Black Women’s Health Futures: Speculative Method as Structural Intervention

Public health research predominantly works in the present tense. It documents the disparities that structural racism and gendered racism produce and projects them forward, modeling futures as extrapolations of present harm. For Black women, positioned at the intersection of racism, sexism, and other systems of domination, and bearing some of the most persistent inequities in maternal, reproductive, and chronic disease outcomes, this orientation is doubly constraining. It can specify what must be dismantled far more readily than it can imagine what should be built, and it cedes the imagining of Black women’s health futures to the institutions that engineered present inequities. This conceptual paper argues that the speculative method, drawn from Afrofuturism, Black feminist futurity, feminist futures methodologies, and participatory speculative design, offers public health a complementary and underused capacity. The speculative method brings two analytically distinguishable emphases to this work. It makes it perceptible how intersecting structures foreclose on opportunities to optimize Black women’s health and the collective imagination toward Black women’s futures, more broadly an orientation that PHCR and intersectionality share. It draws on documented, replicable techniques including collaborative speculation, design probes, artifact-making, and visionary fiction to co-produce health futures with Black women themselves. This is already demonstrated empirically: Hill-Jarrett and colleagues’ Radical Imagination program shows Afrofuturist creative-aging methods improving brain health programming for older Black women, and parallel work in human–computer interaction has used Afrofuturist speculative co-design with Black communities more broadly. Bridging the Black feminist futurity, feminist-futures, and speculative-design studies with Public Health Critical Race praxis and intersectionality, we orient the speculative method, rooted in Black feminist futurity, toward three domains: bias in reproductive and clinical artificial intelligence, inequitable policy regimes, and community-engaged intervention design. We conclude that the speculative method is a disciplined expansion of the questions public health research is able to ask.