Najha Marshall knew early on her passions for social justice and science would have a strong influence on her life. After a lupus diagnosis at the age of 7 and growing up in the grips of a flawed health care system, deciding what she wanted to write her honors thesis about was not a difficult decision.
Recounting her own struggles with lupus treatment, Marshall, who graduated from Texas State in December 2020 with a Bachelor of Science in microbiology, approaches the issue of health inequalities through a social justice lens. Her Honors College thesis, “How Lupus Crossed the Color Line: Chronic Illness and the Reproduction of Racism in Health Care,” addresses the treatment and diagnostic disparities faced by women of color with lupus.
“I've personally experienced growing up and having to constantly deal with the health care system,” Marshall says. “I was always very interested in social justice activism, and I knew that I wanted to write something about the health care system and how it relates to racism so, with my thesis, I was able to tie in both of my passions.”
Lupus is a chronic, autoimmune disease known for causing pain and inflammation throughout the body. Because lupus is an autoimmune disease, the body system of people diagnosed with the disease attacks healthy tissue rather than fights infections.
According to the Lupus Foundation of America, nine out of every 10 people diagnosed with lupus are women. The disease is also three times more common in African American women than in Caucasian women; studies show 1 in 250 African American women will develop lupus.
The reason why lupus is more common in Black women is unknown. Some scientists suggest hormones, stress and environmental factors play a role in the diagnosis.
Marshall’s motivation for completing her thesis stems from her belief that addressing racial disparities in health care could lead to a decline in women of color developing lupus.
“The central theme of my thesis is that Black women get diagnosed with lupus way more than white women or any other group because they are the ones who are the most subject to stress and racism in this country,” Marshall says. “What I'm really trying to argue is that racism is causing Black women to be diagnosed with lupus three times more than white women and, unless we fix the issues of racism and the effects it has, we're just going to continue to see staggering health inequalities.”
Marshall says the health inequalities become more obvious when looking at the rates at which different subgroups are diagnosed with the disease. She says Black people are diagnosed with the disease the most, followed by Latinx and Asian people.
“You're not going to develop lupus until something triggers it, even if you do have a genetic predisposition," Marshall says. "The main trigger for lupus is stress and people of color experience more stress than non-people of color.”
Adrienne Kohlenberg, patient services marketing manager for the Lone Star Chapter of the Lupus Foundation of America, an organization with a mission to improve the quality of life for all people impacted by lupus through research, education and support, says Marshall’s work sets a great example for lupus advocacy.
“Our target population here where we serve is mostly African American women and Hispanic women,” Kohlenberg says. “Advocacy, in general, is important no matter what color you are, but I think that it’s much more important for lupus patients who are women of color to engage in it because it affects them so much more severely.”
Access to health care, or lack thereof, is another reason Marshall cites for why lupus disproportionately impacts women of color. It is imperative, she says, to ensure everyone has access to the best health care professionals regardless of their insurance status. Because lupus is a disease that is not universally understood, she says having access to an innovative and attentive medical staff could make all the difference.
“At the end of the day, health care deals with people's lives, and whenever you have people being treated differently, it becomes a human rights violation," Marshall says. "If we're saying that everybody should have the right to life and liberty, that includes health care because everyone cannot have equal access to their life when they don't have equal access to the means to take care of their health.”
John Mckiernan-Gonzalez, a professor in the Department of History and Marshall’s thesis adviser, supports her research and provided her with historical perspectives to complement her study.
“Najha is deeply driven, incredibly bright and very committed to having her research connect with social justice concerns,” Mckiernan-Gonzalez says. “Honors thesis projects are a learning journey for both the student and the adviser, and as a historian, I felt it was my job to provide her with models of how people have addressed issues like this in the past.”
Mckiernan-Gonzalez believes Marshall’s approach to writing about the health care disparities faced by lupus patients of color provides a valuable perspective to the discourse.
“It was surprising to see how little research was actually done on lupus, and it was really interesting to see the way that conversations about lupus and the positions of African American women in U.S. society are changing,” Mckiernan-Gonzalez says. “When people hear of a disease, they can sometimes assume there is a direct connection between the disease and the community and don't stop to look at the way that the disease appeared. Najha’s work shows that they're not taking social and emotional triggers seriously enough to understand the prevalence of lupus and diagnostic prevalence of lupus among Black and even Latina women in this country.”
Marshall believes addressing the treatment and diagnostic disparities of lupus is a multifaceted issue that must be confronted from multiple angles. The American Medical Association recently recognized racism as a public health concern, which she says can help in the effort to educate doctors on racism in health care.
“Chronic pain is one of the main symptoms of lupus, and it’s been shown that doctors are more likely to think that patients of color can handle more pain so they're more likely not to take their pain seriously,” Marshall says. “We have to look at how well we are listening to patients of color and addressing racism in that way as well.”
As an alumna who worked heavily with the Pan African Action Committee and the Black Lives Matter movement at Texas State, Marshall feels the racist roots of the health care problem need attention in a way that addresses complexities; a way that also promotes community involvement.
“I feel like many people don't really realize that racism has a vast variety of effects,” Marshall says. “It's not just people being shot and killed by the police; it’s multifaceted, so it's important to make yourself aware of these issues and to try to do everything that you can to combat it in your everyday life.”