Linda Villarosa Explores Racism in Healthcare in ‘Under the Skin’ : Shots


A black woman receives a COVID-19 vaccine at a clinic in Tampa, Florida. Black Americans have died from the disease at a rate more than double that of white people.

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Octavio Jones/Getty Images

A black woman receives a COVID-19 vaccine at a clinic in Tampa, Florida. Black Americans have died from the disease at a rate more than double that of white people.

Octavio Jones/Getty Images

The COVID-19 pandemic exposed the racial inequalities plaguing the U.S. healthcare system, with black people dying from the disease at a rate more than double that of white people.

Author Linda Villarosa has been writing about the racial disparities in health outcomes for decades and recently covered the topic for the New York Times’ 1619 project. She says that while she used to think poverty was the root of black Americans’ health problems, she now believes that the biases in the health care system and the “defense” effect of living in a racist society are taking a serious toll on people’s health. African Americans.

Villarosa points to “weathering” — a concept developed by public health professor Dr. Arline Geronimus – as the wear and tear on the body that results from prolonged exposure to stress: “Your heart rate goes up, your cortisol stress levels go up in your body. Your blood pressure goes up,” she says. “It’s not good for the body. But if people are treated badly, it will.”

In her book, under the skinVillarosa argues that any attempt to close the gap in health outcomes must also address the structural racism that underlies the U.S. health care system. She points to historical myths about black bodies — including the misconception that black people have a higher pain tolerance than white people — that continue to influence the way care is delivered.

For example, in 2019, researchers at UNC-Chapel Hill published a study that found that black women didn’t receive as much pain treatment after cesarean section as white women, even if everything else was the same — perhaps, Villarosa says, because of implicit bias among medical students and residents. .

“That’s worrying, because those are America’s future doctors. And that means we have to do things differently here,” she says.

Villarosa says that although she tiptoed around the word “racism” when speaking on panels, she no longer feels the need to avoid the term.

“We’re not accusing individuals of being racist, but we’re saying there’s something wrong with what’s happening in America,” she says. “When you identify the problem, when you discuss the problem, it’s easier to tackle the problem and come up with solutions than if you pretend it doesn’t exist.”

The following interview has been edited for length and clarity.

Highlights of the interview

On writing about the health crisis in Black America for: Essence in the ’80s, and assuming problems were “our own fault”

Under the Skin, by Linda Villarosa

It was clear that there were racial health disparities. Black Americans had more so-called “lifestyle diseases,” as we called them then, and it was heart disease, diabetes, stroke, asthma. We knew that, but we just didn’t understand the cause. And so the statement was that it was our own fault. So either it was something about our genetic makeup that made us sicker, and also… [causing] lower life expectancy and higher infant mortality, or it was something we were doing wrong. so at Essencethe idea was that we can solve racial health inequalities by just getting all the people [who read] our magazine, because those are the people we had access to, just to do better. And what we said is, when you know better, you do better.

About how Dr. Harold Freedman’s research changed the way she understood racial inequalities in health care

He looked at the health of men in Harlem and compared them to men in the impoverished country of Bangladesh. And it turned out that black men in Harlem lived fewer years than men in Bangladesh. It was shocking. It was in the New England Journal of Medicine† So he came to speak to my class at the Harvard School of Public Health, my fellowship class, and I was so interested in everything he had to say. I insisted that this is a poverty problem. And one thing he said to me was, “Wait a minute, look at the people of Harlem. The people of Harlem are not all impoverished. So if you think that the problems of black people, the health problems of black people in America is only because of poverty, you make a mistake and you think it’s going wrong.” What I have learned from him is that if you look at the problem through the wrong lens, you will come up with incorrect and ineffective solutions.

About the myth that black bodies feel less pain than white bodies

That myth started during the years of slavery, and was pushed around that time by doctors and scientists who also had a hand in keeping slavery intact. So the idea that if black people had extreme pain tolerance, you could hurt our bodies, beat us, whip us, take our kids away, and work us from dusk to dusk and it didn’t matter.

What I learned was that myth was pushed using evidence in data in medical journals. So fast forward, for me, to 2016 and it was a University of Virginia study that looked at myths and mythology that [white] medical students still believed…including the idea that black people have a different kind of pain tolerance.

Other myths were that black skin is thicker than white skin. That is certainly a myth. Skin comes in all thicknesses. But if you believe that, it kind of speaks of a kind of false invulnerability that black people have that prevents us from having our pain treated in the same way.

On the myth that black people have weaker lungs – and how there is a race correction to this day

There was a myth that, again, started during the years of slavery that black people had inferior lung function. So it was kind of the opposite of pain tolerance, one where we had a superpower and this was an inferiority. The idea was that because of these weak lungs, it was good for us to work in the fields because it was a form of exercise, free labor as exercise. And this was a myth that was believed by doctors and put forward again in medical journals, at medical conferences.

Fast forward to today and there is a machine called a spirometer that measures lung function, and often in the same machines used today there is a race correction that assumes black people have inferior lung function. And I thought about this not too long ago. A few years ago I had a lung function test because I got over bronchitis. And then I started to think, I wonder if I got the race correction, which would have been really unfair because I grew up in Denver, the Mile High City, so I have really good lungs. So it’s wrong to assume a racial inferiority without looking at other ways I could be different, including that I grew up in the Mile High City.

About the fact that maternal mortality is higher among black women in the US

I heard this while I was playing soccer for a weekend from a woman who was an international lawyer. She told me, “Did you know that the United States is the only country where the number of women who die or nearly die in childbirth is rising?” So I said, “Oh no, I didn’t know that.” Then she said, “It’s driven by black women because black women are 3 to 4 times more likely to die or almost die.” I still had the impression, even in 2017, that this was a matter of poverty. So I had a fight with her and then she kept me cold because she said, “Education isn’t protective.” If you’re a black woman with a master’s degree or more, you’re still more likely to die or nearly die than a white woman with an eighth grade education. So that struck me.

I also noticed that I had had a low birth weight baby, which was very unusual for someone because I was so healthy. I worked as a health editor of Essence magazine. I was a public figure as a healthy person trying to do everything right. And then I had a low birth weight baby. I’ve heard so many other stories from other black women, including Serena Williams, who had a difficult birth. … This is just so widespread. And I think my article struck a chord with people who had experienced this, but never heard it talk about it.

About how “weathering” affects other groups of people

I decided to go to West Virginia, to an area where HIV broke out. There was an HIV outbreak because of opioids. So West Virginia, as we know, was inundated with opioid pills. And then they were withdrawn from the street. So people got addicted to heroin, so they started using heroin and sharing needles. So that caused an HIV outbreak. So I was just curious to see what happens [when] you treat people badly, you shower them with pills, and then you yank them away and they become addicted to heroin. Then they are blamed for their condition with less questioning of what really happened, what drug companies did.

What I discovered was that the first thing I noticed was that people looked so much older than I thought. I’ve always misjudged everyone’s age. I saw people who were homeless. There was such an extreme amount of shame from the people. There was so much pain. And I just thought, this is also weathering. When people are treated badly, they blame themselves. They receive no treatment and care. They are ridiculed and given no support. This is what happens to you, your body ages. So it really is everyone who is being mistreated and marginalized.

About how studying the mistreatment of black people’s health can help other people too

Because our experience in America has lasted so long, our mistreatment began in 1619, and continues to this day, so we are the ones best studied. We are the ones whose bodies were commercialized, which meant a lot of attention was paid to our health and well-being, as well as our pain and harm. And so it’s interesting to look at black bodies and it’s important, but discrimination and harm hurts everyone.

Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Laurel Dalrymple adapted it for the web.