After decades of reporting and editing stories about the physical and emotional health of black women, Linda Villarosa realized that everything she thought – everything we all thought – about health disparities in the United States was wrong. In her new book, Under the Skin: The Hidden Toll of Racism on American Lives and Our Nation’s HealthVillarosa dismantles the notion of the black health crisis as an individual problem and exposes the origins of racism in today’s healthcare system, of which he has gained a deeper understanding over the course of his career, to Essence magazine, as a university professor, as a contributing writer for The New York Times Magazine and Project 1619, and through his own experiences as a black person in America. We talked about the impact of a racist healthcare system on every body and what, despite everything, keeps it going. This interview has been edited for length and clarity.
Blacks have never had the same health since we came to these shores. So it’s like, well, why do we keep thinking of this as a black problem? This is a nationwide problem. This is a problem we all have to solve in America. And thinking about it more broadly helped me say, “Wait a minute, if this isn’t a problem blacks have to solve on their own, then I have to find a way to communicate what’s going on.”
RM: You have written extensively about how the injustices that blacks have faced are rooted in false beliefs about our bodies from the days of movable property slavery. Can you talk about those connections between published theories about black bodies from centuries ago and the treatment blacks experience today?
LV: For Project 1619, I was assigned to look at the mythologies that began during slavery that still exist today. I chose pain tolerance, the idea that we are immune to pain and feel less pain than whites and other people, because during slavery it was convenient to say, so that no one had to feel guilty for whipping, beating, taking away the our children. But this still exists today. I don’t think doctors and other health workers start the profession to be evil. I just think these myths and stereotypes are ingrained in every system and institution in America, including the healthcare system.
The second I was looking at is lung function – the idea that we had weak lungs as people of color, so working in the fields is good for us. But then the idea that the spirometer [a device used to test pulmonary function] was invented by Dr. Samuel Cartwright, who also invented “drapetomania”, which is a completely ridiculous “disease” which says that the reason [enslaved people] running away is why [Black people] have mental illness, not because slavery is terrible. We still use that spirometer with a racial correction for kidney function.
And when the medical school students rejected [the notion of a race correction], simply by asking, “Well, why?” There really isn’t a consistent answer. It’s just the way things are done. But medical students are pushing back and trying to undo some of these old stereotypes that remain ingrained in current medical practice and education.
RM: How are medical students and practitioners forcing change in these institutions and in the system itself?
LV: Much is black-led, including at the American Medical Association, and a lot is student-led when it comes to medical schools. These are students who have come of age, even before George Floyd, with Black Lives Matter, and have become politicized. I’m not just talking about Blacks, but students of all races. They’ve come to medical school and been struck by some of the older, even disproved things that are still being taught and are starting to dismiss.
For this book, I did a lot of research by talking to medical students. I think the problem is that, in many cases, medical schools themselves are not leading the way from above. It is the medical students who are trying to get an education and at the same time they are trying to make a change in the medical school. But I am really encouraged by this. I am also encouraged by several colleges and universities that set up health equity centers and things like that. A lot of things have happened in the last couple of years and that makes me excited.
RM: What does it mean to be black in this country which, as you write, is bad for the body and the baby?
LV: Arline Geronimus coined the term “aging”. Her theory began with the observation of teenage pregnancies. Everyone was worried about teenagers at the time, but when it came to infant mortality, it wasn’t teenagers who were losing their babies. They were slightly older women. Geronimus began to consider the idea that something in the lived experience of being black in America is harmful to the body, and certainly going through labor and delivery for a person giving birth is a complete stress test.
If you are already suffering from toxic stress, then it is no shock that both can be dangerous for mothers and their babies. And as she says it is that whenever something happens to you and you are subjected to discrimination, your body systems increase in volume, be it your heart rate, your blood pressure, your stress hormones. And then it really happens if you are subjected to discrimination at work, by the police or in housing, but even if it is the daily stress described by public health professor David Williams, that you are someone who thinks you are stupid compared to other people. , they follow you into a shop, or you walk into the elevator and people back away.
All that stuff makes you angry enough that if it happens over and over, it simply becomes harmful to your body and creates some kind of accelerated aging.
What really struck me was when the Covid numbers came out and we learned that blacks have had worse cases than Covid 10 years younger [than their white counterparts]. In my Covid story looking at the Zulu crew, when I took that story to my editor, he said, “How old is the guy you want to follow?” I said: “He died at 50”. We were shocked. Since our bodies had already been damaged by living in America, then it affected us worst when we were young.
When it happened, I just took a deep breath.
RM: You traveled to West Virginia to investigate the health crisis. Why was it important for you to connect what’s happening there with the black weather?
LV: Well, there was Arline Geronimus again and a studio in Postville, Iowa, where there was this huge ICE raid in 2008. ICE comes in and they arrest and disperse families. They terrify the people of this city, mostly all Latin, who work in a meat processing company. But it resonated with the people of the city.
Geronimus looked at people’s births in the following year and found that Latinx people had a 24% higher risk of low birth weight than the previous year. I asked her to explain [her theory] because it had been so ingrained especially in black people who give birth.
He explained that it wasn’t about the person’s race; it is because of how they are treated because of their race. So it’s not something that being black is bad for the body. Something about being black causes people in this country, other people to be cruel to you, and it makes a difference to your health.
So I started thinking, “Well, does that mean someone being treated badly?” And she said yes. It’s just that blacks have been treated badly for so long, since 1619. We’ve had a long history of this, and our bodies have been commodified. So we’ve been studied more, but it can happen to anyone, she said. And what I heard was “every body”. That’s why I went to West Virginia.
There was an AIDS epidemic there because drug companies flooded West Virginia with opioid pills. Then they had to pull them back. So people have become addicted to heroin, and when you stack it up, that’s how AIDS can be passed.
When I went there, it broke my heart to see how people were being treated so badly and they were so sick. I noticed that people looked older than they should and I started thinking about what Arline Geronimus said.
RM: How do you, personally, find the balance between knowing too much and living like a black person in this society?
LV: Clearly this is a problem of institutional and structural racism. But I also think people should really take care of themselves and others. My family is very close. I grew up with good food at home. I like cooking. My children have the highest taste. We belong to a food cooperative. We are all super obsessed with cooking well, eating well. My daughter is vegan.
So we take care of ourselves. If any of us get sick or if any of us end up in the health system, we are really good advocates. The last time I was in the hospital with my mother, the doctor came to me and said, “Are you a doctor?” Because I had researched everything to make sure my mom was okay, and I was really her advocate because I don’t trust the health system.
But I also try to compartmentalize my work a bit. You know this job can get you down, and I don’t want to leave it because I want to keep doing it as long as it’s needed. But I take care of myself. I play in an intergenerational soccer league and my daughter plays with me sometimes or against me sometimes. As an individual, family member and community member, I take care of myself even though I know that’s not all you can do. You have to look at the system and you have to think: the hardest part of this dilemma we find ourselves in is the part about racism in society. This is the thing nobody wants to hear about.