Celebrating 10 years and 500 episodes
In this episode we connect with Linda Villarosa, journalist and author of the book Under the Skin, exploring how racism effects the health and the quality of care of Black Americans in the US. Whether it is outdated medical myths about the Black body that some practitioners still believe, the inherent bias of a medical staff that is not representative of their patients of color, or the toll the constant stress of racism, bigotry, and harassment takes on a body. We discuss the term "Weathering," the premature ageing caused by that stress. Linda also shares some of the human stories and personal stories she uses in her book and explains how having a reader feel is as important as having them learn.
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Linda Villarosa is a journalist, an educator and a contributing writer to the New York Times Magazine. She covers the intersection of health and medicine and social justice. She is a journalist in residence and professor at the Craig Newmark School of Journalism at CUNY and teaches journalism, medicine and Black Studies at the City College of New York. Her book Under the Skin was published in June 2022.
"It really showed up during COVID when you saw Black people having worse symptoms that needed hospitalization or led to death 10 years before White people. If the worst cases were at age 70 to 80 for White people, they were 60 to 70 for Black people."
Engaging the World: Leading the Conversation on Health Equity is a series of interviews with activists, artists, educators, historians, and journalists about accessibility, cost, prejudice, and the human experience of healthcare in America.
Guest: Linda Villarosa
Host: Jon-Barrett Ingels
Produced by Past Forward in partnership with Wilkinson College of Arts, Humanities, and Social Sciences at Chapman University.
[00:00:03] Linda Villarosa: Weathering is a wonderful word for a terrible thing. It means that if you are someone who is having to suffer from constant insults, even when you're trying really hard-- Dr. Geronimus, who is at the University of Michigan, she calls it “hard effort coping,” just trying to get by, but then things get in your way. People treat you badly. People say things that are unkind to you, or you're discriminated against by the police at your job or in housing. Each time that happens to you, it causes the fight or flight mechanism to kick in. Then something happens, you get really upset. Your heart rate goes up. Your blood pressure goes up. Your body is flooded with stress hormones. Your muscles tighten. If that happens over and over because of these constant insults, it causes your body to prematurely age.
[00:00:52] Host: Chapman University's Wilkinson College of Arts, Humanities, and Social Sciences and Past Forward present Engaging the World, leading the conversation on health equity. In this series, we explore the historical, cultural, social, and economic disparities that interfere with the access to health and healthcare and examine how these challenges can exist in one of the most wealthy and technologically advanced nations in the world.
We engage with journalists, historians, artists, activists, and educators to look at accessibility, cost, prejudice, and the human experience of healthcare in America as we look for the pathways to health equity. In this episode, we connect with journalist and author Linda Villarosa to discuss her book Under the Skin, which explores the inequities of health and the healthcare system people of color, specifically Black people, face here in the US. Here is Linda Villarosa.
Linda, what I really appreciated while reading your book Under the Skin, along with how informative it was, and these heart-wrenching human stories that you included, it's that you acknowledged your own preconceived notions or bias in relation to health disparities of African Americans. That really allowed me as a reader to feel like I was learning with you, as opposed to just being taught or lectured to.
[00:02:30] Linda: I don't think I did that on purpose. I think that as I was going through how to structure the book, I was doing it chronologically like, "Here's my story" and using it chronologically. Then I realized, "Wait, my trajectory has really changed." That's why the first, basically, chapter is called Everything I Thought Was Wrong because I had preconceived notions.
I think it was good to acknowledge that because a lot of journalists are arrogant, and it seems like you just woke up and understood everything perfectly, which is generally not true. I was grateful to be able to share my own vulnerability in this in order to show other people like you said, it's okay if you had a preconceived notion. Even I did, and I'm the author of the book.
“The other thing to say is that in those maternal mortality statistics, a Black birthing person with a master's degree or more is more likely to die or almost die during childbirth or the first months after she's had her baby than a White woman with an eighth-grade education.”
[00:03:26] Host: Yes. I think it's really important to start from that place. We all have a lot to learn. We're, hopefully, ideally constantly evolving, but to get this out of the way, I think we need to address the challenge and dangers of fusing race and class together when covering health disparity. You touch that first thing in the book, but I think that's the most important thing to get out of the way if you wouldn't mind.
[00:04:06] Linda: Yes, I agree with that. For so long, the preconceived notion was when you looked at racial health disparities from birth, including maternal mortality where a Black birthing person is three to four times more likely to die or almost die, infant mortality where a Black baby is two and a half times more likely not to survive, all the way to the end of life, and you're looking at life expectancy, and Black people used to be three and a half years less and after COVID, six years less.
You're looking at those statistics, and I was thinking, "Oh, this is because there is so much poverty in America among Black Americans, and that is what the problem is." Then I actually did two things, looked at the poverty rate for when I was born, so in 1959, 60% of Black Americans were living under the poverty line at that point, then after the Civil Rights Movement, 40%, and now it's about 19% of Black Americans live under the poverty line, which is high and unconscionable.
However, even though there's been that precipitous drop in poverty and the rise of a robust middle class, you haven't seen the gaps narrowing. Sometimes they've been widening in racial health disparities, like in life expectancy-wise, Black people living so fewer years. If it were just poverty, you would have seen those two lines parallel dropping, but you didn't. In fact, also, maternal mortality has gotten worse.
The other thing is, there have been cases that are really high-profile like Serena Williams. Serena Williams almost had a tragic birth outcome with her first baby. She just had another one, who's fine, but with her first baby. Doctors ignored her legitimate complaints and requests about the kind of care she knew she needed to receive. She was basically shut down. If someone like Serena Williams, who is very rich, knows her body really well, whose husband is really rich, cannot get proper care, then something is wrong beyond just class.
The other thing to say is that in those maternal mortality statistics, a Black birthing person with a master's degree or more is more likely to die or almost die during childbirth or the first months after she's had her baby than a White woman with an eighth-grade education. Later studies have shown even rich people like Serena Williams die or almost die. If education and wealth do not protect you, then this cannot be just a case of poverty.
[00:07:02] Host: You talk a lot about the disparity. A lot of it comes from healthcare practice and study. I'd love for you-- Again, we don't have a lot of time, and there's so much to get out of this book and your research, but will you share some of the outdated and flawed beliefs of the physiology of Black bodies and how detrimental they are to the healthcare of African Americans?
[00:07:27] Linda: Well, I think one that is still in practice and is worrisome-- really, two. I covered them in the book and in the 1619 Project. The first one is that Black people have low lung function. That was a myth that began during enslavement to show that it was good for enslaved people to work in the fields because it would make them healthier. That was created intentionally by White physicians and scientists, many of whom owned people, owned slaves.
Then the through line to today is there's a machine called a spirometer, and the spirometer still has a race correction. I asked a physician friend of mine, "How does it work?" The spirometer measures lung function. There's a switch you flip that if you're with a Black patient, you flip that switch, and it gives a deficit of something like 10% or 15% less lung function. This is really personal to me.
I grew up in Colorado. That's where I'm from. I ran track there. Mile High City. I have great lung function still. I was just there. I was at 13,000 feet, and I was walking up a hill. To correct by this false idea from way back is ridiculous. The other one is that Black people-- the opposite. The one is you have a worse thing. This is we have a high pain threshold, so really superhuman intolerance to pain, again, to justify cruel treatment during slavery.
The through line to today is surveys have shown that medical students, residents, physicians still believe myths about Black people, including that one. That gets in the way of proper treatment. I had this funny conversation with someone who said, "Oh, maybe that's why the opioid crisis is really affecting White people because they've been over-medicated or given more pain management."
I said, "Well, cruelly if Black people aren't getting enough pain medicine, that's terrible. If White people are getting over-medicated, that's terrible. Whatever it is, is Black people shouldn't have to suffer because of a myth that began 400 years ago."
[00:09:49] Host: You also mentioned kidney function. I'm going to mess up because I'm definitely not a medical expert, but a kidney function test that there was an adjustment that they made for Black people as well.
[00:10:07] Linda: Yes, I got my kidney function test back from my checkup about six months ago, and I was like, "Oh my God, I was race-corrected." The kidney function test assumes that Black people have slightly better kidney function. That means, and it's based on the idea that we have more muscle mass as a group. It doesn't take into consideration individuals like somebody like Arnold Schwarzenegger, Aaron Rogers, or somebody who's really built, compared to a skinny person like me, or a skinny dude like Barack Obama would have less [chuckles] muscle mass.
Why would we need this correction? The sad part is it could keep Black people, who actually suffer kidney disease more, off certain treatments and definitely off kidney transplant lists. That is a myth that the kidney function test correction is a myth that has stuck around even today under the false idea that there's some difference in muscle mass.
[00:11:11] Host: It's crazy that medical professionals who went to school forever, that these are still propagated, but in addition to that, I think that the most aha moment in your book was when I got to Dr. Arlene Geronimus's concept of weathering. This is the moment where I was like, "Oh my gosh, it all makes sense," and my heart broke.
Now I feel that this concept of treating and managing stress and the ill effects of stress causes to the body, it's fairly new for all of us, within maybe the last few decades. When you go to the doctor, they ask about stress levels now, which I don't remember that before, but this weathering concept and the effect on people of color really, and all marginalized people, it's a whole other level. I'd love for you to describe this.
[00:12:16] Linda: Weathering is a wonderful word for a terrible thing. It means that if you are someone who is having to suffer from constant insults, even when you're trying really hard, and that's the part that sometimes I forget, it's like you're really trying hard to do a good job. Dr. Geronimus, who is at the University of Michigan, she calls it hard effort coping, just trying to get by, but then things get in your way.
People treat you badly. People say things that are unkind to you, or you're discriminated against by the police at your job or in housing. Each time that happens to you, it causes the fight or flight mechanism to kick in, so then something happens, you get really upset. Your heart rate goes up. Your blood pressure goes up. Your body is flooded with stress hormones. Your muscles tighten.
This is fine if you're really in danger, but if that happens over and over because of these constant insults, it causes your body to prematurely age. It shows up during pregnancy and childbirth, which is basically a stress test of the body. It really showed up during COVID when you saw Black people having worse symptoms that needed hospitalization or led to death 10 years before White people. If the worst cases were at age 70 to 80 for White people, they were 60 to 70 for Black people. It was interesting because I covered COVID for the New York Times magazine. I covered racial health disparities in COVID, and the man died, but his wife, I interviewed her about him, and he died. He was barely 50. He died of COVID. You were seeing this guy who was just really just trying to survive.
It was sad, but I just thought of that. I was like, "How? He was so young" because most of the cases, remember early on, were in older people, so then that's when Dr. Geronimus got much more widely believed, and really, her concept of weathering is being held up. She wrote a book three months ago. I don't think she was even thinking about writing a book the first time I met her three years ago.
[00:14:37] Host: It's a lifetime of othering that I can only imagine would always put you in that almost anxiety state. Like I said, I think we're just slowly starting to understand what any amount of stress does to the body. You do talk a lot about childbirth and this preeclampsia. I don't know if I'm pronouncing. My mother's going to be like, "How do you not know that word?"
[00:15:12] Linda: You learned better than me.
[00:15:13] Host: [chuckles] Yes, but this high blood pressure that leads to hemorrhaging during childbirth, it just makes sense that that constant stress plus the lack of loving care that a lot of these women are receiving in the hospital. That was the moment where I'm like, "This changes everything."
[00:15:40] Linda: Well, I thought of preeclampsia recently. We all did because of the athlete Tori Bowie. Tori Bowie was a 2016 Olympian. She was on the 4-by-100-meter relay team, and she passed away from preeclampsia, and her baby died, too, a few months ago. Then she was in a very bad situation, but her teammate, Allyson Felix, also had preeclampsia, and she was really healthy. She was doing everything right with her pregnancy.
She had preeclampsia, turned into a near-tragic birth, and then what was sad about it was initially she blamed herself. She thought, "This must be something I am doing wrong." Without the framework of society and the way we live, things happen to our bodies. If you are having to deal with hard effort coping or racism or marginalization, that isn't your fault. You are doing the best you can. That's what breaks my heart, is when people blame themselves for something that is not your individual fault.
“If you're a woman, you're supposed to be strong. Black woman, there's actually a term, "strong Black woman," so then you shouldn't need to seek therapy if you need, or you shouldn't have any kind of mental health problems. You should be able to just power through. If you're a man, you add the idea of masculinity, so now you're really not wanting to admit vulnerability, so it keeps us out of the mental healthcare system.”
[00:16:50] Host: Well, and then how much does the individual realize that that's the effect that it's happening to their body? You write about mental health as well. Writing that only 33% of African Americans struggling with mental illness receive treatment, and taking this weathering concept into account, I imagine that would only exacerbate the challenges experienced with mental illness.
[00:17:18] Linda: That's right. I think that we are now seeing-- I wrote that book a couple of years ago. When I was really writing it, it was published last year and published in paperback recently, but I think it's obviously gotten worse because there's so much discussion of mental health. When I look at the race part of it, it has always been hard for us because of the stereotype of us being strong. If you're a woman, you're supposed to be strong. Black woman, there's actually a term, "strong Black woman," so then you shouldn't need to seek therapy if you need, or you shouldn't have any kind of mental health problems. You should be able to just power through. If you're a man, you add the idea of masculinity, so now you're really not wanting to admit vulnerability, so it keeps us out of the mental healthcare system.
I think now it's really hard to get a therapist in the first place because now there's a shortage, but there's a real shortage of Black therapists. There always have been Black therapists, psychiatrists, psychologists. Long, there's a shortage of Black healthcare providers in general but especially in the mental health field. It's hard to get someone who understands where you're coming from, your situation.
It's funny, from a personal note, my therapist is White, so I'm like, "Oh, gosh, I really like her, but I'm going to have to explain everything," and then were on Zoom when we first started, and I saw some Black people walking by [chuckles] in the back of the camera, and she has Black children. Then I realized, "Oh, I won't have to do this." I didn't necessarily get a Black provider, but I got someone who understands my experience, so I feel comfortable sharing and healing.
"...I love activism that's intergenerational as well. I was with an environmental justice group working on a story, and I was loving how many of the people from the community were older and their lived experience reflected the issue that they were rallying against. They were mixing it up with college students from fancy colleges, and everybody was getting along."
[00:19:09] Host: That's something you talk about, this need for representation and recognition in the healthcare world. It really seems, and I guess this is true with every problem, that it's the young people that are going to be the solution. You talk a lot about students in universities and in medical programs demanding change and demanding a reexamination of how things are done, and it really just feels like that's our hope that we're always going to be hoping and holding on to those young people.
[00:19:51] Linda: I love that. I love the blossoming and flowering of medical students who want to be different kinds of doctors, nurses, midwives, public health people who are learning about health justice and birth justice, who want to know more, who want to be able to listen to patients and hear patients and not just look at them as bodies. I've seen that all across the country when traveling around for the book.
I also want to add that I love activism that's intergenerational as well. I was with an environmental justice group working on a story, and I was loving how many of the people from the community were older and their lived experience reflected the issue that they were rallying against. They were mixing it up with college students from fancy colleges, and everybody was getting along. I remember going to the little community dance, and it was like the oldies dance party. All the college kids are dancing with the older folks, and they're all rallying around a common cause. I love activism of all kinds, but intergenerational activism is really fun and important.
“My mother is from Chicago, and my grandparents and all my aunts and uncles came up from Mississippi to Inglewood, that community in Chicago. People to this day in that neighborhood lived to age 60, and then nine miles north they lived to age 90.”
[00:21:07] Host: Speaking of environmental justice, I had the extreme privilege of talking with Robert Bullard for this same podcast a few years back. You talk about him in the book, in your section about where you live being a factor on your health. He told me that two neighboring zip codes, two different zip codes, depending on who lives there, the kinds of investments, infrastructure that have been placed in those neighborhoods, that the differential in life expectancy can be as great as 10 to 15 years in these two neighboring, that the zip code and where you live is one of the strongest determinants for your life expectancy.
[00:21:57] Linda: That is really interesting and true. Two things. One, Dr. Bullard is very funny. I said to him, "You've written so many books. They all have really great titles. Are they actually the same book?" [laughter] He laughed, and he said, "Well, I just say it in a different way, and I call it something else, but I just am going to keep beating this drum until somebody listens to me."
My mother is from Chicago, and my grandparents and all my aunts and uncles came up from Mississippi to Inglewood, that community in Chicago. People to this day in that neighborhood lived to age 60, and then nine miles north they lived to age 90. My mom and I a few years ago went back to that community and saw that it was in such dire condition and then we looked in the history of it, and it had been redlined. That meant that people coming up from the south, 500,000 people came to Chicago from the south, Black people during the Great Migration, but they couldn't buy a home. A home is your biggest wealth asset. Then, what they could do is buy a home for a higher price on a contract, which meant that they could never outright own that home. If they missed a payment, they could lose it.
My grandfather bought, my mother explained, their house on a contract, and that sapped away something like $3 billion from Black Chicagoans. That meant now I could see when I go back to that neighborhood of Inglewood and people living only to age 60, with so much wealth sapped away from it, it made sense that people live shorter lives. It also had some of the worst COVID outcomes in the City of Chicago, in those Black communities that were historically segregated and redlined.
[00:23:46] Host: Also, the targeting of those communities for waste treatment and dumps as Dr. Bullard started his career fighting against [crosstalk]
[00:24:01] Linda: Dumping in Dixie, one of those fights. Well, he told that really interesting story of when, in Houston, there was a middle-class community, and there was building going on. They saw construction machines coming in and out, and nobody said anything. They thought it was a shopping mall, and I think it was a dump or an incinerator or something. It was something polluting.
They put it next to this Black community. I remember he was saying that I think it was a dump because trucks were going in and out. It was near a school. The kids, the noise, much less the pollution, but the noise and also the smell because Houston's so hot, and when they opened the windows, they could smell this toxic place. They chose to do it by a community that had less power than other communities. If you keep doing that, then you could see that it would lead to differing life expectancies.
[00:25:03] Host: What is the importance for you to include all of these lived stories of individuals in this book rather than just facts and dates in history?
[00:25:15] Linda: Well, I think what I try to do is, I used to say give people dessert with their broccoli, but I love broccoli, so it's not a negative. I try to mix it. I think you get bored if you're just reading numbers and I'm just going, blah, blah according to this, that, and the other. If you are reading or consuming the stories of people that are relatable to you, it's more believable.
I think it was Dr. Maya Angelou who said you can say something to a person and have them listen, but it's better to make them feel. What I try to do is tell stories through the lens and the eyes of real people so that other people can relate to them. Also, honestly, I'm good at that. I'm a numbers nerd, and I'm sciencey, but what I really love to do is interview people. Then what happens to me as a writer is I sit down to write after doing all these fun interviews and talking to all these people, and then I was like, "Oh, right. I don't like this part, [laughs] this is hard," how to intersperse the stories of the wonderful people with the data that I also like, but it's like, "Oh, right. Writing is less fun than interviewing," and then having written and having published, really fun again.
[00:26:36] Host: Well, like you said, it does connect you, it draws you in, but then it really shows you when you look at X number of people died or it doesn't have that same effect of reading the story of a person's life and losing a child or losing a father or a husband or a wife or just any of the experiences. It really allowed me to connect and see it as a human story, not just a facts-and-figures exploration.
[00:27:16] Linda: I also like to do that with my experts. Like Dr. Geronimus, I told her story, how she came up with the concept of weathering, in each step, what she learned, and what was her life like. There was another gentleman that I interviewed. He gives me the end of the book, the last quote in the book. He's a cardiologist from New Orleans, and he talked about COVID and going to a Zulu parade, which I had written about, in 2020 was a place where a lot of Black people got COVID in New Orleans from going to this really wonderful parade.
His thing was, "This is so many innocent people, why did this happen?" He talked about it from his lens of going to the parade when he was a little boy. Then later, he talked about it from the lens of an expert, a cardiologist who had written a really beautiful piece for the Journal of the American Medical Association about COVID health disparities. I really tried to get at why people go into this field in the first place, including Dr. Bullard and the story of his wife, and [laughs] how she was the one who got him into this.
"Well, my father was treated very badly by the medical field. When he was hospitalized, he was restrained to the bed even though he was a kind, very educated as a scientist, person. He was a veteran. He loved the country. To see him treated that way was so painful, and it infused me with more passion for covering this topic."
[00:28:28] Host: As he said, not dragged in but-- Oh, what was the word that he said? Accidental environmentalist. You also include your own personal stories as well. Really, I don't know if you knew that that was what you were going to do as you were putting this book together but your experience with childbirth and also your experience with your father, both very personal but also exemplary of everything that you're writing about.
[00:29:01] Linda: Well, my father was treated very badly by the medical field. When he was hospitalized, he was restrained to the bed even though he was a kind, very educated as a scientist, person. He was a veteran. He loved the country. To see him treated that way was so painful, and it infused me with more passion for covering this topic. I think during the first pass, I had my neighbor, who's a writer, too, read the first pass of the book.
It was skeletal, and then she's so nice and she said, "You know what's missing in this?" I said no because I had all the stories, I had all the facts. She said a through line. I said, "Well, it's chronological." She said, "You're missing. Where were you?" Like we were saying at the beginning, I've also progressed throughout my career in learning about this. Once I added that through line, I had to go through and start and go, "Where was I here? What was I doing?"
I could see it became better, and it became easier to write the book because I was learning along the way. I hadn't thought of it that way. It's super obvious now, but I hadn't thought, "Oh, here I was at Essence Magazine, thinking the wrong thing. Here I was having a low-birth-weight baby. Here I was seeing my father mistreated horribly. Here I was learning about my mother and her community in Chicago and how people have such short lifespans. Then here I am covering COVID at the end, in New Orleans." It really made a lot of sense. As journalists, we were trained, back in the old days, not to do that. It took a little bit of change, forcing myself to put myself in, but I think it paid off.
[00:31:01] Host: If you would like to continue the conversation, visit chapman.edu/wilkinson to learn more. To access recommended books from our guests for further learning and for more socially conscious content, visit firstname.lastname@example.org or follow us at Apple, Spotify, or wherever you podcast.
[00:31:28] [END OF AUDIO]
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