This piece is published in collaboration with Echoing Ida, a Strong Families project.

Two years ago, one of my close friends recommended that I read bell hooks’ All About Love, and it literally changed my life. The book is the first installation of her trilogy about love and the intersections of race, gender, and sexuality. In the last installation, Communion: The Female Search for Love, she writes, “the most feminist action any female can take on her behalf is doing the work of creating positive self-esteem, the foundation of self-love.” During my journey through these books I began to do the work of fiercely protecting my self-esteem to build a stronger foundation of self-love. My work toward greater self-love included holding in higher regard my physical and mental health. I worked out more, ate better, and practiced better self-care (which can be hard for me as an organizer who sometimes works odd and long hours). In embarking on this journey, I realized that as a Black woman, I was raised to “carry” and present myself in a very particular way, despite sometimes lacking the self-esteem internally that I always displayed outwardly.

Since Black bodies, especially female Black bodies, are always up for scrutiny, our mothers try to protect us by teaching us how to care and attend to every little detail when it comes to our hair, clothes, and even posture as a way to appeal to the world as people worthy of respect. These acts are brilliantly described as “respectability politics” and, though often an effective defense mechanism against harsh criticism, have resulted in acceptable facades that often mask internal illnesses.

While I can see that now, I grew up admiring my mother who would wake up hours before starting her ten- to 12-hour work day to put a perfect crease in her work pants, meritoriously apply her makeup, and place every strand of hair in its rightful place. She was and is a diva to say the least. Despite her careful attention to her outer appearance, my mother is terrified of going to the doctor, as are many of the women in my family. She is a woman who agonizes over seeing the doctor and often only goes when something is hurting too severely for her to work. This lands her in an emergency room instead of the more affordable office of her primary care physician. Through my mother, I can see how I deal with my own inner fear and mistrust that I mask by trying to create a seemingly perfect appearance.

Being my mother’s daughter, even down to carrying her diva gene, I’ve had to actively fight my own fear of proactively making doctor appointments. This is an issue that is so common in Black communities and yet is being ignored as the health care and Affordable Care Act (ACA) enrollment conversations continue to take place in the media. In all the frenzy to get people to enroll, the president paints a rosy picture for some while ignoring that this health-care discussion is particularly important to historically marginalized multicultural communities, specifically Black women, whose health goes far beyond whether we have insurance coverage.

Though the Obama administration has nearly solved the functionality of the ACA website as a barrier to enrollment and extended the enrollment deadline to March 31, the fear and distrust communities of color have toward our medical system may prove to be a greater roadblock if they continue to be ignored. Black people and indeed many of others of non-European descent harbor fear and distrust of doctors—and we have every right to be fearful. Dr. Harriet A. Washington has compiled a history of the medical exploitation of Black people in the United States in her book Medical Apartheid. She describes how the forced, often grotesque exploitation of Black women’s bodies led to many of the reproductive breakthroughs of our time, including birth control and preventing pregnancy complications. Her work speaks to the nation’s long history of heinous medical crimes of abuse and experimentation on Black Americans that included the Tuskegee Syphilis Experiment, the eugenics movement, and countless other examples where we were victims of our health-care system instead of patients who received quality care. More recent studies show that “mainstream American medicine has absorbed traditional racial stereotypes about African Americans and produced misguided interpretations of black children, elderly black people, black athletes, black pain thresholds and other aspects of black minds and bodies.” From historical exploitation to the current medical industry’s stereotypical understanding of Black people and our health, African Americans often harbor anxiety about receiving health care in a Western medical context. Within this reality, and considering the financial barriers to accessing care, it is no wonder that African Americans have and continue to care for ourselves and avoid seeing the doctor for fear we may be coerced, stigmatized, or receive news of an illness we cannot afford to treat.

As navigators and organizations continue to go into communities of color to enroll people in the ACA, we need to acknowledge the historical and current failures of the medical care system in communities of color as well as push for cultural competency to further increase Black communities’ access to care. This looks like ensuring that medical professionals are trained to be culturally competent and aware as well as intentionally making attempts to rectify the fear communities of color feel toward the medical system. This will go a long way in encouraging people of color to do more than enroll in health care but to proactively access medical care that sees us as whole beings. We must understand and promote that quality health care is culturally competent health care.

The Urban League of Portland as well as the Oregon Health Authority Office of Equity are two examples of organizations that are taking steps beyond just connecting communities of color to health care. They are working to connect health-care policy with advocacy to promote cultural competency through programs like their Community Health Worker Program: We Are Health Movement, which links people with health care as well as providing them with a guide or health worker to assist them in navigating our health-care system to make it a more pleasurable and less fearful experience.

While intentional programs like these might improve the situation, overcoming the residual impact of multiple generations’ exploitation and mistrust requires that we approach our bodies with love and care. Perhaps that is what my mother and so many other women are trying to do: In an effort to push down the fear, mistrust, and disdain we have been taught to absorb, she chose to press her kinks and crease her pants. And before bell hooks, my mother used to encourage me to love the skin and body that I’m in, always saying, “It’s the only one you have” as I entered my doctor’s office. Mantras like these build the confidence that I and other Black women need when facing a medical industry that often doesn’t understand us.

My pursuit toward building a strong foundation for self-love is something I battle and navigate through everyday. In this journey, I’ve had my successes, set-backs, and flat-out failures. However, I always remind myself that I have already accomplished the hardest part: identifying that I wanted to see a change in my life, realizing that I have the power to make the change, and making the decision to simply take the first step toward whole health. I’ve decided that I want to live long so I can raise hell long enough to see some of the changes I’m fighting for come to fruition. In conversations with my mother, I have encouraged her to allow her overall fierceness to be the catalyst for a proactive sashay into her doctor’s office. It’s conversations like these that provide the support we need—being there for each other as we seek to overcome our fears and demand better treatment from our medical system and health-care professionals.

My hope, as we move away from talking about the failures of the ACA website, is that we begin to hold more of the important conversations about how to proactively utilize our health care once we have access. The more conversations we have, the more these barriers can be lifted and issues of cultural competency can be addressed in our doctors’ offices. We must continue to connect that self-love isn’t just about our physical appearance but the well-being of our entire bodies and lives, and we deserve to be cared for with respect. So let’s make sure to do more than enroll in the ACA by the March 31 deadline. Let’s make our doctor’s appointments as easily as we throw up a flawless selfie on Instagram (with or without a filter), without any hesitation. We owe that to ourselves.