The COVID-19 pandemic exposed the inequalities that plague American health care. Blacks died at twice the rate of whites.
Linda Villarosa, author of the article on racial disparities and health outcomes has been writing for over a decade about this topic. She recently wrote about it for the New York Times 1619 Project. Although she once believed that poverty was the reason for Black Americans’ health problems she now believes that racism in the health system and the “weathering effect” of living in a racist environment are putting a severe strain on African Americans.
Villarosa refers to “weathering”, a term Dr. Arline Geronimus, a public health professor, has coined to describe the damage to the body caused by prolonged stress exposure. “Your heart rate increases and your cortisol levels rise in your body. She says that blood pressure increases. It’s not healthy for the body. However, when people are treated poorly, this is what happens.
Villarosa, in her book Under the Skin, argues that any attempt to close the health gap must address the structural racism underpinning the U.S. healthcare system. She cites historical myths regarding Black bodies, including the belief that Black people are more sensitive to pain than whites. These myths continue to influence the delivery of care.
For instance, UNC-Chapel Hill researchers published a 2019 study showing that Black women didn’t receive the same pain management after a C-section. This could be due to implicit biases in medical students or residents.
“This is concerning because these are the future doctors in America,” she says. She says that this means we have to do things differently.
Villarosa said that she is no longer afraid to use the term “racism”, despite her tendency to shun it when speaking on panels.
She says, “We are not accusing people of being racists. But we are saying that there is something wrong in America.” “It’s much easier to identify the problem and discuss it, than it is to pretend it doesn’t exist.
This interview was edited to be more concise and clear.
When I wrote about the health crisis that hit Black America in the 1980s for Essence, I assumed the problems were our own.
There were clear racial disparities in health. Black Americans were more likely to have “lifestyle diseases”, which was what we used to call them back then. They included heart disease, stroke, diabetes, and asthma. Although we knew this, we didn’t know why. It was our fault. Either our genetic makeup was making us sicker, which also led to lower life expectancy, higher infant mortality rates, or we were doing something wrong. Essence’s idea was to fix racial inequality by getting everyone who reads our magazine to do better. We said that if you are smarter than you think, you can do better.
How Dr. Harold Freedman’s research changed her understanding of racial disparities within healthcare
He compared the health of Harlem men to those in Bangladesh, an impoverished nation. It turned out that Black Harlem men lived for fewer years than those in Bangladesh. It was quite shocking. It was published in the New England Journal of Medicine. He came to speak to me at Harvard School of Public Health. I was so intrigued by everything he had. He insisted that poverty is the problem. He said something to me that he thought was a problem of poverty. Harlem’s population isn’t all poor. If you think that Black people’s problems and health issues in America are due to poverty, then you’re wrong. He taught me that if you look at the problem from the wrong perspective, you will come up with ineffective and incorrect solutions.
The myth that black bodies feel less pain than white ones
This myth was propagated by scientists and doctors who were also involved in the preservation of slavery during years of enslavement. The idea that Black people could tolerate extreme pain and could be beaten, whipped, taken away, and worked from sundown to sunrise was a common misconception.
My research revealed that the evidence found in medical journals was used to push myth. Fast forward to 2016, and I discovered that a University of Virginia study examined myths and mythology that white medical students believed, including the notion that Black people had a different type of pain tolerance.
Another myth was that black skin is thicker then white skin. This is untrue. There are many thicknesses to skin. It is possible to believe that this speaks to a false vulnerability that Black people have, which would allow us to not have our pain treated the same.
The myth that Black people have weaker lung function aEUR” and the race correction to it
Another myth was that Black people had poorer lung function. This myth started in the years of slavery. It was the opposite of pain tolerance. We had a superpower, and this was an inferiority. Because of our weak lungs, we were able to work in the fields as it was like exercise. This was a myth believed by doctors, and further promoted at medical conferences, medical journals, and medical conferences.
Today, a machine called the spirometer measures lung function. Often, these machines are also used today. A race correction is used to assume that Black people have poorer lung function. This was something I was thinking about a while back. I had a lung function test a few years back as I was recovering from bronchitis. Then I thought, “I wonder if I got a race correction.” This would have been unfair since I was born in Denver, the Mile High City, and have very good lungs. It’s wrong to assume that I am inferior racially without considering other possibilities, such as having been raised in Denver.
Black women are more likely to die from maternal causes in the U.S.
This was something I heard from an international lawyer while playing soccer one weekend. I was listening to her tell me that the United States is the only country in which the number of mothers who die in childbirth or are almost killed is increasing. So I replied, “Oh, no, that’s not what I knew.” She said that it was driven by Black women, because Black women are three to four times more likely to be killed or nearly die. Even in 2017, I still believed that poverty was the issue. I was having a heated argument with her when she interrupted me and said, “Education does not protect.” A Black woman who has a master’s degree is more likely to die than one with an eighth-grade education. This struck me.
A Black woman who has a master’s or higher degree is more likely to die in childbirth than a woman of the same age with an eighth-grade education.
It struck me also that I had a low-birth-weight baby. This was quite unusual considering that I was so healthy. I was the health editor at Essence magazine. As a person who was trying to be healthy, I was well-known. Then I had this baby with a low birth weight. There are many stories of Black women who have had difficult births, such as Serena Williams. … This is so common. It’s a common experience.
How “weathering” affects different groups of people
I chose to travel to West Virginia to escape the HIV epidemic. The opioids were causing an HIV epidemic in West Virginia. As we all know, West Virginia was inundated with opioid pills. Then they were taken off the streets. People became addicted to heroin and started sharing needles and using heroin. This created an HIV epidemic. I was curious to see what happens when you abuse people. You inundate them, then you yank away, and then they become addicted to heroin. They are then blamed for their condition, with less investigation of what happened and what the pharmaceutical companies did.
The first thing that I noticed was that people seemed older than I thought. I was constantly misjudging the age of everyone. I was able to see homeless people. People were so ashamed. It was so painful. This was just the beginning of my weathering. People blame themselves when they are treated poorly. They don’t receive treatment or care. They are ridiculed and don’t get the support they need. Your body ages and this is what it does. It’s anyone who is mistreated or marginalized.
How can we help others by studying how Black people are treated for their health?
Our experience in America has been so extensive that it began in 1619 and continues to this day. We are therefore the best-studied. Our bodies were commodified. This meant that we had to pay close attention to our health, well-being, and also our pain, and any damage. It’s fascinating to see Black bodies. While it’s important, discrimination and harm can hurt anyone.
This interview was edited and produced by Joel Wolfram and Sam Briger. It was adapted for the internet by Bridget Bentz and Molly Seavy–Nesper.
