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“Under the Skin: The Hidden Toll of Racism on American Lives.." | Reviewed by Bill Schwab

“Under the Skin” examines and explains the connection between United States history and the cumulative effects systemic racism has had on the physical and psychological health of individual citizens and the nation. Journalist Linda Villarosa’s highly acclaimed study of the disparity between the health care available to and received by Whites and Blacks in the United States is now available in a paperback edition.

Villarosa demonstrates that unequal treatment in the health care system continues because of three major obstacles: institutional and structural discrimination; implicit biases in the medical profession; and “the struggle with anger and grief triggered by everyday racist insults and microaggressions...[which] can, over time, deteriorate the systems of the body.”

This intelligently written, well-researched, and illuminating, assessment of the United States health system documents why Black people “live sicker and die quicker” than White people. Villarosa cites some passages from current medical books that still convey false assumptions that the physiology of Blacks is innately different from the physiology of Whites. She discusses the creation of this myth which began during the transatlantic slave trade and maintained that Blacks had “a primitive psychological organization” that made them “uniquely fitted for bondage.” As an example, she quotes a New Orleans doctor who asserted that the desire to escape was itself proof of a mental illness.

By providing data from multiple medical settings, she also proves that Blacks receive worse treatment and poorer health outcomes than Whites. Villarosa, who is African American, had assumed, like the White medical establishment, that poverty was the key factor determining these different outcomes. But, as she and her co-researchers studied their extensive collection of statistics, the data indicates that “babies of more educated, higher income black parents were still more likely to be born small compared to their white counterparts.” The research proves, “the lived experience of being Black in America regardless of income and education, also affects health.”

The facts reveal that the racial disparity in infant mortality is “actually greater in the present day than in 1850, when Black women were human chattel.” African Americans aged 18 to 49 “are twice as likely to die from heart disease.” Black infants are more than twice as likely as White babies to die before their first birthday.

She also demonstrates how the continuing scourge of racism ages Black people prematurely by skillfully interweaving historical and medical facts with anecdotal profiles of patients suffering from HIV/AIDS, Covid-19, and other public health issues.

Despite all this negative information, however, Villarosa remains optimistic about possible improvements in the health of Blacks and makes an impassioned call for equality in America’s medical system. The author recalls how excited she was when the former governor of New York, Andrew Cuomo, responded to her study with a pilot project to expand Medicaid coverage for birth doulas, “citing the need to target racial disparities in maternal mortality.” To combat racism in health care, Villarosa also champions implicit-bias training for medical workers and urges expanding the diversity of students, faculty, and courses in medical schools.

Anchored by hauntingly-told human stories and irrefutable facts, “Under the Skin” is stunning, heartbreaking, and vital reading.

About the Author: Linda Villarosa is a reporter, writer, and editor, currently a journalism professor at the City University of New York and a contributor to The 1619 Project. Her writing on the intersection of race and health has appeared in the “New York Times Magazine” since 2017 and her 2018 article on maternal and infant mortality was a finalist for a National Magazine Award.




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