For most of my life I didn’t feel I could wear my hair the way it naturally grows from my head. As a child, I already stood out from the crowd at school because of my brown skin, but the thing that I most remember being bullied about was my hair. My mother tried to protect me: from the age of about five, she started taking me to the hairdresser to get my hair relaxed, meaning chemically straightened. Later, she began buying the products herself and relaxing mine and my younger sister’s hair in our bathroom at home. “I wanted my kids to be accepted, to fit in,” she later explained to me.
Growing up in Lebanon in the 1960s and ’70s as the only Black child in her family, and one of only two Black children at her school, my mother faced significant discrimination. She is Lebanese on her father’s side, and Ghanaian on her mother’s side. Her parents divorced when she was a baby, in Ghana, and she eventually ended up in the care of her father’s family in Lebanon. He soon got remarried to a Lebanese woman—my teita (grandma in Arabic)—and together they had five more children. Being the only Black or Mixed child in her lighter-skinned family was tough for my mum. During family outings, people found it difficult to believe she was part of the family.149
Her hair was also an issue for people. Her family didn’t know how to take care of textured hair, so they always kept her head closely shaved. She was bullied about her hair at school, further lowering her already low self-esteem. This was all the more reason why she was delighted, as a teenager, when she learned of a product that could make her hair straight.
“I was desperate to fit in,” she told me. “I had no idea what it was and what it involved,” she said, remembering her first hair relaxing appointment. “It was an unpleasant experience.” In those days, she recalled, the hair relaxing products available were very thick pastes that were difficult to spread onto the hair—and they didn’t smell great. The process could also be painful. “I started experiencing this tingling and burning,” my mum said.
Listening to her describe those sensations brought back memories of having my own hair relaxed. I would sit patiently with my scalp on fire because there was this notion that the longer you left the product on your hair, the straighter it would become. Eventually, I would be relieved by the flow of water against my hair and scalp, removing the foul-smelling product and leaving me with what I hoped would be a slightly more acceptable appearance. Looking back, I think a part of myself was also being washed down the drain, along with those nasty-smelling chemicals (and a bunch of money).
“I feel saddened and angry that we were made to feel inferior, because of frizzy hair,” my mum said. Even though she experienced “a few little burns” on her scalp from relaxers on one or two occasions, she thinks the emotional scars from that feeling of inferiority affected her more.
She and I were both wearing our hair naturally as we sat together in her living room, sharing experiences. I stopped relaxing my hair when I was in my early twenties, in the early 2010s; the natural hair movement was taking off at the time, encouraging people like me to embrace our natural Afro-textured hair. My mom and sister soon followed. My mom was in her early fifties when she stopped relaxing her hair. “Seeing you and your sister embracing your natural hair really impacted me,” she said, tears in her eyes. “It makes me very proud.”
I don’t judge my mom for choosing to relax my hair when I was a child, nor myself for continuing to do it as a teenager and young adult. There are plenty of reasons why millions of people with textured or Afro hair globally use products to chemically straighten it. But I think a lot of those reasons are related to racism—or, more specifically, colorism.
The author and activist Alice Walker is often credited as being the first person to use the word colorism, which she defined in her 1983 book In Search of Our Mothers’ Gardens as “prejudicial or preferential treatment of same-race people based solely on their color.” Colorism is usually associated with preference for lighter skin tones and prejudice against darker ones. In practice, colorism often also encompasses featurism—a less frequently used term that refers to similar prejudice based on commonly racialized features, such as nose or eye shape and hair texture. At its root, colorism is a form of racism—but while racism separates people into racial and ethnic groups, colorism typically separates people within those groups. Like racism, colorism manifests both at a systemic and an interpersonal level, and causes harm to mental well-being as well as to physical health.150
To illustrate this, let’s continue with the example of hair discrimination. My mom told me that when she worked as a pharmacist in London in the 1980s and ’90s, even though she was part of a diverse team, she didn’t feel that natural hairstyles would be considered acceptable in her workplace. “There was nobody who was going with natural hair,” she said. A few decades later, when I was living in London myself, I was preparing to travel to Oxford for a PhD interview when a Black friend recommended that I should straighten my hair before leaving. “You can’t show up with an Afro,” she said. “It isn’t professional.” I am proud to say I showed up with my Afro anyway and I was accepted into the PhD program but, unfortunately, many people aren’t so lucky.
In 2016, about a year after that PhD interview, Google’s image search feature came under criticism after a user tweeted screenshots revealing that a search for “unprofessional hairstyles for work” retrieved mainly images of Black women with natural hairstyles. Typing “professional hairstyles for work” into the search bar, on the other hand, yielded mainly photographs of White women with straight hair. According to the Halo Collective, an advocacy group fighting against hair discrimination in the UK, one in five Black women feel societal pressure to straighten their hair for work, and 46 percent of parents say their children’s school policy penalizes Afro hair. Ruby Williams, a pupil in London who was repeatedly sent home from her school in Hackney because of her Afro hair, received $10,390 in an out-of-court settlement in 2020 after her family took legal action against the school (the school didn’t accept any liability). There have been similar instances of hair discrimination in other countries, including the US and South Africa. In the US, the last few decades have seen numerous court cases filed by Black employees alleging workplace hair discrimination and, as of 2022, at least eighteen US states have felt the need to pass legislation known as the CROWN Act to explicitly make hair discrimination illegal. Even Olympic athletes aren’t exempt from this form of racism. In July 2021, the international swimming federation FINA turned down an application from the Black-owned swimming cap company Soul Cap to use their products at the Tokyo Olympics that year. Soul Cap is designed to protect Afro or textured hair, as well as natural hairstyles such as braids, twists, and locks.151
If discrimination at work and at school wasn’t enough to persuade someone to try chemical straightening, worrying about their safety might. The first time I remember being called the N-word in a threatening manner, by a group of guys outside a nightclub in the Netherlands, they used my hair to target me. I hadn’t touched up my roots for a while, so even though most of my hair was still relaxed, it looked more textured than usual. “N***** with the Afro!” I remember them shouting. I was a teenager at the time and I felt afraid. I had lost track of my friends, so I was on my own. I rushed home as fast as I could, my heart racing.
We have already seen how racism in societies contributes to disparities in general health and well-being for marginalized racial and ethnic groups. But the pressure for Black women, in particular, to solve the problem of hair discrimination by using products like relaxers comes with its own very specific set of potential health risks. Chemical burns are an example. “Some women do actually suffer third-degree burns, chemical burns,” said Kimberly Bertrand, an epidemiologist at Boston University School of Medicine in Massachusetts whom I spoke with a few weeks before my conversation with my mother.
Bertrand and her colleagues published a study in 2021 examining data on hair relaxer use and breast cancer incidence among a group of more than fifty thousand Black women in the US. She emphasized that the main takeaway from that study was that moderate use of hair relaxers wasn’t associated with an increased risk of breast cancer. “Our findings, I would say, were really quite reassuring,” said Bertrand. “For most women in our study, there was no evidence of a link between use of these relaxers and future breast cancer,” she explained. However, Bertrand and her colleagues did notice a slightly concerning pattern among a subset of the women in the study who reported using hair relaxers containing a chemical known as lye. They found that the women who reported using lye-based relaxers most frequently and over the longest periods of time—more than seven times a year for a period of more than fifteen years—were 30 percent more likely to develop breast cancer, compared with those who reported lighter use of these products. “That’s a concern for sure,” said Bertrand.152
The data Bertrand and her colleagues analyzed were from the Black Women’s Health Study, which began tracking the health of fifty-nine thousand self-identified Black women in the US in 1995, with the hope of identifying factors contributing to racial disparities in health. “Most women were recruited from subscription lists to Essence magazine,” said Bertrand, who first became involved in the study as a researcher back in 1997. The enrolled women, who were aged between twenty-one and sixty-nine at the time the study started, regularly complete surveys and share health data to provide a resource for researchers to identify potential associations between various environmental factors and health outcomes. Bertrand is particularly interested in breast cancer. “Black women are 40 percent more likely to die from their breast cancer than White women,” she noted, highlighting the glaring disparity we touched on in chapter 2. “In the US, you can imagine that there are lots of factors that contribute to that higher mortality. Much of it is, I would say, racism,” she said. One aspect of that racism is hair discrimination, which, as we just explored, prompts many Black women to opt for chemical hair straightening.
“Relaxers are heavily marketed to Black women,” said Bertrand. She explained that after coming across earlier research highlighting a potential link between exposure to some of these products and breast cancer risk, she had decided to investigate further. “Chemical hair relaxers or straighteners, as we call them, we know they contain many thousands of chemicals,” she told me. “And we know they contain chemicals that are known to be toxic, especially these toxic chemicals called endocrine disruptors,” she said.153
Endocrine disruptors are chemicals that can interfere with signaling by hormones, such as the sex hormone estrogen, which plays a key role in many breast cancers. These chemicals may have profound effects on our bodies. A 2011 study led by Tamarra James-Todd, an epidemiologist now at Harvard University, found that African American children were more likely to use hair products and to start menstruating at younger ages compared to children belonging to other racial and ethnic groups in the US. A more recent study by James-Todd and colleagues showed that several hair products commonly used by Black women exhibit hormonal activity in laboratory tests, suggesting that they could potentially contribute to reproductive and metabolic health disparities. And although Bertrand’s research suggests that moderate use of hair relaxers in general doesn’t increase breast cancer risk, she believes the observation of greater risk among heavy users of lye-based products in particular warrants further investigation. “I don’t know if this is why these women got cancer. But it does make you think, what can we do as a society to make these products safer, or to counsel women about the risks in their own daily lives?” she said.154
When my mother and I were swapping stories about our experiences with hair relaxers a few weeks later, I thought back to my discussion with Bertrand. At the time when my mom started relaxing her hair, the range of products on the market was quite limited. She remembers all the products available to her being lye-based ones. By the time she started taking my sister and I to have our hair relaxed as children, the range of available products had expanded, and many were non-lye relaxers. In fact, my mom said that the products that were used on my and my sister’s hair were specifically marketed as being for children. “When I was young, it was not promoted for children. There was no such thing as a relaxer for children, you had to be a certain age before you could use the relaxer. But when you were kids, suddenly there were these products,” she told me. I asked her if she had ever been concerned about the potential health risks associated with any of the ingredients in these types of products, particularly the lye-based ones that she had used on her own hair for many years. “No,” she answered. “It never occurred to me about the chemicals in the products, but I was concerned about the burn. I thought, this can’t be good for your scalp to have repeated burns,” she added, though I couldn’t help but worry about the potential harm done beyond her scalp. I resolved to refresh my memory on what lye actually is—and to try to understand the basic chemistry of hair and hair relaxing.
Lye is a common name for the compound sodium hydroxide. I am familiar with sodium hydroxide in its pure form from my days as a laboratory researcher. It is very alkaline and corrosive, so in the laboratory we always worked with it in a chemical fume closet for safety reasons, in addition to wearing personal protective equipment such as gloves and safety goggles. Sodium hydroxide is also the main ingredient in many drain cleaners, which, incidentally, have pH ranges similar to those of many hair relaxers. In the case of the cleaning product, the sodium hydroxide helps to decompose hairs and solubilize fats clogging the drain by reacting with them to make soap. With hair relaxing, on the other hand, the goal isn’t to completely decompose the hair but rather to break the strong chemical bonds that exist naturally between the keratin molecules in Afro or textured hair. All human hair, regardless of texture, is made up of the protein keratin. But in Afro or textured hair, strong chemical bonds called disulphide bonds connect the keratin molecules together in a way that produces kinks or curls. By breaking these bonds, hair relaxers leave the hair permanently straight. But just as hair dye can’t permanently alter hair color as new hair grows, hair relaxers can’t permanently change the texture of the hair that grows out from the scalp. In the past, that’s what kept my mom—and later me and my sister—going back to the salon every so often to touch up our roots.
In lye-based relaxers, the ingredient responsible for the straightening effect is sodium hydroxide, whereas in non-lye relaxers, other compounds—such as calcium hydroxide, which is slightly less alkaline than sodium hydroxide—are used instead. These are the chemicals that are responsible for that burning or tingling sensation that my mother and I talked about feeling on our scalps, during hair relaxing. They are also the reason why relaxers can cause damage to the scalp, including cuts and burns, as my mom experienced. But relaxers also contain plenty of other chemicals, often including endocrine disruptors—the chemicals Bertrand cautioned about—which aren’t always specifically named in ingredients lists because of the proprietary nature of formulations. For instance, “fragrance,” which is listed as an ingredient in one of the hair relaxer products I used to use, can refer to many different chemicals, including endocrine disruptors.155
Bertrand suspects that lye, which is particularly harsh, may damage the scalp in such a way that it makes it easier for other chemicals in the hair relaxer to then penetrate the skin and potentially cause further harm. “Our skin is a big component of our immune system. The purpose of our skin is to serve as a physical barrier to the outside world,” she said. “If you’re getting scalp burn on your head, and creating wounds, that’s a mechanism of entry for the hair straightener to enter your bloodstream, and these other chemicals, the known endocrine disruptors or potentially other toxic chemicals, to get into your system,” Bertrand explained. Even in the absence of a visible burn or wound, the lye could still be causing microtears to the skin, she pointed out. An increased penetration of endocrine-disrupting chemicals through the scalp and into the bloodstream following use of lye-based relaxers could potentially explain why the heavy users of these products in Bertrand’s study had an increased risk of breast cancer.
Bertrand thinks the contents of hair relaxers should be more tightly regulated, for instance by the FDA. “I consider this an issue of environmental justice,” she told me. Indeed, the vast majority of people who use hair relaxers around the world are Black. My mother agrees—she suspects that the fact that the main users of hair relaxers are Black women may have something to do with the limited amount of research and regulation in this area, particularly at the time when these products first became available on the market. “People didn’t care to do the research,” she told me. In the European Union, where my mom and I both currently live, manufacturers are legally obliged to ensure that cosmetic products undergo an expert scientific safety assessment before they are put on the market, but in the US there isn’t a requirement for ingredients in cosmetics to be safety tested. Even in the EU, there is pressure for legislators to do more. In 2021, the campaign group EDC-Free Europe called for the EU to completely ban the use of endocrine disrupting chemicals in cosmetics, for example.156
For my mother, all of this is too little too late. Sitting together in the living room, we both wondered what we might have done differently if we had been more aware of the potential health risks associated with hair relaxers. Would my mom still have opted to chemically straighten her hair all those years? We agreed that she might have, because the pressure to feel accepted by society was that strong. “I think if I was accepted and liked for who I am, it would never have occurred to me to make any changes about how I look,” she said. “I think the major factor in me having to do things like that is the fact that I was discriminated against and there was racism, and I wasn’t accepted as I am,” said my mom.
When it comes to racial disparities in breast cancer mortality in the US, as Bertrand put it: “Society is not off the hook.” While hair relaxer use may contribute minimally to that racial health gap, its contribution is most certainly dwarfed by other factors driven by structural racism, such as economic and environmental inequalities, she pointed out. Bertrand thinks the lesson from her research on hair relaxers might simply be “everything in moderation” and she hopes that increased research on the ingredients in these products might help to pinpoint any particularly harmful substances, which could then be removed. “It’s not my advice to stop using them,” she told me. “I think women should feel empowered to wear their hair how they want to wear their hair.”
Colorism and featurism operate within, as well as between, racial and ethnic groups, with wide-ranging health harms. For instance, even within the natural hair movement, supposedly aimed at encouraging Black people to love their hair in its natural state, some hair types are more celebrated than others. When I stopped chemically straightening my hair, I turned to social media channels for guidance from natural hair beauty bloggers on how to care for and style my natural hair. But I quickly noticed that hair textures with looser and more defined curls—known in the natural hair community as “type 3” hair—seemed to be perceived as more favorable than kinkier “type 4” hair, like mine. This reminded me of when I used to go to get my hair done with my family as a child and teenager: the Black hairdressers would often comment on the fact that my hair was “bad” or “difficult” in comparison to my mom’s or my sister’s, because it was kinkier than theirs. Growing up, people also compared our skin tones, with the implication being that lighter was better. This skin color hierarchy was promoted by White people too, and not always in the most subtle of ways. A former employer of mine in the Netherlands once commented while I was working that he thought my skin color was beautiful, but that anything darker wasn’t appealing to him (it was intended as a compliment). As soon as he made that comment, I thought back to one of my first visits to Ghana with my family when I was a child. Looking out of the car window as we drove around Accra, I noticed that most of the people on billboards and in other advertisements had skin tones several shades lighter than the average person on the street. Later, as an adult, I would realize that some of those ads were for products promoted as skin lighteners (and that even those ads for other products were reflecting the same beauty standard).
Unlike hair straightening, skin lightening wasn’t a thing in my family when I was growing up. “I wasn’t in a situation where I considered that,” said my mother, when I asked her about her experiences as a young person. When my mom was fourteen, civil war in Lebanon forced her and her family to flee to Ghana, which is where she first came across skin lightening or bleaching cream. “I remember seeing people in Ghana who were using it, and I knew it burns and damages your skin,” she said. Although her childhood in Lebanon had taught her that her brown skin was undesirable, she decided it wasn’t worth it to risk burning her face in the pursuit of lighter skin. “If somebody told me, oh, there’s a pill, if you swallow it, that makes you White? Who knows what I would have done then?” she commented.
I could relate. As a child in the Netherlands, I remember wishing that I was White and blond. However, it never occurred to me to try to lighten my skin. Perhaps if I had been living in Ghana, where skin lightening products are more heavily marketed, I might have considered it. In the end, I think my and my mother’s decisions not to lighten our skin are probably also reflections of our relative privilege. We both naturally have lighter brown skin tones, not too far off those promoted as the desirable end-result in advertisements for skin lightening products in Ghana. If we had darker brown skin, we both might have felt more pressure to lighten. Indeed, many people in Ghana and in other countries around the world do. This isn’t about vanity; in many cases people feel that having lighter skin will increase their economic and social opportunities. There is evidence to support this. Research from the US has shown that Black job applicants with fairer skin are considered more favorably than equivalent Black applicants with darker skin tones, for instance. Meanwhile, in India, you only have to look at the casting in Bollywood to notice the strong bias toward fairer-skinned people. This bias extends to marriage opportunities too. A study on arranged marriages in India found that darker-skinned marriage candidates were rated as less preferable by their prospective in-laws, compared to lighter-skinned candidates. Colorism is present in countries all over the world, and given the impact that it has on people’s life opportunities, it is wholly unsurprising that the global market for skin lightening products was estimated to be worth $8 billion as of 2020. All of this comes at an equally global cost to health.157
“Here in the Philippines, skin whitening is really a big business,” Thony Dizon, a chemical safety campaigner at the Ecological Waste Coalition of the Philippines (EcoWaste Coalition) advocacy group, told me. Dizon is extremely passionate about his campaign work raising awareness of the health risks associated with skin lightening—or whitening, as he calls it—in the Philippines. In particular, he has long been concerned about illegal skin lightening products being sold at markets in the country and online, which often contain levels of mercury that are harmful to health. These products are popular because they are relatively cheap and can produce the effect desired by so many; mercury salts inhibit the production of melanin, the collective term for a large group of molecules responsible for skin pigmentation, thus lightening the skin.
The fact that mercury is toxic hasn’t curbed the growing appetite for these products. “The toxic trade of often illegal mercury-added skin lightening products is a global crisis expected to only worsen with skyrocketing demand, especially in Africa, Asia and the Middle East,” reads a 2019 report by the WHO. That report goes on to list the many adverse health effects of mercury in skin lightening creams and soaps, including kidney damage, skin rashes, skin discoloration and scarring, reduction in the skin’s resistance to bacterial and fungal infections, anxiety, depression, psychosis, and peripheral neuropathy. Yet, as Dizon explained to me, even in countries such as the Philippines where these types of products are banned, they are still advertised and available to consumers via the internet as well as at street markets.158
“Our periodic visits to the marketplace have confirmed that the illicit trade in skin whitening cosmetics laced with mercury is quite widespread,” said Dizon. He and his team regularly take samples from skin lightening products sold at markets throughout the Philippines or online and screen them in their laboratory for the presence of heavy metals, such as mercury. “We’ll visit places where ordinary people will go to buy these personal care and cosmetic products. We’ll buy samples and, once we purchase it, we screen it,” he explained.
Whenever Dizon and his team identify any unsafe products, particularly those containing mercury above the trace amount limit of 1 part per million established by a global convention in 2017, they immediately notify the Philippines Food and Drug Administration (FDA). At least eighty such products were banned by the FDA between 2010 and 2018, as a direct result of his and his team’s efforts. Dizon and his collaborators also work to share data regarding the health risks of these types of products to the wider public, since the products usually aren’t labeled as containing mercury. “We create media stories using this data generated to inform the public,” he said. The data are shocking. One analysis by the EcoWaste Coalition found that of sixty-five samples purchased from online sources in 2020, forty had mercury levels above the trace amount limit of 1 part per million, making them illegal to sell in the Philippines. The product with the highest level of mercury was found to have a concentration of 41,200 parts per million—more than 40,000 times the limit. “Imagine,” sighed Dizon, as he shared the appalling figures with me. “The concentration of mercury is really very high.”
Through his campaign work in the Philippines, Dizon has met many people who have experienced negative health effects as a result of exposure to mercury in skin lightening products. Some of these people have even joined his campaign, sharing their testimonies to try to help raise awareness about the dangers of these types of products. Grace Reguyal is one of them. Dizon connected the two of us, and Grace kindly agreed to speak with me about her experience. Although she understands English, she felt less confident with speaking, so her husband, Ben, joined us on the call to help interpret. Their young son appeared in the background of the video call as we were chatting. “Our son was also affected by this skin disease that was caused by this product,” Ben told me. The product he was referring to is a skin lightening product, consisting of a soap and a cream, which Grace had decided to try out back in 2018. And the “skin disease” was in fact a reaction to mercury, later found to be present at illegal levels in the skin lightening product that Grace had used.
A friend of hers had used the product first and recommended it. Grace was drawn in by her friend’s claim that it could whiten skin within just seven days. She ordered it online to try it out for herself and was delighted when her friend’s claim proved true—her skin became visibly lighter. She had been using the soap and cream for more than three weeks when she first noticed some red spots had appeared on her skin. She wasn’t especially concerned initially, putting it down to a mild heat rash. But within two days, the rash on her face, neck, and chest had become redder and more pronounced. It was also becoming itchy. Eventually, Grace and Ben noticed that their son, who was being breast-fed by Grace at the time, was starting to develop a similar rash. They had already begun to suspect that it might be related to the skin lightening product, and when they noticed that their son had also been affected, they became even more concerned. They took their son to see his pediatrician, and Grace also went to see a dermatologist, bringing samples of the skin lightening product along with her.
The dermatologist immediately confirmed her and her husband’s suspicions, noting that Grace was the fifth patient who had come in recently with similar symptoms after having used the exact same product. The product was found to contain levels of mercury above the trace amount limit and should never have been sold to them in the first place, because it was illegal, the doctor explained. Fortunately, Grace and her son both recovered, although Grace still occasionally experiences skin rashes, especially when it’s very hot outside or when she’s stressed. The experience also caused her a great deal of mental anguish. When I asked her how it made her feel, she replied to me directly in English. “Depressed,” she said.
Grace decided to share her experience publicly, via social media, in the hope that it might prevent the same experience from happening to someone else. She was invited to appear on several television programs in the Philippines, along with other people who had experienced similar negative health effects after using skin lightening products found to contain mercury. A photograph showing the rash on her face, neck, and chest, which she posted on Facebook, is featured in a report by the EcoWaste Coalition, the advocacy group that Dizon campaigns with. Dizon hopes that the publicity surrounding the experiences of Grace and others will help to raise awareness about the health risks associated with mercury-tainted cosmetics. In their report, the EcoWaste Coalition made several recommendations, including that the government should strengthen laws and regulations on the sale of these products, that the cosmetics industry should move away from White-centric beauty standards and instead promote diversity in beauty, and that online shopping and social media platforms should crack down on the sale of illegal products via their platforms. They also recommended that consumers should embrace their natural skin color with pride and stand up to color-based bias, prejudice, and discrimination.159
Dizon believes that colorism is a major reason why skin lightening—with all its associated health risks—is so prevalent in the Philippines. When asked in an internal survey in 2020 to suggest possible reasons for the popularity of skin whitening nationally, the following statements were among the top answers provided by EcoWaste Coalition members based across the country: “White skin is beautiful,” “White skin is attractive,” “Because it can be seen on TV, movies and commercials,” “This is due to colonial mentality,” “White skin is clean to look at,” and “White skin symbolizes a better status in life.” Dizon is passionate about tackling colorism in the Philippines to reduce the pressure on people to expose themselves to potentially dangerous chemicals in skin lightening products. “I like your color, Layal,” he said to me at one point during our conversation, smiling. “Thank you. I like yours too,” I replied, and we both laughed.
“We want Filipinos to embrace our natural skin color and stop poisoning our bodies,” Dizon continued, speaking emphatically. “And imagine, Layal, it doesn’t just poison our bodies, it poisons the environment,” he pointed out. Mercury in skin lightening products, such as soaps and creams, is eventually discharged into wastewater. In the environment, the mercury becomes methylated and can enter the food chain, for instance via fish as highly toxic methylmercury (exposure to methylmercury during pregnancy can affect developing fetuses, resulting in neurodevelopmental conditions).
Back on the call with Grace and her family, I wondered whether their feelings about skin lightening products had been influenced by their ordeal. Grace still uses products to try to lighten her skin, but she is now much more cautious about the specific products she uses and where she purchases them. She said her motivation for pursuing a lighter skin tone is to boost her confidence, because lighter skin is seen as more beautiful in the Philippines. According to her husband, Ben, lighter skin is also often perceived by employers in the country as more presentable for the workplace. I asked him if he also felt pressure to lighten his skin. “Me, personally, I don’t really mind the color of my skin. If I get dark, it’s okay, because I’m a man,” he replied.
There certainly seems to be a gendered aspect to colorism and skin lightening, as there is with the use of hair relaxers and with many other beauty ideals, although the practice is by no means restricted to women, according to Dizon. “Both men and women are using skin lightening,” he emphasized. Data on skin lightening product use suggest that the balance is tilted more toward women, though. A survey of university students in twenty-six countries across Asia, Africa, and the Americas conducted in 2013 found that 30 percent of female and about 17 percent of male students reported having used skin lightening products in the prior twelve months, for instance.160
For Grace, marketing through online advertisements, as well as seeing many lighter-skinned TV personalities and social media influencers, contributed to her aspiration for lighter skin. She wanted to offer some advice to young women in a similar situation to her. “To everyone who’s trying to look more beautiful, Whiter, just make sure that what you’re buying is something that is approved, safe, effective,” she advised. Nowadays, she only buys products from pharmacies, and she opts for well-known brands. The advantage is that these products should be safer than many of the cheaper, potentially mercury-laced products available at street markets or online, but the disadvantage is that they are also much more costly. “It’s really more expensive,” commented Grace’s husband, Ben. Indeed while Dizon welcomes increased consumer consciousness regarding product safety, he worries about the many people in the Philippines who simply can’t afford to buy pricier products. With the pressure to be Whiter so great, many people may feel left with no choice but to try cheaper and riskier options to lighten their skin.
It was becoming clear to me that the health and environmental injustices associated with skin lightening are direct products of racism, and specifically colorism. But when I put my interpretation to Grace and Ben, it didn’t seem to resonate with them. “Here in the Philippines, colorism’s really not that … that’s not much of an issue,” said Ben. So, if colorism isn’t the culprit, why the perception of lighter skin as better or more beautiful, I wondered. According to Grace and Ben, “it’s just a feeling.” I understand that feeling. It’s the same feeling I had as a child and teenager when I sat at the hairdresser with my scalp on fire, hoping to achieve flowing, straight hair. If I had been asked at the time to articulate why I thought straighter hair was superior to my natural Afro hair texture, I would have struggled to explain. In fact, it is only through the process of writing this book that I have been able to find the vocabulary to fully express what I was experiencing. It was the effect of racism, and specifically colorism, which I had internalized in the form of Eurocentric beauty standards. Whether or not we are conscious of it, this kind of internalized racism—and the extent to which it can drive us to try to alter our hair texture, skin color, and other racialized features—can cause harm that extends far more than skin deep.
“I think that it’s so normalized that there’s almost this lack of awareness and when you bring up this issue of colorism, people are almost offended,” said Joanne Rondilla, a sociologist at San Jose State University in California. Rondilla’s research explores the complex ways in which colonial legacies exist within our everyday lives, including in the context of power dynamics related to skin tone. As part of her research, she has conducted extensive interviews of people both in the US, where she’s based, as well as in the Philippines, examining the relationships between historical colonization, colorism, and skin lightening. Her research interests have very much been shaped by her own experiences of colorism as a Filipina born and raised on the US island territory Guam, and as someone who spent over twelve years working in the cosmetics industry, which has long been criticized for promoting Eurocentric beauty ideals.
“These ideas of beauty definitely damaged me,” Rondilla told me. “So much so that I ended up researching it,” she said with a chuckle. Growing up, Rondilla was often compared to her mother who had lighter skin than her. She quickly learned from her family and wider community that lighter skin was valued over darker skin—an idea that was reinforced during her time working in the cosmetics business. “I interviewed someone, and I’ll never forget, you know, this thing that she said. She said, ‘In the Philippines, you are not a cosmetics company unless you have a skin lightening product.’ ” Rondilla feels companies that profit from colorism, by marketing and selling skin lightening products, are perpetuating the problem. Even though the skin lightening products marketed by large cosmetics companies might not be unsafe in and of themselves, the promotion of skin lightening in general undoubtedly feeds into the narrative that lighter skin is more beautiful and desirable, contributing to demand for more dangerous, illegal products. And selling lighter skin as a beauty ideal isn’t only harmful to physical health, Rondilla told me, it harms mental health too.
“Here’s an example,” said Rondilla. “One of my interviewees had talked about how, because she was the darkest daughter, as well as the darkest cousin, […] her mom often harassed her about her skin tone.” The same interviewee told Rondilla that in addition to encouraging her to use skin whitening soaps, when she was eight years old her mother had once rubbed lemon juice all over her skin in the hope that it would make it lighter. “She decided to do that to me not knowing how bad it would hurt. “’Cause the lemon juice, you know, is very acidic,” said the interviewee. “She felt she was being punished for her skin,” said Rondilla. The pain was emotional as well as physical. In the words of the interviewee: “It’s traumatizing when people tell you to be a certain way. Even though you really can’t control who you are.”161
Increasing general awareness about the history behind colorism—and its harmful health effects—may help to tackle the problem. Before speaking with Rondilla, I was aware that colorism within Black communities globally had been traced back to skin color hierarchies established by European colonizers and enslavers in Africa and the Americas. Enslaved people received differential treatment according to skin tone: while darker-skinned enslaved people in the Americas were usually forced to labor outdoors in fields, those with lighter skin were typically made to perform domestic tasks indoors. This differential treatment has been linked to the fact that lighter-skinned enslaved people were often related to their enslavers; rape of enslaved women by enslavers was widespread. European colonization in Africa and Asia also contributed to colorism in the affected countries. In India, for example, British colonial rule is thought to have exacerbated colorism that has been connected to the country’s preexisting, ancient Hindu caste system. Marginalized caste groups include people sometimes referred to as Dalits or “Untouchables,” who were excluded from the traditional Hindu caste hierarchy—an occupational division of people, where ancestry determines acceptable occupations and positions in society—and considered to be impure due to their perceived darker skin and lower-status occupations.162
Despite modern laws prohibiting caste discrimination, persistent structural inequities and prejudices continue to contribute to poorer health outcomes among marginalized caste groups, according to Suresh Jungari, who researches social determinants of health at the International Institute for Population Sciences in Mumbai, India. Jungari, who grew up more than six hundred miles east of Mumbai in the Gadchiroli district, has experienced this firsthand. “I belong myself to the Scheduled Caste community,” he told me. “I know the struggles.”
Centuries of discrimination in India mean that people belonging to marginalized caste groups are disproportionately poor, and research by Jungari and others indicates that this inequality is a significant driver of caste-based disparities in health. On top of this, he told me, experiences of overt discrimination may additionally discourage people from engaging with health services. To take the example of maternal and infant health, which is the main focus of Jungari’s research: in a 2021 review, he and his colleagues found that “lower caste” women were more likely to report experiencing mistreatment by health care providers compared with women belonging to other caste groups. This, combined with other barriers in accessing health services, may explain why women belonging to marginalized caste groups are more likely to have received no prenatal care during pregnancy and their infants are less likely to have received routine vaccinations compared with their counterparts belonging to other caste groups. “Discrimination is resulting in underutilization of health care,” said Jungari.163
I was also curious to learn more about the origins of colorism in the Philippines, which was colonized and occupied by various countries throughout its history, including Spain, Britain, the US, and Japan. The Philippines was also significantly culturally connected to China through migration and trade, long before its colonization. All these factors have contributed to present day associations between lighter skin and higher social status, according to Rondilla. “When we’re looking at colorism in the Philippines, what informs beauty standards is the multiple layers of colonialism,” she explained to me. “Colorism in the Filipinx community is rooted in both anti-Black and anti-Indigenous racism,” said Rondilla. However, she added, “our notion of lightness is not just about European-ness, it’s also about being Chinese or Mixed Chinese or being East Asian, because, again, this has to do with who the Chinese have been historically in the Philippines and the type of power positions that they’ve held, and that also informs colorism for the Filipinx community.”
In 2020, worldwide anti-racism protests put a spotlight on colorism in the marketing of cosmetics, particularly in the marketing of skin lighteners and whiteners to consumers predominantly in Africa and Asia. Amid this increased scrutiny, big players in the cosmetics industry, including Unilever, L’Oréal, Procter & Gamble, and Johnson & Johnson, announced changes to some of their products. For instance, Unilever said it would rename one of its skin creams, at the time called Fair & Lovely but since renamed to Glow & Lovely, and committed to removing references to “fair/fairness,” “white/whitening,” and “light/lightening” from its products’ packs and communication, noting that the use of these words “suggest a singular ideal of beauty.” L’Oréal and Procter & Gamble made similar commitments to remove references to certain words or rename products. Johnson & Johnson appeared to go a step further by discontinuing its Clean & Clear Fairness and Neutrogena Fine Fairness product lines, before replacing the latter with a new line named Neutrogena Bright Boost.164
To Rondilla, these rebranding efforts by companies equate to a repackaging of the same old problem. “I see those moves in the same way I would see someone putting a Band-Aid on cancer,” she commented wryly. “They did it as a marketing move, they did it as this sort of political stunt,” said Rondilla. “This is how these companies sort of pat themselves on the back thinking that they did a public good and, it’s like, if you really wanted to do a public good, you would have just done away with this product.”
In its June 2020 statement announcing its rebranding, Unilever said that “Fair & Lovely has never been, and is not, a skin bleaching product,” adding that its products represented a “much-needed move from harmful chemicals like mercury and bleach, which consumers were using.” But it isn’t clear to me that mainstream products like Unilever’s are actually moving consumers away from more dangerous, illegal products. Indeed, Grace’s experience in the Philippines suggests the exact opposite: she had mentioned that seeing advertisements for mainstream skin lightening products was one of the motivating factors behind her dangerous attempt to lighten her skin, using what turned out to be a harmful, illegal knockoff. While colorism obviously wasn’t invented by companies—and we are all collectively responsible for tackling this and other forms of racism in our societies—I am not convinced that their profiting from it is helping matters.
Beyond companies abandoning the promotion and sale of skin lightening products, Rondilla is also in favor of increasing media representation of darker-skinned people and educating people about the history of colorism. She is hopeful that colorism and its health harms can be addressed at a societal level, including by changing conversations within families. “I do feel optimistic about the future just because we talk about colorism way more now than five, ten years ago,” she told me.
Speaking to Rondilla was part of what inspired me to start the conversation I had with my mother about colorism and our hair, which I found very healing. At one point during that discussion, my mom pointed out how much things had improved in her lifetime, comparing mine and my sister’s experiences of colorism or featurism to hers, and even comparing her experiences to her mother’s. My mom was a lot older than me or my sister when she first felt able to accept her natural, Afro hair, but this was still a huge leap compared to her mother (my biological grandmother from Ghana) who didn’t see natural hair as acceptable for most of her life. “Whenever I got dressed and wanted to go out, my mother would look at my hair and say, am I going to do something about my hair?” My mum laughed, remembering when she first stopped chemically straightening her hair.
My grandmother came to live with us in the Netherlands when I was a teenager, after she was diagnosed with bone marrow cancer. She died from the illness in 2017, by which point I had left home and was living in the UK. Before my grandmother passed away, my mom said she had noticed a change in her relationship with her hair. “I think the first time I saw my mum just embracing her hair is after she had chemotherapy and she lost her hair, and it grew—and I saw some more acceptance of her natural look,” my mom told me during our chat. “She looked beautiful, I mean, I remember always saying to her that she looked beautiful, even when she was bald.”
Rondilla’s research suggests that conversations within families are important in shaping people’s perceptions of themselves and their self-esteem, both of which impact mental health and well-being. “When we look at colorism and mental health, one of the components that is often forgotten is intergenerational trauma,” said Rondilla. “For me, engaging in the research was really about finding a sense of healing and trying to change a generational narrative,” she explained.
It is positive to see improvements across generations, but the persistence of racial, ethnic, and caste health gaps suggests there is more work to be done to tackle racism and its health harms across societies globally. We have seen how racism in societies, including systemic and interpersonal forms of racism, are major contributors to health inequities. But the institutions of medicine and science aren’t separate from these societies, nor are they immune to its ills; racism within these institutions—particularly in the Western world—also contributes to racial and ethnic health gaps globally. And that is what I want to examine next.