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'Under the Skin' delves into systemic racism and its toll on health


Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

Judy Woodruff: Health disparities among different racial groups remain a major problem in the United States, one that was magnified during the height of the pandemic, but has been part of American history since its earliest days.

A new book looks at the causes for that.

Amna Nawaz has our conversation.

Amna Nawaz: Author Linda Villarosa puts it this way — quote — "At every stage of life, Blacks have poorer health outcomes than whites and in most cases than other ethnic groups."

That is true whether we're talking about maternal and infant health or cardiac disease, diabetes, or many other conditions.

Villarosa says that racism, both personal discrimination and structural racism, are at the heart of these problems and play a much bigger role than is generally acknowledged. It's the focus of her new book, "Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation."

And Linda Villarosa joins me now.

Linda, welcome back to the "NewsHour." Thank you for joining us.

The book begins with kind of this personal revelation. I mean, you have been reporting in this space for years, but even you say at the beginning of the book you came to realize what you believed about all these health disparities was wrong. What did you have wrong?

Linda Villarosa, Author, "Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation": I think I grew up in a household of strivers.

And so we believed that personal responsibility was everything. So, if you just took good care of yourself, you would be fine, and if you just did everything right.

And then I ended up at "Essence" magazine as its health editor. And that was, we believed in self-health. We believed, if every Black person, every Black woman especially, took care of herself and the others around her, it would lift the health status of the race in general, Black Americans.

And no matter how hard we tried, that just wasn't true. So it took a minute to say, wait, I need to shift my thinking.

Amna Nawaz: You write about this dangerous and persistent myth, we should say, that, as you say, that Black bodies are somehow different.

And in that section, you tell us the story of the Relf sisters, tell me why their story is important.

Linda Villarosa: It was important to look at is — it's a form of reproductive justice, that we didn't have the right to have children. So, during the enslavement years, we had a kind of forced labor and that had a double meaning.

So our babies were worth something. We were commodified because of the free labor that was upholding the economic structure of the country. But once the enslavement years were over, then it was sort of like, well, no, we don't want you to have children anymore. And the Relf sisters fell into that.

They were 12 and 14 in 1973, when they were sterilized without their parents explicit consent, and without their knowledge even. And what I did was, I looked into that case. And I had read about it. I had heard about it. And I went back to Montgomery, Alabama, where it happened.

And I found that the sisters, who are now in their 60s, and they're living in a way that they don't exactly know how their case changed history. So, after they won their case, it became illegal to sterilize people against their will and without their consent. But they didn't benefit in any way.

Amna Nawaz: You know, you tell these stories and I think sometimes people look at them and say, well, these are things that happened.

But you document how some of those dangerous ideas and myths persist today and impact health decisions and how health care is practiced today. There's a specific kidney test, which shocked me to learn about. I did not know that it's processed differently for Black people than it is for any other race.

Tell me about the justification for that and why it matters.

Linda Villarosa: It seems like the justification came a long time ago. And it was the idea that Black people had genetically different bodies than white people, including in lung function, in pain tolerance, and also in kidney function.

And that became, that dangerous idea and really myth became embedded in medical education and practice. And it was interesting, because I was trying to tell someone that this still existed, that you get a Black reading or a white reading. And I went to the doctor six months ago. I had a kidney function test. And I got — there was a Black reading and a white reading. And the Black reading was circled for me.

And it was different. And I just had to say to my friend, look at this test. This proves that we're still doing this.

Amna Nawaz: And we should say that so-called Black reading, as you put it, requires a higher threshold for any kind of care, and that Black Americans suffer from kidney failure at a rate three times higher than white Americans. So that's where it links to the outcome.

But the book is intensely personal. I mean, I read your reporting for years. But you talk about your own family and your own experience and the racism you endured in a mostly white neighborhood in the Denver suburbs.

You also write that the research became real for you when you became pregnant. Tell me about that.

Linda Villarosa: I was very surprised. I was doing everything right when I became pregnant in the late '90s.

And I was expecting to have a really perfect pregnancy. I was. I was eating bright. I was taking care of myself. I was the health editor of "Essence," so I was being a role model for other people. So I was really surprised when I — my doctor, who — I had really good health care and a doctor who was my friend.

And I went to the doctor and she said, you need to go to a specialist because your baby is not growing at a rate that is expected at your level of pregnancy. So I went to the specialist. And I got — the specialist talked to me and was asking me if I was — what I was doing wrong, sort of, well, how are you eating? What kind of drugs are you taking and all — asking me about all kinds of illicit drug use.

I finally said, what is going on here? My baby was born very small, four pounds, 13 ounces. She's a healthy young adult now. But I often thought of sort of the racism that I endured as younger person throughout my life. And I thought, does that have anything to do with my baby's size?

And now, I mean, I'm a case study of one. But I have certainly heard and reported on a lot of other pregnant and birthing people who have had terrible birth outcomes or tragic often birth outcomes.

And it's beginning to be widely acknowledged that something about toxic stress, something about enduring discrimination in America is bad for your baby and bad for your body.

Amna Nawaz: Linda, these are issues that have been studied for generations. They have been well-documented, the disparities, for generations.

I'm curious what you think about, from your perspective, why are we still having this conversation today?

Linda Villarosa: I think it's very hard to talk about race and racism in America.

And even when I talk to medical groups, and they're very interested in these ideas, but there's a level of defensiveness. And it makes it seem like I'm saying to you, individual physician or nurse or medical practitioner, that you're racist, which I don't believe.

I think that racism and discrimination are baked into our system in our society and our institutions, including the health care system. And when I talk about it, it's not an individual indictment. And this has been well-evidenced, very well-documented,

And it's not a personal indictment. What it is, is a — should be a call to action to make a change in the way medicine is practiced in America.

Amna Nawaz: That is Linda Villarosa, author of the book "Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation."

Linda, thank you for your time.

Linda Villarosa: Thank you so much.

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