes (The Evidence)

Research consistently shows:

• Communities with higher voter participation experience better health outcomes and more responsive policy environments, as highlighted by the Healthy Democracy Healthy People initiative.

• The federal government now recognizes civic engagement as a public health priority:

  • Healthy People 2030 includes civic participation as a core objective.

Why?

Because voting influences:

• Healthcare funding

• Hospital access

• Environmental protections

• Education investment

• Economic opportunity

This Is Exactly What the Playbook Warns About

In The John Henry Health Equity Playbook, I argue that:

• Civic engagement is a determinant of health

• Political power shapes access to care, housing, and economic opportunity

The economic stakes reinforce this:

• Racial and ethnic health disparities cost $421 billion annually, according to research highlighted by the National Institutes of Health.

• Health inequities tied to education cost nearly $940 billion, as noted in analyses from organizations like Deloitte.

When representation is diluted,
those inequities are harder to address.

The Strategic Shift

This ruling signals a transition:

From:

• Legal protection as the primary safeguard

To:

• Civic engagement as the primary lever

The courts are not removing the system.

They are redefining how you navigate it.

What Comes Next

We should expect:

• More redistricting battles framed as “partisan,” not racial

• Fewer successful Voting Rights Act challenges

• Increased importance of local and state elections

Because increasingly:

Power will be decided upstream, not corrected downstream.

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Closing

If health is shaped by policy,
and policy is shaped by power,
then voting rights are not just civil rights.

They are health equity infrastructure.

The question is no longer whether the law protects representation.
The question is whether we are prepared to protect it ourselves.

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Elevate,

Dr. Okey K. Enyia

Why this matters

There is a growing conversation about how Black men are perceived in politics. But what is often framed as a “perception gap” is actually something much deeper and more consequential.

It is a policy failure.

Because how a group is perceived directly shapes how systems respond to them. And when those perceptions are incomplete, distorted, or outdated, the policies that follow are just as misaligned.

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The real issue: misalignment, not absence

Black men are not disengaged. They are structurally underrecognized.

They are voting, organizing, building, leading families, and driving culture. Yet policy frameworks often fail to account for this complexity. Instead, they rely on outdated narratives that treat Black men as problems to manage rather than stakeholders to engage.

This misalignment creates a predictable cycle:

Misperception leads to underinvestment.
Underinvestment leads to uneven outcomes.
Uneven outcomes are then used to justify the original misperception.

This is not just a communications issue. It is a systems issue.

Where policy gets it wrong

In the John Henry Health Equity Playbook, I argue that civic engagement is a critical, yet often overlooked, determinant of health. Communities that are seen, heard, and engaged are better positioned to influence decisions around healthcare, housing, education, and economic opportunity.

But engagement alone is not enough.

Systems must also be designed to accurately interpret that engagement.

Otherwise, we create a dynamic where Black men are participating in systems that are not fully responsive to them. The result is not a lack of effort, but a lack of alignment between participation and policy response.

A case study in misalignment: the Affordable Care Act

The issue is no longer whether Black men are showing up.

The issue is whether our systems are calibrated to see them clearly.

Until we address that, we will continue to design policies that are technically sound but fundamentally misaligned.

For example, my doctoral research examining the Affordable Care Act illustrates this clearly. The ACA reduced uninsured rates by nearly 50% for both Black and White men, yet disparities persisted. Black men still had significantly higher odds of being uninsured and were less likely to have a usual source of care, a critical gateway to preventive services, chronic disease management, and long-term health outcomes.

In other words, coverage increased, but equitable access did not.

Race remained an independent predictor of access, even after one of the most significant health policy interventions in modern history.

This is the distinction we often miss. Expanding insurance is necessary, but it is not sufficient. Even well-designed, large-scale policies can improve overall outcomes while failing to close structural gaps.

What this means for policy design

If we are serious about closing gaps in health, economic stability, and opportunity, we need to rethink how policy is designed.

This means:

1. Moving from assumptions to precision
We must use disaggregated data and intersectional analysis to understand how different groups experience policy in practice.

2. Embedding lived experience into policy design
Lived experience should not be an afterthought. It should shape how problems are defined and how solutions are built.

3. Treating civic engagement as infrastructure
Civic participation is not symbolic. It is a mechanism through which communities influence the conditions that determine their health and well-being.

4. Advancing targeted universalism
Universal goals require targeted strategies. Equity is not achieved through one-size-fits-all approaches.

5. Building structural accountability into policy
We must evaluate not just whether policies work, but for whom they work and under what conditions.

Where we go from here

The issue is not whether Black men are engaged.

The issue is whether our systems are designed to recognize, respond to, and invest in that engagement effectively.

Until we address that, we will continue to produce policies that are technically sound, politically viable, and broadly beneficial, yet fundamentally misaligned for those who experience the greatest gaps.

And misaligned systems do not produce equitable outcomes.

They reproduce the very disparities we claim to solve.

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Final thought

If we want different outcomes, we need different inputs.

Not just more data.
Better data.
Not just more policy.
Better design.

Because who policy sees clearly determines who policy serves effectively.

Elevate,

Dr. Okey K. Enyia

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I sat with this news all day yesterday and today — processing it, grappling with it.

A fraternity brother. Someone I knew personally in professional circles.
A life lost. A life taken.
Children who will now live with a permanent fracture in their story. His teenage son called 911.

There are no words that make sense of that.

This is heartbreaking. Devastating. Complex.

And we have to be honest about all of it.

I do not condone what happened. Full stop.

Let me be equally clear about what I am and am not saying. I am not excusing violence. I am not attributing this solely to mental health. And I am not minimizing the impact on his wife, his children, and everyone affected. What I am saying is that if we only focus on the outcome, we will continue to miss opportunities for prevention.

But if we stop there, we miss the deeper truth. And the deeper responsibility.

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Holding Two Truths at the Same Time

We live in a moment where people will rush to flatten this story.

Some will reduce him to his worst act.
Others will try to over-contextualize it.

Neither approach gets us closer to prevention.

This moment requires something harder:

Accountability and root cause analysis.

Scripture reminds us:

“Search me, O God, and know my heart; test me and know my anxious thoughts.” (Psalm 139:23, WEB)

If we are serious about protecting families, we must be serious about examining what leads to moments like this before they happen.

What We Know and What We Ignore

Emerging research shows that murder-suicide events are more common than previously understood and often involve intimate partners, firearms, and a history of escalating stressors and warning signs.

At the same time, not all domestic violence is caused by mental illness. That distinction matters.

To be clear, naming mental health as a contributing factor is not the same as assigning it as the cause. Violence is a choice. Accountability remains. But ignoring the conditions that precede that choice limits our ability to intervene earlier.

But what also matters is this:

Unaddressed mental health challenges, compounded by stress, isolation, and access to lethal means, can create catastrophic outcomes.

In this case, reports point to concerns about mental health, prior incidents, legal stress, and a highly public life under scrutiny.

That combination is not unique.
It is just rarely addressed early enough.

What makes this even more painful is knowing that Justin did have people in his life he confided in, people who encouraged him to seek support. And yet, the stress became relentless. And this was the outcome.

This is not to suggest that support does not work. It is to highlight that encouragement alone is not always enough when stress becomes cumulative, systems are fragmented, and coping mechanisms are underdeveloped.

The High-Functioning Myth

One of the most dangerous dynamics we face, especially among Black men, is this:

You can be high-functioning and deeply unwell at the same time.

You can be a leader. A provider. A public figure.
And still be struggling with depression, anxiety, trauma, and unresolved pain.

I know this personally.

I have written and spoken openly over the past several years across the country about navigating at different points in my life: depression, anxiety, unprocessed trauma and post-partum depression as a Black man.

And I do that intentionally.

Because what we normalize, we make safe to address.
What we stigmatize, we drive underground.

The Structural Reality

Let’s be clear. This is not just about individual choices.

It is also about systems.

According to the American Psychological Association, only about 4 percent of psychologists in the U.S. are Black.

That matters.

Because access is not just about availability.
It is about cultural alignment, trust, and relevance.

Support must also be affordable and culturally resonant.

Research consistently shows that men, in general, are less likely to seek mental health support. When they do, it is often later, during crisis points, and through non-traditional pathways.

For Black men, this is compounded by:

• Stigma

• Structural barriers to care

• Lack of culturally competent providers

• Norms around emotional suppression

• Pressure to perform and provide

The result?

Isolation. Rumination. Suppression.

And sometimes, tragic outcomes.

Public Life vs. Private Struggle

There is another layer we have to name.

The public/private dichotomy.

When professional identity becomes the primary source of validation, what happens when it is disrupted?

Loss of status. Legal battles. Public scrutiny.
Custody disputes. Relationship breakdowns.

These are not just events.

They are identity shocks.

And without the emotional infrastructure to process them, they can destabilize everything.

Men, Connection, and the Illusion of “Being Good”

Here is something I have learned in my own journey:

Men often go together.
But we are not always being together.

Meaningful connection matters.

We gather. We network. We build.

But we do not always connect.

We do not always say:

• “I am not okay.”

• “I am struggling.”

• “I need help.”

And if we do not name it, we cannot address it.

“Confess your sins to one another, and pray for one another, that you may be healed.” (James 5:16, WEB)

There is power in naming.

There is healing in community.

Where Do Black Men Actually Go for Support?

Let’s be practical.

Black men are already seeking support.

Just not always in clinical settings.

They are going to:

• Barbershops (there has been movement in training barbers to be “early first responders”)

• Fraternities

• Cigar lounges

• Faith communities

• Group chats

• Travel groups

In many cases, the church remains one of the most trusted spaces, where pastors often provide informal counseling and support.

At the same time, the church is just one form of community. We are all spiritual beings navigating meaning, purpose, and connection in different ways. Support can and should exist across multiple spaces, and this is not about prescribing one path, but about expanding access to spaces where people feel seen, safe, and supported.

As Dr. Na’im Akbar has long emphasized, healing for Black communities must be grounded in cultural, historical, and communal context, not just clinical frameworks.

We have to meet men where they are.

Reimagining Mental Health for Black Men

If we are serious about prevention, we have to rethink the system.

This means:

• Expanding culturally competent care

• Investing in community-based mental health models

• Normalizing therapy and emotional expression

• Creating safe spaces for vulnerability

• Integrating faith, culture, and clinical care

This is not about replacing clinical care with community or faith-based approaches. It is about integrating them in ways that reflect how people actually live, process, and seek support.

It also means embracing new realities.

Recent insights suggest that some men are turning to tools like AI because it removes stigma and judgment. (Disclaimer: AI has the potential to expand access to mental health support through scalable, low barrier tools, but it must be positioned as a complement, not a replacement, for human care. Without intentional oversight, equity centered design, and clear accountability, these technologies risk reinforcing the very disparities they aim to address).

That tells us something important:

Men want support.
They just want it in ways that feel safe.

The Role of Community and Ubuntu

We cannot individualize what is fundamentally communal.

Ubuntu teaches us:

“I am because we are.”

You cannot be your best self by yourself.

We need:

• Healing circles

• Brotherhood spaces

• Intergenerational dialogue

• Family-centered interventions

Because the impact of this tragedy will not stop with one moment.

It will ripple across:

• Children

• Families

• Communities

• Systems

Faith, Formation, and Responsibility

As a man of faith, I also believe this:

God is not absent from hard conversations.

“Be sober and self-controlled.” (1 Peter 5:8, WEB)

“A prudent man sees danger and takes refuge.” (Proverbs 22:3, WEB)

We are called to:

• Be aware

• Be accountable

• Be responsible for how we show up

Not just for ourselves.

But for those we love.

From Grief to Action

This is where my work comes in.

In The John Henry Health Equity Playbook, I argue that mental health, violence prevention, and community support must be addressed together, not in silos.

We need policy and practice that:

• Expands access to mental health services

• Builds community-based support systems

• Addresses social drivers of stress and instability

• Invests in fatherhood and family stability

• Treats violence as a public health issue

Because by the time we get to violence, we have already missed multiple opportunities for intervention.

A Personal Note

The same day I found out about this, I had a scheduled therapy session with my Black male psychologist.

I did not plan that.

But I needed it.

I needed space to process:

• The shock

• The grief

• The questions

And I am grateful I had access to that space.

Not every man does.

Final Thought

This is not just about one person.

This is about all of us.

How we show up.
How we process.
How we support one another.

And how we intervene before it is too late.

We owe that to the children.
We owe that to our communities.
We owe that to ourselves.

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Call to Action

If you are a man reading this:

• Check on yourself

• Check on your brother

• Get support before you need it

If you are a policymaker, advocate, or leader:

• Invest in culturally competent mental health care

• Fund community-based solutions

• Build systems that meet men where they are

This is not about choosing between accountability and compassion. We need both.

If you or someone you know is in crisis or needs immediate support, you can call or text 988, the Suicide and Crisis Lifeline (https://988lifeline.org/). Additional resources include the National Alliance on Mental Illness (NAMI), the American Psychological Association (APA), and Mental Health First Aid (https://mentalhealthfirstaid.org/organizations/employers/), which provides tools for individuals and workplaces to recognize and respond to mental health challenges.

Here is a resource on domestic violence.

For culturally relevant resources focused on young people and communities of color, The Steve Fund (https://stevefund.org/resources/) offers critical support and guidance.

Because the urgency is now.

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Elevate,

Dr. Okey K. Enyia