After decades of editing reports and stories about the physical and emotional health of black women, Linda Villarosa has realized that everything she thought about health inequality in the United States — everything we all thought — was wrong. In his new book, Under the Skin: The Hidden Impact of Racism on American Lives and the Health of Our NationVillarosa dismisses the concept of the black health crisis as an individual problem and reveals the origins of racism in the current health care system, which he has understood more deeply throughout his career. The essence the magazine, as a university professor, as an assistant writer The New York Times Magazine and the 1619 Project, and his experiences as a Black in the Americas. We talked about the impact that a racist health care system has on every body, and yet what goes on. This interview has been edited for length and clarity.
Blacks have never been in the same health since we came to these shores. And then this is, well, why do we still think of it as a black problem? This is a problem for the whole country. This is a problem that we all need to solve in America. And thinking more broadly helped me say, “Wait a minute, if this isn’t a problem that we blacks need to solve on our own, then I need to find a way to communicate what’s going on.”
RM: You have written a lot about the injustices suffered by blacks from the times of civil slavery rooted in false beliefs about our bodies. Can you talk about the connection between the theories published about Black Bodies centuries ago and the treatment that Blacks are experiencing today?
LV: For the 1619 project, I was asked to study the mythologies that began in the era of slavery that still exist today. I chose pain tolerance: the idea that we are immune to pain and feel less hurt than whites and others, that it was convenient in the time of slavery, that no one should feel bad for whipping us, beating us, depriving us of our children. But that still exists. I don’t think doctors and other health care providers are going to be in a bad profession. I believe that these myths and stereotypes are embedded in all American systems and organizations, including the health care system.
The second thing I was looking at was lung function: the idea that we had weak lungs like blacks, so working in the field is good for us. But then the idea of the spirometer [a device used to test pulmonary function] It was invented by Dr. Samuel Cartwright, and he also invented “drapetomania,” which is a completely ridiculous “disease” that claims to be the cause. [enslaved people] because to escape [Black people] be mentally ill, not because slavery is horrible. We are still using this spirometer to guide the race for kidney function.
And when medical students objected [the notion of a race correction], “Well, why is that?” just asking. There really is no consistent answer. It’s just a way of doing things. But medical students are stepping back and trying to dispel some of those old stereotypes that remain in the current medical practice and education.
RM: How are medical students and physicians being forced to change in these institutions and in the system itself?
LV: A lot of it is run by blacks, as well as the American Medical Association, and a lot of it is available to students if you’re in medical school. They are students who arrived with Black Lives Matter before George Floyd, and became politicized. I don’t just mean Blacks, I mean students of all races. They went into medical school, and they are still successful with the older things that are still being taught to them and are being pushed back.
For this book, I have done a lot of research talking to medical students. I think the problem is, in many cases, that the medical schools themselves are not doing it from the top down. Medical students are those who are trying to get an education and at the same time trying to make changes in medical school. But that really encourages me. I am also encouraged by various schools and universities to run health equity centers and the like. A lot of things have happened in the last two years, and it makes me excited.
RM: What is it like to be black, as you write, in this country that is bad for both body and baby?
LV: Arline Geronimus coined the term “weather.” His theory began with the study of teenage pregnancies. At one time everyone was worried about teenage girls, but when it came to child mortality, it wasn’t teenagers who were losing their children. The women were a little older. Geronimus began to think that something about the experience of being a Black American is bad for the body, and it is certainly a stress test for a person to give birth and give birth.
If you are already experiencing toxic stress, it is not surprising that both can be dangerous for mothers and their children. And as he says, every time something happens to you and you are the subject of discrimination, your body system speeds up, your heart rate, your blood pressure, are stress hormones. And then it really happens if you are discriminated against at work, in the police, or at home, but despite the daily stress described by public health professor David Williams — whether someone thinks you’re stupid compared to other people, follows you into a store, or gets in the elevator and people back you do.
All of these things make you feel bad enough that if it happens over and over again, it becomes bad for your body and causes a rapid aging.
What really surprised me was when Covid’s numbers came out and we found out that blacks were the worst cases of Covid when they were 10 years younger. [than their white counterparts]. Looking at the Zulu crew in my Covid story, when I took that story to my editor, he said, “How old are the guys you want to follow?” I said, “He died at the age of 50.” We were amazed. Because our bodies were already damaged by living in America, then it got worse when we were younger.
When that happened, I took a deep breath.
RM: You went to West Virginia to study the health crisis there. Why was it important for you to relate what was going on there to the Black weather?
LV: Well, again a study by Arline Geronimus and Postville, Iowa, in 2008 was this big ICE attack. ICE enters and they arrest and break up families. They scare the people of this town who were mostly Latins, working in a meat processing company. But it resonated with the people of the village.
Geronimus looked at people’s births the following year and found that Latinx had a 24 percent higher risk of being underweight compared to the previous year. I asked him to explain [her theory] mainly because it was so grounded in the birth of black people.
He explained that it was not about the person’s race; because of their race and how they are treated. So being black is not something that is bad for the body. Something about being black affects people in this country, being cruel to other people and making a difference in your health.
So I started thinking, “Well, does that mean anyone is being mistreated?” And he said yes. It’s just that Blacks have been mistreated for so long, since 1619. We’ve had a long history around this, and our bodies have been commodified. So they’ve looked at us more, but it can happen to everyone, he said. And what I heard was “every body”. That’s why I moved to West Virginia.
There has been an outbreak of AIDS where pharmaceutical companies have flooded West Virginia with opioid pills. Then they had to go back. So people got addicted to heroin, and when you’re shooting, that’s how AIDS can go.
When I went there, it broke my heart to go there because people treated me so badly, and they were so sick. I noticed that people were older than they should be, and I started thinking about what Arline Geronimus had to say.
RM: How do you personally find a balance between knowing too much and living as a Black in this society?
LV: It is clear that this is a problem of institutional and structural racism. But I think people need to take good care of themselves and each other. My family is very close. I grew up with good food at home. I like to cook. My kids have the ultimate taste. We belong to a food cooperative. We are all very obsessed with cooking well, eating well. My daughter is a vegan.
So we take good care of ourselves. If one of us gets sick or one of us ends up in the health care system, we are good advocates. The last time I was in the hospital with my mother, the doctor came back to me and said, “Are you a doctor?” Because I researched everything to make sure my mom was okay, and I was really her advocate, because I don’t trust the health care system.
But I also try to share my work a bit. You know that this job can be down, and I don’t want to let it go because I want to keep doing it. But I take care of myself. I play in the intergenerational football league, and my daughter plays with me sometimes or sometimes against me. As an individual and as a member of a family and community, I take good care of myself, even though I know that’s not all you can do. You just have to be more discriminating with the help you render toward other people. That’s something no one wants to hear.