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 differences in the United States was wrong. In his new book, Under the skin: The hidden result of racism on the lives of Americans and the health of our nationVilarosis destroys the notion of the crisis in the health of blacks as an individual problem and reveals the origins of racism in today’s health care system, of which she has gained a deeper understanding throughout her career. Essence magazine, as a college professor, as an author who contributes to New York Times Magazine and Project 1619, and through his own experience of living as a black man in America. We talked about the impact of the racist health care system on every organism and what, after all, sustains it. This interview has been edited for length and clarity.
Black people have never had equal health since we came to these shores. And then it’s like, well, why do we still think of it as a black problem? This is a problem for the whole country. This is a problem we all need to solve in America. And thinking about it more broadly helped me say, “Wait a minute, if this isn’t a problem that blacks have to solve on their own, then I need to find a way to report what’s going on.”
RM: You have written extensively about how the injustices faced by blacks are rooted in false beliefs about our bodies from the days of the enslavement of movable property. Can you talk about these connections between published theories about black bodies centuries ago and the treatment that black people are experiencing today?
LV: For Project 1619, I was tasked with examining the mythologies that began during the enslavement that still exist today. I chose pain tolerance – the idea that we are immune to pain and feel less pain than white people and other people, because it was convenient to say during slavery, so no one should feel bad beating us , beating, taking away our children. But it still exists today. I don’t think doctors and other health care providers enter the profession to be evil. I just think that these myths and stereotypes are embedded in every system and institution in America, including the health care system.
The second one I looked at was lung function – the idea that as blacks we had weak lungs, so field work 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 “drapemania”, which is a completely ridiculous “disease” that says the cause [enslaved people] run is because [Black people] have a mental illness, not because slavery is terrible. We still use this race-corrected spirometer for kidney function.
And when medical students are repulsed [the notion of a race correction], just by asking, “Well, why is that?” There really is no consistent answer. That’s just the way things are done. But medical students are rejecting and trying to remove some of these old stereotypes that remain ingrained in current medical practice and education.
RM: How do medical students and practitioners impose change in these institutions and in the system itself?
LV: A lot of them are run by blacks, even in the American Medical Association, and a lot of them are run by students if you’re talking about medical schools. These are students who have reached the age of majority, even before George Floyd, with the Black Lives Matter and are politicizing. I do not mean only blacks, but students of all races. They came to medical school and are somehow struck by some of the older, even refuted, things that still teach them and start to repel them.
I did a lot of research on this book, talking to medical students. I think the problem is that in many cases the medical schools themselves do not lead from above. Medical students are trying to get an education and at the same time trying to make a change in medical school. But I’m really encouraged by that. I am also encouraged by various colleges and universities that set up health justice centers and things like that. A lot of this has happened in the last two years and that excites me.
RM: What is it like to be black in this country, which, as you write, is bad for the body and the baby?
LV: Arlene Geronimus coined the term “weathering.” Her theory began with a study of teenage pregnancy. Everyone used to worry about teenage girls, but when you look at infant mortality, teenagers didn’t lose their babies. These were slightly older women. Jeronimus began to consider the idea that something in the experience of being black in America is bad for the body, and certainly going through childbirth and childbirth 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 she says that every time something happens to you and you are discriminated against, your body systems speed up, whether it’s your heart rate, your blood pressure, your stress hormones. And then it really happens if you are discriminated against at work, by the police or in the home, but even if it is the daily stress described by public health professor David Williams – whether someone thinks you are stupid compared to other people , they follow you to the store or enter the elevator and people back away.
All of these things upset you enough that if it happens over and over again, it just gets bad for your body and creates a kind of accelerated aging.
What really struck me was when the Covid numbers came out and we learned that blacks got worse cases of Covid by 10 years younger. [than their white counterparts]. In my Covid story about the Zulu team, when I brought this story to my editor, she said, “How old is the person you want to follow?” I said, “He died at 50.” We were shocked. Since our bodies were already damaged by life in America, it hit us even younger.
When that happened, I just took a breath.
RM: You traveled to West Virginia to investigate the health crisis there. Why was it important for you to connect what was happening there with the weathering of black people?
LV: Well, it was Arlene Jeronimus and a study of Postville, Iowa, where there was this huge ICE attack in 2008. ICE comes and they arrest and break up families. They are terrorizing the people in this city, who are mostly Latin Americans working for a meat processing company. But it resonated with the people of the city.
Geronimus looked at next year’s births and found that Latinos had a 24 percent higher risk of low birth weight than the previous year. I asked her to explain [her theory] because she was so grounded in giving birth to black people especially.
She explained that it was not about the human race; it is because of the way they are treated because of their race. So it’s not that being black is bad for the body. Something about being black makes people in this country, other people cruel to you, and that makes a difference in your health.
So I started thinking, “Well, does that mean someone who’s being treated badly?” And she said yes. It’s just that black people have been treated badly for so long, since 1619. We have a long history of this and our bodies have been reworked. So we’ve researched more, but it can happen to anyone, she said. And what I heard was “every body.” So I went to West Virginia.
There was an outbreak of AIDS because pharmaceutical companies flooded West Virginia with opioid pills. Then they had to pull them back. So people are addicted to heroin, and when you shoot, here’s how AIDS can be transmitted.
When I went there, my heart broke as I went there, how people treated me so badly and were so sick. I noticed that people looked older than they should, and I began to think about what Arlene Jerome had said.
RM: How do you personally find a balance between knowing too much and living as a black person in this society?
LV: Obviously, this is a problem of institutional and structural racism. But I also think that people need to take really good care of themselves and each other. My family is really close. I grew up with good food in the house. I love to cook. My children have the highest class of taste. We belong to a food cooperative. We are all super obsessed with cooking well, eating well. My daughter is vegan.
So we take good care of ourselves. If any of us get sick or if any of us end up in the health care system, we are really good defenders. The last time I was in the hospital with my mother, the doctor turned to me and she said, “Are you a doctor?” Because I had studied everything to make sure my mother was okay, and I really was her advocate. because I don’t trust the health care system.
But I’m also trying to split my work a little. You know this job can pull you down, and I don’t want to let it go because I want to keep doing it for as long as it takes. But I take care of myself. I play in a football league between generations and my daughter plays with me sometimes or against me sometimes. As an individual and a member of the family and a member of a community, I take good care of myself, even though I know that’s not all you can do. You have to look at the system and think – the hardest part of this dilemma we are in is the part about racism in society. This is something no one wants to hear about.