The colloquial phrase “Black Don’t Crack” refers to perceptions of African American women retaining youthful features over time and seemingly defying the aging process. This conjecture appears to only be skin deep, as across almost every health indicator, African American women fare worse than women in other racial/ethnic groups. African American women experience excess morbidity in obesity, diabetes, and adverse birth outcomes, and are more likely than women of other ethnic groups to die from breast and cervical cancer, cardiovascular disease, and HIV/AIDS. This article provides an overview of social, biological, psychological, and cultural factors that contribute to African American women’s health. Attention is directed to cultural factors that are both protective and risky for African American women’s health. There is a need to garner a better understanding of the complex nature of health disparities experienced by African American women in order to move the field forward in making progress toward achieving health equity for this population. This article addresses this need and offers recommendations for translating science in this area into meaningful population level impact.