Inside hip-hop’s complex relationship with health

When Freeway was diagnosed with kidney failure in 2015, members of his team warned him not to go public with the news.

“They was like, ‘Yo, you shouldn’t do this. You shouldn’t say this. We just have to deal with this amongst ourselves,’” the 42-year-old rapper recalled in an interview with NBC News. 

“They said to keep it to myself so I wouldn’t look weak; hide it from people because I’m a celebrity. A lot of people felt like I shouldn’t be so open and letting people know what’s going on,” Freeway said.

He didn’t listen. A scroll through Freeway’s Instagram account will show the ups and downs of his life with kidney failure: his time in dialysis — four hours a day, three days a week — various doctor appointments, his kidney transplant in 2019 and his recovery since (with updates from his hospital bed).

Freeway isn’t the only rapper to speak publicly about his medical conditions. Rick Ross has consistently been open in interviews about his commitment to health after experiencing several seizures over the years; he has since reportedly invested $1 million in a Florida-based telehealth startup called Jetdoc. Such consistent public recognition of a rapper’s personal medical struggles hasn’t always been the norm in hip-hop culture.

“A majority of rappers are Black men, especially in the ‘90s and early 2000s, and Black men want it to seem like nothing can affect them, like they’re invincible,” Freeway said. “Nobody wanted to show any weakness.”

Hip-hop is an industry where any misfortune — like health issues, financial struggles, relationship woes — could quickly make even a beloved artist the butt of a joke. This is why only a few batted an eye when Tupac joked about rapper Prodigy’s sickle cell anemia in his famous 1996 Bad Boy Records diss track “Hit ‘Em Up,” which is still hailed today as one of rap music’s most caustic, disrespectful disses of all time. This is also likely why rumors swirled at the time of Eazy-E’s 1995 death that he died of a gunshot wound and not of AIDS-related pneumonia — likely an attempt to protect the NWA rapper’s “tough guy” image and quell any assumptions of homosexuality. 

This isn’t hip-hop’s singular attitude about health, though. In Drake’s infamous beef with Pusha T, the masses — while, no doubt, enjoying the feud — said Pusha went too far when he took a jab at Drake’s producer Noah “40” Shebib, who has multiple sclerosis, in “The Story of Adidon” rapping, “OVO 40, hunched over like he 80, tick, tick, tick/ How much time he got? That man is sick, sick, sick.” 

Even though hip-hop’s history is riddled with public health messages and campaigns for HIV prevention, healthy eating and more, it is growing more and more common for individual rap stars to both vulnerably share their personal medical ails with the world and commit themselves to raising awareness about their conditions.  

Perhaps the accessibility and instantaneous nature of social media can be partly credited for this shift. But the change is shining a renewed light on hip-hop’s — both as a genre and culture — complex relationship with medical health. Like all of Black culture, hip-hop has not been monolithic in its approach to physical well-being.

As much as a rapper’s medical condition could earn them a jab in a diss track, hip-hop has a long, rich history of prioritizing health and wellness both in the recording booth and the streets, according to Dave “Davey D” Cook, renowned hip-hop journalist and lecturer of Africana studies at San Francisco State University.

“In terms of rappers, anything that’s considered a weakness, people are gonna say something about it. Shock and awe is often rewarded. But from day one, hip-hop artists have always been about health,” Cook said. He noted that much of hip-hop’s golden age (the mid-1980s to mid-‘90s) “was immersed in the crack era.” 

“Health was in the forefront,” he said. “It might not have been on records … but we saw immediately the health implications. The crack and AIDS epidemic definitely made conversations around health unavoidable in hip-hop. I think what we’re looking at now is people paying more attention to artists when they talk about health issues, rather than artists ‘suddenly’ talking about it.” 

The complexities of hip-hop’s relationship with health can be seen throughout history. Even if artists weren’t doling out the details of their diagnoses of lupus, cancer or kidney failure on a track or in interviews, many musicians were promoting health and wellness in their communities.

In hip-hop’s golden age emerged the Good Life Cafe in Los Angeles’ Crenshaw neighborhood, which was the go-to spot for open mic talent by night and a natural health food store by day. Activist Rafiq Bilal worked with young rappers at The Nu Upper Room, the alcohol-free space in Oakland, California, for young artists. 

Today, rapper Styles P runs Juices for Life, a small juice bar with four locations throughout New York. The former Lox member said that even as a famous rapper, he didn’t feel his body was at its best. Now, for almost a decade, he’s been sharing his love for juicing with Black communities in the area. 

A 2017 study found that hip-hop is routinely used as a culturally relevant intervention to address mental and physical health among Black kids because “hip hop culture resonates so strongly with youth.” One example of such an intervention is Hip-Hop Public Health, a national music-oriented organization aimed at promoting health among young people. HHPH recently launched “Community Immunity: A Rap Anthology About Vaccines,” which features a series of animated videos and other resources to make sure Black communities have accurate information about Covid-19 vaccines. 

And in 2017, Quincy Jones III and Shawn Ullman co-founded Feel Rich, a music-inspired entertainment company aimed at promoting artists’ health and wellness efforts.

“We’ve got Styles P opening up juice bars in the Bronx and Yonkers. The Game, who’s got 60 Days of Fitness. Slim Thug, who’s got Huslfit. stic.man, who’s got RBG Fit Club,” Ullman told Black Health Matters. “I saw that a lot of these hip-hop artists were living a healthy lifestyle, but there was no platform for them to talk about it.”

The deaths of rappers like Big Pun, who died following a heart attack; J. Dilla, who died from complications of lupus, and DMX, who died of a heart attack, sparked conversations about physical health and addiction. But even as artists launched their own health movements through stores and community spaces over the years, it has long been rare for a hip-hop star to make a medical diagnosis a prominent part of their public identity. That’s why Freeway thought it necessary to share his story. 

The rapper rose to stardom in the early 2000s as part of State Property, one of hip-hop’s grittiest, most hard-hitting rap supergroups. Signed to Jay-Z’s Roc-A-Fella records, the group of Philadelphia rappers dominated, and they even released two crime movies named after the group. So, the “What We Do” rapper certainly had a reputation as an indestructible rap star, but it wasn’t one he was concerned with upholding when he learned of his kidney failure, diabetes and high blood pressure. 

Freeway has made a point of highlighting in interviews and social media posts that Black people are diagnosed with kidney failure at more than three times the rate of white people. Thus, as an esteemed name in hip-hop, he believed he had a responsibility to raise awareness by sharing his individual journey, he said. Hip-hop culture is Black culture; the two are inextricably bound in such a way that the music, clothing, language, struggles and more have always reflected Black life. Health matters are no different. 

“I felt it was more important for me to spread the knowledge than to portray being invincible,” said Freeway, who founded Freedom Thinkers Academy, which provides workshops and mentorships grounded in music, health, and education . “That’s why I wanted to get in front of it, because it affects African Americans. And I’m happy I did.”

This changing tide in hip-hop is perhaps in no area more evident than mental health. Artists have always rapped and sang about their experiences with depression, post-traumatic stress disorder and even anxiety using subtle, poetic lyrics: Grandmaster Flash and The Furious Five’s classic “The Message” is a famous example of this. But in recent years, hip-hop’s expression of mental health woes have gotten greater attention. Stephan Pennington, associate professor of music at Tufts University, said this change within the culture reflects that of larger society.

“I think there’s been a general societal shift from condition to identity. So people who have ADHD consider themselves a person with ADHD as an identity and they’ll put it in their Twitter bio,” Pennington said. “So mental and physical health things are now identities rather than conditions. This shift is one of the things that is changing the way hip-hop is talking about mental health because our entire society is talking about mental health differently.”

Hip-hop culture has long been a reflection of the times and conditions in which Black people live. This was likely only bolstered by the rise of social media, promoting a sense of community among Black people who can now see their own personal health struggles reflected in an artist’s social media posts. So it’s no wonder that even hip-hop’s most intimidating figures would find today’s culture a somewhat safe space to be vulnerable about their medical woes. 

However, among the culture shifts and change in public perception around many aspects of health, hip-hop has been slow to embrace disabled communities, said Leroy Moore, founder of Krip-Hop Nation, a national association of Black artists with disabilities. 

Moore, who has cerebral palsy, holds that within hip-hop culture, the approach to disabled communities has been one of secrecy, ridicule or charity. He pointed to the “hyphy” movement, a hip-hop subculture that re-emerged in the early 2000s, and its use of derisive terms like “retarded” and “dumb” as an example of hip-hop’s use of “disability lingo” while excluding the group. 

“In the beginning, hip-hop was diverse; you had people on crutches. Today I can count on one hand the amount of famous, visibly disabled artists,” Moore lamented. “There has to be more progressive voices and more push around disabilities in general in mainstream hip-hop. Hip-hop hasn’t dealt with its own ableism. In hip-hop they do a lot of charity programs for disabled communities, but that’s not education.”

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