Portsmouth, Virginia, a city marked by significant socioeconomic challenges, is facing critical health disparities that have worsened due to recent state health policy decisions. With over half of its residents being African American and nearly 20% living below the poverty line, Portsmouth has earned a reputation as one of the poorest cities in the commonwealth. The area battles alarming health inequities, including HIV and sexually transmitted infection (STI) rates that far exceed the state average, alongside one of the highest maternal mortality rates for Black women in the United States.
Under the leadership of Governor Glenn Youngkin, Health Commissioner Karen Shelton, and Deputy Commissioner Susan Fischer Davis, the Virginia Department of Health (VDH) has enacted changes that many argue undermine essential health programs. Rather than addressing these disparities, the VDH has reportedly weakened initiatives aimed at protecting vulnerable populations. Critics say this reflects a broader political agenda that prioritizes budget cuts and the reduction of safety-net services, disguised as “modernization.”
The shift in focus from health equity to “parental rights” and “local control” has led to significant resource reallocation away from high-need communities. Programs that primarily support low-income Black and LGBTQ+ residents, including crucial HIV prevention and STI treatment services, have lost momentum. Many critical health care positions remain unfilled for extended periods, resulting in a diminished capacity to serve the community effectively.
One particularly troubling decision involved the rejection of a proposed grant aimed at addressing maternal mortality among Black women in Portsmouth. Despite evidence that these women are several times more likely to experience pregnancy-related complications than their white counterparts, the state declined the opportunity to invest in a solution. Wealthier and predominantly white localities have not faced the same barriers, with their budgets and services remaining largely intact.
The impact of these policies has been immediate and severe. Portsmouth’s health department lost its director amid ongoing pressure from Richmond to cut back on essential maternal health and reproductive health initiatives. Her efforts to restore obstetric services, expand harm-reduction programs, and collaborate with hospitals to reduce racial disparities were met with resistance. Employees advocating for the maternal mortality grant or seeking to improve transparency encountered barriers that discouraged their efforts.
The actions taken by state officials send a concerning message to local leaders advocating for marginalized communities. Across Virginia, the VDH has shifted from evidence-based public health strategies to messages that emphasize “personal responsibility,” undermining the systemic factors contributing to health disparities. Funding for Title V and maternal-child health programs has been cut, leaving districts that serve the most impoverished families with inadequate resources.
As a result, programs for HIV prevention and pre-exposure prophylaxis (PrEP) have stagnated while infection rates continue to rise. Official reports have removed references to race, poverty, and inequity, opting for vague language about “community wellness” instead. This change not only obscures the root causes of health issues but also implies that health outcomes are merely the result of individual choices, relieving policymakers of accountability.
Since local leadership in Portsmouth has deteriorated, staff morale has plummeted. Nursing and clinical vacancies remain unfilled, and promising maternal health initiatives have stalled. Residents are acutely aware of the fallout: mothers unable to find prenatal care, young adults waiting months for HIV tests, and families no longer receiving outreach services. These are not abstract policy matters; they represent the real-world consequences of decisions made by individuals disconnected from the communities they affect.
The dismantling of Portsmouth’s health services reflects a troubling ideology prioritizing control over compassion and privatization over the public good. By suppressing local autonomy, the state ensures that those in the poorest communities have the least voice in health matters that directly impact their lives.
Health equity is a fundamental demand for a just society. If the VDH aims to protect all Virginians, it must halt punitive measures against districts that confront uncomfortable truths. It must invest in programs that save Black mothers’ lives and acknowledge that inaction in the face of inequity equates to complicity. Portsmouth deserves leadership that recognizes its residents as individuals whose lives are as valuable as those in more affluent areas of the commonwealth.
Grace Bagley, a former Navy officer and registered nurse with over 20 years of experience in Hampton Roads, emphasizes the need for a compassionate approach to health care that truly serves all communities.
