Guest Perspective: We invite perspectives that expand how we understand women's health, work, and the body.
Policy is often discussed in the abstract, as spreadsheets or legislation. But for Dr. Maya Rockeymoore Cummings, policy is something we carry in our cells. As a distinguished scholar and CEO of the health tech company HyperVigilant, she has spent over 25 years studying the combination of racism and ageism she calls "rageism," and how these systems dictate who is protected and who is left to weather the storm. Her new book on the subject, RAGEism: Racism, Ageism, and the Quest for Liberation Democracy, is set for release on May 5th.
For Dr. Rockeymoore Cummings, these inequities aren't academic; they are deeply personal. Having navigated the health system as a primary caregiver and lived within the environmental stressors she documents, she has seen firsthand how structural bias manifests as physical illness.
In this conversation, we discuss why health is a political act, the "overlapping fogs of bias" women of color face in the doctor's office, and why she views practices like seed cycling as a form of bodily liberation. At its heart, her work is a call for a world where women own their data, trust their own rhythms, and build systems designed for their survival.
1. You coined the term “rageism” to name something that existed but hadn't been precisely named. Why does naming matter and what do you hope changes now that the word exists?
"Rageism", a combination of racism and ageism operating across the life course, is the term I coined to describe how policymakers use the tools of government to disadvantage populations they deem less worthy of protection, investment, and care.
When Medicaid benefits are cut as wasteful spending while tax breaks for private jets are expanded, that's rageism. When older Black women's health concerns are dismissed as "normal aging" while similar symptoms in younger white patients trigger immediate investigation, that's rageism. Naming it mattered to me because unnamed harms are easier to deny, normalize, and reproduce.
When something has a name, people can see it more clearly, talk about it more directly, and challenge it more effectively. My hope is that now that the word exists, it gives people a sharper way to identify these patterns in policy, politics, and public life, and to demand policies that value all lives across race and age rather than creating hierarchies of worthiness based on who policymakers think deserves to thrive.
2. You write that “politics determines health.” For readers who think of health as a personal or biological matter, what do you want them to understand about the relationship between policy and the body?
Health is not just personal; it is political. Our bodies are shaped not only by biology and behavior, but also by the policy decisions that determine whether we live with clean air and water, safe housing, healthy food, economic security, and access to quality care.
A child's asthma isn't just about their lungs - it's about zoning laws that allow polluting facilities in their neighborhood, housing policies that concentrate poverty, and healthcare policies that determine whether their family can afford an inhaler.
When people reduce health to personal choices, they overlook the systems of power that promote or undermine health. Policy, the outcome of political decisions, is how governments organize protection, risk, and resources that affect health, and it is why politics determines health. And when those policy decisions systematically disadvantage certain populations based on who policymakers think deserves protection, you get rageism.
3. RAGEism documents how structural racism shapes health outcomes from birth to death. When you look specifically at women's hormonal and reproductive health, an area historically neglected by medical research for all women, what additional layers of inequity do Black and Brown women face?
RAGEism addresses the intersectionality question by showing how racism, sexism, life-course ageism, and classism often combine to undermine the health of women of color, and especially Black and Brown women. In the area of hormonal and reproductive health, already historically neglected in medical research, these women often face additional layers of inequity, including dismissal, underdiagnosis, undertreatment, and policy neglect.
Black women are three to four times more likely to die from pregnancy-related causes than white women. Conditions like endometriosis and fibroids that disproportionately affect Black women are routinely misdiagnosed for years, with symptoms attributed to stress or pain tolerance myths.
When policies are shaped by what I describe as ethno-patriarchs, predominantly white male decision-makers who center their own experiences while being indifferent or even hostile to the needs of women of color, women of color and their families are often the first to bear the burden of harmful policy choices. We see this in the rollback of reproductive rights, restrictions on Medicaid coverage for contraception, and research funding that continues to prioritize conditions affecting white men.
Ultimately, this translates into a lack of access and attention that contributes to the stark maternal mortality disparities we see today, higher rates of undiagnosed autoimmune conditions, and the early deaths that could be prevented with equitable care and policy attention.
4. The medical research gap in women's health is well documented. Women weren't required to be included in clinical trials until 1993. How does that structural exclusion compound for women of color, and what does the downstream effect look like in clinical practice today?
The 1993 NIH Revitalization Act is often cited as the turning point, but that framing obscures what the exclusion was actually doing. For decades, the reference body in American medicine, the body against which symptoms were read and dosages calibrated, was the white male body. Everyone else was a deviation.
For women of color, that exclusion compounds. You have the sex-based exclusion that persisted until 1993. You have the race-based exclusion that persisted much longer in practice than in policy. And you have the ways these interact: a Black woman presenting with cardiac symptoms is read through a diagnostic framework built on white male physiology, then filtered through diagnostic bias shaped by a century of racialized assumptions about pain tolerance and credibility.
The downstream effects are not subtle. Black women are three to four times more likely to die from pregnancy-related causes than white women, and that gap holds across income and education. Lupus, which disproportionately affects Black and Latina women, is routinely misdiagnosed for years. Pain is undertreated. Symptoms are attributed to stress or noncompliance before they are investigated. What gets underdiscussed is what happens as women of color age.
The exclusion doesn't stop accumulating, it intensifies. The research base for cardiometabolic disease, cognitive decline, and mental health in older women of color is astonishingly thin. Older Black women with cardiac symptoms get told they're anxious. Older Latinas with early cognitive changes get told it's normal aging.
The clinical encounter becomes a site where racism, sexism, and the devaluation of older lives converge, three overlapping fogs of bias read onto one body. Closing this gap requires more than representation in trials. It requires rebuilding the reference body itself. The personal and the political:
5. Beyond stress - how does structural discrimination create physical changes in the body?
When we talk about "stress" and health, we're often missing the deeper physiological story. Structural discrimination doesn't just create psychological pressure - it triggers a trauma response that literally rewires the nervous system and dysregulates core bodily functions.
I've experienced this firsthand through how trauma affects the vagus nerve, which controls everything from heart rate to digestion to immune response. When the vagus nerve becomes dysregulated through chronic trauma exposure, it triggers a cascade of physiological changes: cortisol dysregulation, chronic inflammation, metabolic disruption, and immune system dysfunction. This is why women, who bear the brunt of interpersonal and structural sexism as well as other isms in our society, are more likely to develop autoimmune disorders, and why I've dealt with autoimmune responses in my own body.
For women of color, this biological disruption is amplified because we face trauma from multiple discrimination systems simultaneously - racism, sexism, and often classism operating together. The chronic hypervigilance required to navigate these systems keeps the nervous system in a state of activation that the body was never designed to sustain long-term.
The RAGEism framework helps us see that what looks like individual health failures are actually the predictable outcomes of discriminatory systems operating across the life course. As Dr. Bessel van der Kolk writes, the body keeps the score of structural injustice, and until we address the systems creating the trauma, we'll continue to see these devastating health disparities persist.
6. You are both a scholar of these systems and someone who has lived inside them. How has your own relationship to your health and your body been shaped by the realities you document in the book?
My relationship to my health and my body has been shaped profoundly by the realities I document in RAGEism. I have experienced firsthand how chronic stress and systemic inequities manifest in the body - affecting hormonal balance, mental clarity, cardiovascular health, and overall well-being.
For nearly twenty years, I've lived in an underserved inner-city neighborhood, and I've felt how environmental stressors compound these effects. The combination of academic work on these systems while living inside them taught me that the frameworks I analyze are not abstractions. They have measurable physiological consequences.
It also changed how I navigate medical encounters. I learned to advocate more assertively for myself, to come prepared with research, and to push back when symptoms were too quickly attributed to stress or dismissed. I had to develop strategies for being heard, which is a form of labor that shouldn't be necessary but often is.
That lived experience didn't just inform my scholarship, it drove me to build solutions. HyperVigilant, my AI health technology company, emerged directly from this work. We're focused on improving risk identification, diagnosis, and preventive care for populations the health system routinely overlooks or underserves.
The goal is to create intelligence that can see what current systems miss - patterns in symptoms, risk factors, and health trajectories that get filtered out when the diagnostic framework assumes a white, male, younger reference body. The book documents the problem. The company is my attempt to build a piece of the solution.
7. You practice seed cycling, a food-based approach to hormonal health that is rooted in traditional and ancestral knowledge. What draws you to practices that center the body's natural rhythms, and how does that connect to the larger argument you're making about whose knowledge systems get validated by mainstream medicine?
I practice a modified version of seed cycling that I've adapted for my post-menopausal body to support hormonal balance and gut health. Traditional seed cycling rotates different seeds throughout the menstrual cycle to support natural hormone production, but as a post-menopausal woman, I've shifted the approach to focus on the anti-inflammatory and micronutrient benefits of rotating seeds - I'm particularly drawn to hemp and chia, along with flax, pumpkin, sesame, and sunflower.
It's about working with my body's current needs rather than trying to replicate pre-menopausal rhythms.
What draws me to these practices is their recognition that the body has its own intelligence—needs that don't require pharmaceutical intervention to support, just attention and the right nutritional tools.
Even in menopause, the body has rhythms and requirements that respond to thoughtful nutrition. This connects directly to the larger argument I make in RAGEism about whose knowledge gets validated.
Indigenous communities and traditional healing systems have understood food as medicine for millennia, but mainstream medicine has been slow to investigate or validate these approaches, partly because they can't be patented, and partly because the knowledge holders have been systematically marginalized.
When a practice like seed cycling gains attention, it's often repackaged without acknowledging its roots in traditional knowledge systems. The irony is that we're now seeing research validate what these communities have long known, that certain seeds contain compounds that can support hormone balance, reduce inflammation, and improve gut health.
But the validation process still centers Western research methodologies as the gold standard, rather than recognizing that empirical knowledge built over generations might have its own validity. It's part of why I'm interested in building health technologies that can recognize patterns and relationships that current systems miss.
HyperVigilant actually integrates traditional medicine recommendations as a supplement to Western medical approaches, not to replace conventional care, but to create space for different ways of understanding how bodies work and heal. The goal is to build intelligence that can see the value in both evidence-based medicine and time-tested traditional practices, rather than forcing people to choose between them.
8. Your framework of “liberation democracy” offers a path forward that goes beyond diagnosis. For women specifically who are both disproportionately affected by structural health inequities and disproportionately active as caregivers, advocates, and community organizers, what does liberation look like in practice?
Liberation democracy in health means fundamentally restructuring who has power in the systems that shape our well-being. For women, especially women of color who bear the heaviest burden of both health inequities and caregiving responsibilities, liberation looks like several concrete shifts.
- First, it means moving from patient to participant. Instead of being passive recipients of care determined by others, women become active agents in defining what health means for their bodies, their families, and their communities. This includes having real decision-making power in clinical encounters, not just the illusion of "shared decision-making" where the physician still controls the frame.
- Second, it means recognizing and compensating the care work that women already do. As someone who spent several years out of the workforce providing unpaid care for my ailing husband, I can honestly say that receiving compensation for that work would have been a godsend.
Women are the primary caregivers for children, aging parents, and sick family members, but this labor is invisible to economic systems and health policy.Liberation democracy would make this work visible and valued, through caregiver credits, respite support, and policies that don't penalize people for taking time to care for others.
- Third, it means democratizing health knowledge and technology. Women shouldn't have to become medical researchers to get adequate care for endometriosis or autoimmune conditions.
The tools for understanding our bodies, tracking our symptoms, and advocating for appropriate treatment should be accessible, not gatekept by systems that profit from our ignorance.
- Fourth, it means building health systems that encompass the lived experiences of everyone - systems that respect who people are, take their preferences and experiences into account, and offer them dignity. This should be included in the definition of quality care itself, not treated as an add-on or accommodation.
What would healthcare look like if it were designed to honor the full humanity of every person who walks through the door?
Liberation isn't just about fixing the current system. It's about building power to create different systems altogether, systems where people's knowledge of their own bodies is trusted, where care work is valued, and where health is seen as fundamental to collective well-being, not individual responsibility.
9. What would a genuinely equitable women's health system look like?
Not incrementally better but truly different. A genuinely equitable women's health system would ensure quality care from birth to death, with women owning their complete, uninterrupted, longitudinal health data, not fragmented across different providers and systems that don't talk to each other.
Our research in "Tangled in the Web" showed that 86% of patients want control over their personal data usage, yet current systems trap them in a "take-it-or-leave-it" approach to privacy that forces them to sacrifice control for access to care.
The system would be built by women for women, with female experiences and examples at the forefront rather than treated as variations from a male norm. Research and solutions would be designed specifically for the female body and female experience, from puberty through menopause and beyond, not retrofitted from studies done primarily on men.
What our study revealed is that women are sophisticated users of digital health tools - 90% use health portals, 73% participate in online support groups - but they're making nuanced judgments about when and how to share their data. They'll share with researchers (64% consent) and nonprofits focused on health advances (58% consent) but are much more cautious with for-profit companies (only 29% consent).
An equitable system would honor that sophisticated decision-making rather than forcing blanket consent. Culturally, the system would be age and gender appropriate, recognizing that a 20-year-old's health needs are different from a 50-year-old's, and that women of different racial, ethnic, and cultural backgrounds bring different knowledge systems and preferences to their care.
Economically, it would be quality-first, not fee-first. Instead of systems designed to maximize billable procedures, we'd have systems scaled for outcomes that matter to women - preventive care, pain management that takes women seriously, mental health integration, and support for the full spectrum of reproductive choices.
This isn't about making the current system slightly more inclusive.
It's about building entirely different infrastructure - infrastructure that starts with women's lived reality as the foundation, not the exception.
10. What do you want readers to do after they close the book?
I want readers to recognize that the systems I describe in RAGEism aren't abstract - they're operating right now, in the clinical encounter they had last week, in the policy debates happening in their state legislature, in the algorithms making decisions about their healthcare access. And I want them to understand that those systems can be changed.
Practically, I want them to start advocating more assertively for themselves and the people they care about.
Bring a list to your doctor's appointment. Ask questions. Push back when your symptoms are dismissed. Use the language from the book - when someone tries to gaslight you about your own experience, name it. I want them to vote, and to vote with an understanding that health equity is on the ballot.
The frameworks in RAGEism aren't just academic concepts, they're tools for evaluating policy proposals, candidate platforms, and ballot initiatives. When you see a policy that would restrict reproductive access or gut Medicaid expansion, you're seeing the White Root Directive in action. When you see a candidate talking about "personal responsibility" for health outcomes while ignoring systemic inequities, you're seeing ethno-patriarchy at work.
I also want them to demand transparency and accountability from the institutions that shape their lives. If you're using a health app, read the privacy policy. Ask your insurance company how they're using AI to make coverage decisions. Support organizations that are fighting for patient data rights.
And if you're a woman, especially a woman of color, I want you to know that your body is not the problem - the system is.
The exhaustion you feel navigating healthcare isn't your fault. The dismissal you've experienced isn't in your head. There are others fighting to change this, and your voice matters in that fight.
Ultimately, I want readers to move from individual survival strategies to collective action.
The book documents the problem, but the solutions require all of us working together to build something different.
In Conversation With
Dr. Maya Rockeymoore Cummings is CEO of HyperVigilant Inc., author of RAGEism: Racism, Ageism, and the Quest for Liberation Democracy, former Visiting Scholar at Johns Hopkins University SNF Agora Institute, and former Senior Fellow at Brookings. With 25+ years in policy research and advocacy, she's appeared on major networks and published widely.