Portsmouth has long been one of the poorest and Blackest cities in the commonwealth. More than half its residents are African American, and nearly 1 in 5 lives below the poverty line. Decades of underinvestment have made Portsmouth ground zero for health inequities — from HIV and STI rates several times higher than the state average to one of the worst maternal-mortality rates for Black women in the nation.
Instead of confronting these disparities, the Virginia Department of Health under Gov. Glenn Youngkin, Health Commissioner Karen Shelton and Deputy Commissioner Susan Fischer Davis has weakened the very programs meant to protect these residents. Their actions mirror a broader political agenda aimed at scaling back safety-net services while branding the changes as “modernization.”
Under Shelton, VDH has echoed the rhetoric behind Youngkin’s themes of “parental rights” and “local control.” But behind the language of efficiency are decisions that divert resources from high-need communities and erode the public-health infrastructure that keeps cities such as Portsmouth afloat.
Programs that primarily serve low-income Black and LGBTQ+ residents — such as HIV prevention and STI treatment — have slowed or lost momentum under the banner of restructuring. Critical health care positions remain vacant for months. Most alarming, the state rejected a proposed Black maternal mortality grant designed to address Portsmouth’s staggering rate of preventable deaths among Black mothers, even though Black women here are several times more likely to die from pregnancy-related complications than white women.
Wealthier, whiter localities have not faced these barriers. Their budgets remain intact, their leadership supported, and their services uninterrupted. The contrast makes clear that some communities are treated as more deserving than others.
In Portsmouth, the consequences have been immediate. The health department lost its director after months of pressure from Richmond to scale back maternal-health, harm-reduction and reproductive-health initiatives. Her vision — restoring obstetric services to a city that has become a birthing-hospital desert, expanding harm-reduction programs and partnering with hospitals to reduce racial disparities — should have been welcomed. Instead, staff who pushed for the maternal-mortality grant or tried to improve transparency found themselves blocked. Richmond’s message was clear: fall in line, or face consequences.
This pattern of sidelining leaders who advocate for marginalized communities sends a chilling signal. Across Virginia, VDH has drifted from evidence-based public health toward politically safe messaging about “personal responsibility.” Funding for Title V and maternal-child health programs has been reduced, leaving districts that serve the poorest families with fewer resources to meet urgent needs.
HIV prevention and PrEP programs have seen budgets stagnate as infection rates rise. References to race, poverty and inequity have been removed from official reports, replaced with vague language about “community wellness.” This shift is not harmless — it erases systemic causes and implies that health outcomes are matters of personal choice, conveniently absolving policymakers of responsibility.
Since Portsmouth lost its local leadership, morale has deteriorated. Nursing and clinical vacancies go unfilled. Promising maternal-health initiatives have stalled. Residents feel the impact every day: the mother who can’t find prenatal care, the young man waiting months for an HIV test, the family who no longer sees an outreach nurse on their block.
These are not abstract policy debates. They are the lived consequences of decisions made by people who will never face them personally. The dismantling of Portsmouth’s health services reflects an ideology that values control over compassion and privatization over public good. By suppressing local autonomy, the state ensures that the poorest communities have the least voice.
Health equity is not a radical demand. It is the foundation of a just society. If VDH intends to protect every Virginian, it must stop punishing districts that speak uncomfortable truths, invest in programs that save Black mothers’ lives, and acknowledge that silence in the face of inequity is complicity.
Portsmouth deserves leadership that sees its residents not as a budget line, but as people whose lives matter just as much as anyone in this commonwealth.
Grace Bagley of Suffolk is a former Navy officer who has practiced as a registered nurse in Hampton Roads for more than 20 years.
