The fact that there are significant gaps in our healthcare system that influences the health and wellness of Black people in America isn't revelatory information. For instance, the U.S. Department of Health and Human Services released the Heckler Report in 1985, which documented the existence of health disparities among People of Color in the United States. At the time, according to the Centers for Disease Control and Prevention, those disparities were considered "an affront both to our ideals and to the ongoing genius of American medicine." This led to the report's most significant outcome: the creation of the Office of Minority Health in 1986.
While 37 years have passed since the landmark report, health inequities among People of Color haven’t really shifted in a more positive direction, nor have the systems in place that contribute to ongoing racism. Moreover, according to the American Cancer Society, African Americans die at the highest rates of any racial/ethnic group from most cancers. And when it comes to heart disease, Black Americans are 30% more likely to die from it than white Americans.
BET.com talks with esteemed author (“The 1619 Project”), journalist, educator, and contributing writer to the New York Times Magazine, Linda Villarosa, who often writes about the intersection of race and health, about her new book "Under the Skin: The Hidden Toll Of Racism on American Lives And On the Health Of Our Nation" and what we can do to better advocate for ourselves.
BET.com: What has propelled you to write this book at this moment in time?
Linda Villarosa: It was two things. I had been writing stories for New York Times Magazine, and they were really long articles. My editor would say to me 'you're off topic here, take out a passage, and I would tell her that I liked that passage, and she'd say, save it for the book.' Through all my stories, there was always something to save, but I would always say 'I'm not writing a book; there's no saving this.' But then it became, 'why am I not writing a book? I have all this extra stuff.'
Additionally, people throughout the country sent me notes and asked if they could reuse my articles for presentations in their classes or show them to their colleagues they worked with. I realized that people were asking because they needed to have something that was evidence-based and data-driven, that looks at racial health disparities, and I realized that a book was necessary. People shouldn't be cobbling this evidence together.
BET.com: The fact that there are health disparities in America isn't new. There are studies that talk about the gaps in healthcare, but what's stopping the medical community from going beyond knowing and doing something about those issues?
Linda Villarosa: I think in America, which is known for its rugged individualism, the most common idea is that the disparities are the individual's fault. So if you know better, you do better. Your physician is telling you what to do, and generally, what they tell you makes sense, like to eat better, exercise, take care of yourself. All of these things are very practical. Then you go to websites and [they] say the same things as do commercials. [You are told] these are the things you do what you do to stay healthy, with less interrogation about the institutional structural and historical discrimination that exists in our society that harms our bodies—especially in the healthcare system.
There is a blind spot, and sometimes when I talk about it or people talk about it, we're saying, 'oh, you're racist if you're a doctor or a nurse.' But it's not that, it's our systems that have discrimination baked into them, and our society is segregated. People don't treat people that aren't like them as carefully or as lovingly as they might somebody who's more like them.
So if most doctors are white doctors and men and you have white men treating People of Color, Black women specifically, then you have a disconnect that is hard to grapple with. And you can see what happens when we grapple with race in America. We're dealing with it right now. There's a Capital Riot and people who push back against Black Lives Matter because this is a hard moment for our country, but it matters, and it matters to our health.
BET.com: In chapter one, you specifically call out how American women have higher death rates due to pregnancy and childbirth than other countries. Why do you believe that is?
Linda Villarosa: We're the only wealthy country where the number of women who die in childbirth has been inching up. When I first heard that, I thought it was a mistake. I thought it had to do with extreme poverty, but the person I was talking to said this is a problem for Black women because they are three to four times more likely to die or almost die because of pregnancy, childbirth, and postpartum than white women.
And it has nothing to do with whether you are educated or not. She brought research that said a Black woman with a master's degree or more is more likely to die or almost die related to childbirth and pregnancy than a white woman with an eighth-grade education.
That's when I started wondering what that meant, and I then learned about the theory of weathering from Dr. Arlene Geronimus, who is a University of Michigan Professor of Public Health. Her theory is that because of racism in America, discrimination, comprised of both micro aggressions and bigger aggressions, those experiences compound over time and prematurely age the body, which happens to marginalized people. We know that if you're Black, it happens to you. It happens to women—especially Black women because pregnancy, childbirth, labor, and delivery is a stress test to the body and your body is already stressed prematurely [prior to being pregnant].
In my book and research, I talk about not only women who are poor and disadvantaged with these problems, which is unfair and horrible, but also middle-class women. I had a low birth weight baby. I was the health editor of Essence. I had great health insurance. My physician was my actual friend; I trusted her so we were shocked when I had this rare condition that caused me to have a baby who could fit in the palm of my hand. It happened to me, and I had done everything right.
You have both the research and first-hand experience with someone like Serena Williams, who is wealthy, has good healthcare, knows her body, and she's not heard or believed [after she gave birth to her daughter]. You know that both the lived experience of being Black in America is doing something to our bodies, plus the treatment in the healthcare system, even when we have resources, can be unfair and unkind.
BET.com: How can people better advocate for themselves? How can they ensure they are treated fairly by people in the healthcare system?
Linda Villarosa: If I go in with my loved one, I will ask questions and write things down. I am going to read about the procedure, problem or issue. I want them to talk to me about my loved ones. And if it is for me, I know that I am not always my best advocate when something's going on, and I might be afraid even though I have a lot of knowledge and I have a lot of courage, so I will bring someone else in to be my second ears and eyes. I am very cautious.
The next generation of health care professionals in America at medical schools and in medical training have been radicalized by Black Lives Matter. They were in high school or undergraduate college when we first started talking about Black Lives Matter and when we started seeing these police killings. Now, they are pushing back against some of their education that may be outdated and some of the racism that's baked into healthcare and in society. I've seen some energized young folks doing their best to make a difference and do things differently, which makes me happy.
I also see that there are hospital systems, state and national agencies, health commissions, and professional groups trying to incorporate antiracism in their training and practices and saying out loud that racism is a public health threat.
It is not about [our] race or something wrong with our culture or our bodies, but there's something wrong with a society that treats people badly and makes them ill.
“Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation” (Penguin Random House) by Linda Villarosa is available at bookstores now.
Editor’s note: This interview has been edited and condensed for clarity.