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Under the Skin: The Hidden Toll of Racism on Health in America
From an award-winning writer at the New York Times Magazine and a contributor to the 1619 Project comes a landmark book that tells the full story of racial health disparities in America, revealing the toll racism takes on individuals and the health of our nation.
In 2018, Linda Villarosa's New York Times Magazine article on maternal and infant mortality among black mothers and babies in America caused an awakening. Hundreds of studies had previously established a link between racial discrimination and the health of Black Americans, with little progress toward solutions. But Villarosa's article exposing that a Black woman with a college education is as likely to die or nearly die in childbirth as a white woman with an eighth grade education made racial disparities in health care impossible to ignore.
Now, in Under the Skin, Linda Villarosa lays bare the forces in the American health-care system and in American society that cause Black people to “live sicker and die quicker” compared to their white counterparts. Today's medical texts and instruments still carry fallacious slavery-era assumptions that Black bodies are fundamentally different from white bodies. Study after study of medical settings show worse treatment and outcomes for Black patients. Black people live in dirtier, more polluted communities due to environmental racism and neglect from all levels of government. And, most powerfully, Villarosa describes the new understanding that coping with the daily scourge of racism ages Black people prematurely. Anchored by unforgettable human stories and offering incontrovertible proof, Under the Skin is dramatic, tragic, and necessary reading.
In 2018, Linda Villarosa's New York Times Magazine article on maternal and infant mortality among black mothers and babies in America caused an awakening. Hundreds of studies had previously established a link between racial discrimination and the health of Black Americans, with little progress toward solutions. But Villarosa's article exposing that a Black woman with a college education is as likely to die or nearly die in childbirth as a white woman with an eighth grade education made racial disparities in health care impossible to ignore.
Now, in Under the Skin, Linda Villarosa lays bare the forces in the American health-care system and in American society that cause Black people to “live sicker and die quicker” compared to their white counterparts. Today's medical texts and instruments still carry fallacious slavery-era assumptions that Black bodies are fundamentally different from white bodies. Study after study of medical settings show worse treatment and outcomes for Black patients. Black people live in dirtier, more polluted communities due to environmental racism and neglect from all levels of government. And, most powerfully, Villarosa describes the new understanding that coping with the daily scourge of racism ages Black people prematurely. Anchored by unforgettable human stories and offering incontrovertible proof, Under the Skin is dramatic, tragic, and necessary reading.
288 pages, Paperback
First published June 14, 2022
426 people are currently reading
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January 10, 2022
Linda Villarosa, one of our fiercest and most cutting-edge journalists, has given us a classic for the ages. Through engrossing stories of people's real experiences and her signature rigorous reporting, she reveals the biggest picture in American life- that racism has done us all in, and produced a nation so steeped in white supremacy mythology that we cannot take care of ourselves or each other. This book is a gift, a map and a necessity, relevant for every reader who wants to understand their own time.
July 2, 2022
Thanks to Netgalley and Random House for the opportunity to read this ARC: This book needs to be read by all health care providers--both in training and in practice. As a physician, I was familiar with the author not through medical education but through adult education. I have taken the California mandatory training in racial bias and obstetrics, for adult education and found it critically important. As recently as 2021, JAMA tweeted: "No physician is racist, so how can there be structural racism in healthcare?' Yet, structural racism in health care is rampant. The author writes clearly, with careful and extensive research about the issue and ends with proposed solutions. She addresses the disparities in healthcare, the myths that never seem to die about Black health and predispositions, and the fact that although systemic racism may be finally dying in healthcare--it's dying "ugly". I consider this book an essential text and reference. It's powerful, important and deserves wide readership. It should be required in all medical school and continuing medical eduction curriculum. A tour de force.
April 7, 2023
This book makes a convincing case for racism as a public health problem. With chapters on maternal outcomes, environmental pollution, mental health, AIDS, and an Afterword on COVID, the book cites data that shows even after making adjustments for social, economic, and diet considerations the health outcomes for African Americans lags those of White Americans. Then to refute the conclusion that the cause of poor health outcomes must be due to inherited genetic susceptibility to poorer health, some comparisons are made to African populations elsewhere that don’t have the same issues.
The book insists that the problem is not with being Black, it’s with being Black in America. The author argues there are three primary obstacles to equitable health outcomes in America: (1) long-standing institutional and structural discrimination; (2) implicit biases in the medical profession resulting not only in misdiagnoses but even blame for being unwell; and (3)“weathering,” which, Villarosa writes, refers to the “struggle with anger and grief triggered by everyday racist insults and microaggressions … [which] can, over time, deteriorate the systems of the body.”
The weathering term used above refers to a relatively new hypothesis initially formulated by Dr.Arline T. Geraniums to explain the poor maternal health outcomes of African American women that increases with age. An example that illustrates this comes from a 2007 AJPH study that demonstrates that Black women who reported experiencing racial discrimination had double to triple the rate of low-birth-weight babies compared with Black women who did not report incidents of discrimination. Summing up, Villarosa writes, “The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”
The book insists that the problem is not with being Black, it’s with being Black in America. The author argues there are three primary obstacles to equitable health outcomes in America: (1) long-standing institutional and structural discrimination; (2) implicit biases in the medical profession resulting not only in misdiagnoses but even blame for being unwell; and (3)“weathering,” which, Villarosa writes, refers to the “struggle with anger and grief triggered by everyday racist insults and microaggressions … [which] can, over time, deteriorate the systems of the body.”
The weathering term used above refers to a relatively new hypothesis initially formulated by Dr.Arline T. Geraniums to explain the poor maternal health outcomes of African American women that increases with age. An example that illustrates this comes from a 2007 AJPH study that demonstrates that Black women who reported experiencing racial discrimination had double to triple the rate of low-birth-weight babies compared with Black women who did not report incidents of discrimination. Summing up, Villarosa writes, “The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”
June 19, 2022
Half the Story
I worked in the field of public health for ten years; none of the points presented in the book were new to me; in fact, they aren't new to anyone I've met that's worked in the field of public health. My specialty was 'minority' health issues, and I managed to procure grants from the CDC, Dept. of Education, Heath and Human Services, and so on, to address minority health issues and to 'enlighten' the general public as well as health care professionals regarding racism in health care. I wouldn't say that racism is a 'hidden' problem, more like an underreported one or more precisely one that meets with significant disinterest. In that regard, the author does an adequate job.
However, there is a complementary side of this issue about racism that needs to be addressed at least as much, and probably more than the issues presented in the book. And that too is 'under the skin,' but it involves contrasting diets and lifestyles. If you examine, in public health terms, that is statistically, the diet of African-Americans and that of 'non African-Americans,' you will find a wide gap in healthy living. This is a point that Dick Gregory pointed out in his book 'Natural Diet for Folks Who Eat', published in 1974, and republished in 2021. Apparently 47 years of advice hasn't done much as pointed out by a study headed by the University of Alabama at Birmingham. To expedite the findings, here is a summary:
'After analyzing nearly 7,000 adults, researchers identified factors that help explain why African-Americans have a higher risk of hypertension than whites. The leading factor to explain the difference is eating a southern-style diet, which is high in fried and processed foods. The other key factors are salt intake and level of education.
The study, based on data from a national study based at the School of Public Health at UAB, was published Oct. 2 in the Journal of the American Medical Association.
Lead study author, George Howard, DrPH, professor of biostatistics in the UAB School of Public Health, says the most significant part of the study is that it identifies some lifestyle changes that can be made to reduce the higher risk of hypertension in African-Americans. This higher risk of hypertension in African-Americans is the main reason they are at higher risk of stroke and heart attacks, and also one of the main reasons they have a shorter life expectancy.
“Hypertension is the single biggest contributor to racial disparities in cardiovascular disease,” Howard said. “Preventing hypertension is a critical piece of reducing health disparities in cardiovascular disease. This work identifies factors contributing to the development of high blood pressure and how they differ between African-Americans and white Americans.”
Cardiovascular disease, including stroke, is the largest contributor to the mortality difference between the black and white populations of the United States, accounting for 34 percent of the difference in years of life lost, according to data from the National Health Interview Survey.
The main reason I have included this information is because the MSM, whether TV, the web, social media, etc., determine how people perceive the world, and to improve it, one needs a more robust, holistic understanding of it.
I worked in the field of public health for ten years; none of the points presented in the book were new to me; in fact, they aren't new to anyone I've met that's worked in the field of public health. My specialty was 'minority' health issues, and I managed to procure grants from the CDC, Dept. of Education, Heath and Human Services, and so on, to address minority health issues and to 'enlighten' the general public as well as health care professionals regarding racism in health care. I wouldn't say that racism is a 'hidden' problem, more like an underreported one or more precisely one that meets with significant disinterest. In that regard, the author does an adequate job.
However, there is a complementary side of this issue about racism that needs to be addressed at least as much, and probably more than the issues presented in the book. And that too is 'under the skin,' but it involves contrasting diets and lifestyles. If you examine, in public health terms, that is statistically, the diet of African-Americans and that of 'non African-Americans,' you will find a wide gap in healthy living. This is a point that Dick Gregory pointed out in his book 'Natural Diet for Folks Who Eat', published in 1974, and republished in 2021. Apparently 47 years of advice hasn't done much as pointed out by a study headed by the University of Alabama at Birmingham. To expedite the findings, here is a summary:
'After analyzing nearly 7,000 adults, researchers identified factors that help explain why African-Americans have a higher risk of hypertension than whites. The leading factor to explain the difference is eating a southern-style diet, which is high in fried and processed foods. The other key factors are salt intake and level of education.
The study, based on data from a national study based at the School of Public Health at UAB, was published Oct. 2 in the Journal of the American Medical Association.
Lead study author, George Howard, DrPH, professor of biostatistics in the UAB School of Public Health, says the most significant part of the study is that it identifies some lifestyle changes that can be made to reduce the higher risk of hypertension in African-Americans. This higher risk of hypertension in African-Americans is the main reason they are at higher risk of stroke and heart attacks, and also one of the main reasons they have a shorter life expectancy.
“Hypertension is the single biggest contributor to racial disparities in cardiovascular disease,” Howard said. “Preventing hypertension is a critical piece of reducing health disparities in cardiovascular disease. This work identifies factors contributing to the development of high blood pressure and how they differ between African-Americans and white Americans.”
Cardiovascular disease, including stroke, is the largest contributor to the mortality difference between the black and white populations of the United States, accounting for 34 percent of the difference in years of life lost, according to data from the National Health Interview Survey.
The main reason I have included this information is because the MSM, whether TV, the web, social media, etc., determine how people perceive the world, and to improve it, one needs a more robust, holistic understanding of it.
September 28, 2024
This was a historical retrospective of medical/health care for African Americans. It is compelling and it is infuriating. The early chapters with the experimentation on slave women are horrifying. I get why the South is so reluctant to teach African American history. It will absolutely make white people feel bad and uncomfortable. There's a reason they should feel bad about the past, so that it precludes a repeat and/or perpetuation of the mistreatment in various forms. People reject the idea that unconscious bias is in effect these days. They can't see the irrefutable statistics about Black women and childbirth regardless of wealth in the 2020's. They can't see the medical treatment for COVID was based on color. They didn't recognize the symptoms in Black people as serious. Complaints of pain are minimized and dismissed. The disparate treatment of people color and specifically African Americans in the US is much greater than most people realize. It's not that professionals are overtly racist; it's the systemic racism within the healthcare system that can cause the professionals to minimize pain, underestimate the extent of injuries, undervalue patient statements, apply mythology to treatment, attribute some symptoms as the fault of and controlled by the patients etc. It's also the environments that blacks are living in, conditions which are the direct result of systemic racism. Toxic neighborhoods, lack of clean water or air, lack of access to fresh food, the list goes on. Nothing is absolute nor is the system binary. There are all sorts of exceptions to assertions of biased racial medical care outcomes. But that too is an issue because the world sees things in the binary and in general treatment is too often based upon assumptions due to the race of the patients (and the healthcare workers). And I'm not going to go into the mental/emotional traumas that people of color endure daily that take their toll on their bodies and physical and emotional health. All the calls to be antiracist are not a response to lynchings or using the n-word or other forms of overt racism. They are calls to rise above the systemic biases in the systems of education, of training, of government, of wealth, of American culture. Yes, slavery is one of the primary root causes of these racially biased systemic issues in America. Regardless of whether or not someone has ever owned a slave; many of the laws and attitudes that exist today are built upon the foundation of 400 years of slavery and the almost 200 years of post-slavery but unequal treatment that has followed and continues. Yes, it is shocking but we are not yet 200 years out of slavery in America in 2024. As for the Civil Rights Acts and Voting Rights Acts that the Supreme Court is currently trampling upon are not even 100 years old. I am older than they are and I am still (what I consider anyways) midlife. We are going backward! For those living in a rapidly deteriorating post racial fantasy and can't see color, I quote James Baldwin "You cannot fix what you will not face."
4+ Stars
Listened to the audiobook. Karen Chilton was very good!
4+ Stars
Listened to the audiobook. Karen Chilton was very good!
August 16, 2022
I’m so glad I took my time to read this; it’s packed with so much knowledge of systemic racism that’s baked in the American society, and its inevitable impact upon POC, especially African Americans.
Consequently, most if not all white Americans experience implicit bias against black individuals and this notion - which is deeply tethered to the earlier days of slavery - is an ongoing issue affecting African Americans to this very day. Every event that transpires in this book boils down to racism, and it shows how little white Americans consider this as a problem which falls into the notion of white privilege. There’s so much takeaway from a book that’s relatively short and I highly recommend picking this up.
Consequently, most if not all white Americans experience implicit bias against black individuals and this notion - which is deeply tethered to the earlier days of slavery - is an ongoing issue affecting African Americans to this very day. Every event that transpires in this book boils down to racism, and it shows how little white Americans consider this as a problem which falls into the notion of white privilege. There’s so much takeaway from a book that’s relatively short and I highly recommend picking this up.
August 1, 2023
Read for the Booktube Prize.
January 25, 2023
Whew...this was incredible and incredibly tough. I had to take several breaks to get through. My body ached with the tragedy and the sorrow that the scourge of racism wreaks on Black and Brown bodies. But the treatment of the issues was thorough and measured and I'm grateful to have had the opportunity to learn more about the depth of the current problem (eg erroneous race-based checks embedded in medical practice, even medical equipment!)
"Racism has disadvantaged Black people with the least empathy, the most harm, and the fewest options."
"Racism has disadvantaged Black people with the least empathy, the most harm, and the fewest options."
February 27, 2023
I was driving to work back in 2018 when I heard a snippet on NPR about how Black women with advanced degrees experienced infant/maternal mortality rates equivalent to white women with an 8th grade education. If that weren’t shocking enough, the segment went on to detail that Black immigrants experienced these poor outcomes within one generation of being in the US. That was my introduction to Linda Villarosa’s work.
This book was equal parts frustrating, eye-opening, and validating for me. So much of the content matched my own experiences (particularly the chapter on maternal and infant health) and that of family members and friends. Like others have said, this should be a must read for anyone in the healthcare industry.
This book was equal parts frustrating, eye-opening, and validating for me. So much of the content matched my own experiences (particularly the chapter on maternal and infant health) and that of family members and friends. Like others have said, this should be a must read for anyone in the healthcare industry.
February 11, 2023
A well written and researched exploration of the impact of systemic racism on health, wellness, and healthcare in America filled with facts and case studies bringing statistics to life. Villarosa adds a layer probing intersections of race, sex, and class exploring how systems of stratification create disparities and vulnerabilities for so many Americans.
Recommended for fans of The Sum of Us.
Recommended for fans of The Sum of Us.
February 18, 2023
One of the most fascinating and essential books I've ever read! Villarosa illuminates almost unthinkable history and data in a way that is searing, but still hopeful. A must read for absolutely everyone.
March 29, 2023
My favorite book of the year (so far)! I think this book should be required reading for anyone in healthcare or interested in antiracism.
The weathering caused by racism is vastly misunderstood and/or unknown to most; and it’s costing the black and people of color in the US years off their lives.
The weathering caused by racism is vastly misunderstood and/or unknown to most; and it’s costing the black and people of color in the US years off their lives.
October 1, 2023
This was a difficult read. Always a difficult read when a book puts some of your experiences into words, and vivifies those of others. If you are a medical provider providing care to black, brown and other marginalized groups, read it!
August 22, 2023
This should be a required reading
Read
December 13, 2022"Villarosa, a veteran journalist who has covered Black health and wellness for decades, begins her forceful exposure of racism’s toxic effect on the U.S.’s health system by recounting her own personal awakening. She had to learn, she explains, to see health disparities in her own community as resulting from something more than just poverty. That 'something is racism,' not lack of education, poor diet, or bad individual choices. She exhaustively explains how implicit bias on the part of physicians, centuries of entrenched discrimination, and the toll of encountering and fighting daily aggression can translate to high rates of kidney disease and HIV/AIDS, as well as disproportionately elevated infant and maternal mortality. Through sensitive reporting and straightforward science, Villarosa builds to a searing call to action. The issue is not the fault of Black patients, is not what they do or don’t do; it is 'the American problem in need of an American solution,' and it requires an urgent remedy."
https://www.theatlantic.com/books/arc...
https://www.theatlantic.com/books/arc...
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April 28, 2023Book tube prize book
April 19, 2023
In her brilliant, illuminating book, “Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation,” Villarosa expands on the theme. She discovers that racial bias within the health-care system is a compounding factor to racial bias in America. Meticulously researched, sweeping in its historical breadth, damning in its clear-eyed assessment of facts and yet hopeful in its outlook, “Under the Skin” is a must-read for all who affirm that Black lives matter. It will be especially eye-opening for anyone who believes that wealth, education and access to quality medical services are the great equalizers, the attainable means by which Black Americans can achieve health-care parity.
Equal treatment within the health-care system, Villarosa argues, regardless of class or social status, remains elusive because of three primary obstacles: long-standing institutional and structural discrimination; implicit biases in the medical profession resulting not only in misdiagnoses but even blame for being unwell; and “weathering,” which, Villarosa writes, refers to the “struggle with anger and grief triggered by everyday racist insults and microaggressions … [which] can, over time, deteriorate the systems of the body.”
The female reproductive system is not immune. Villarosa cites a 2007 American Journal of Public Health study that demonstrates that Black women who reported experiencing racial discrimination had double to triple the rate of low-birth-weight babies compared with Black women who did not report incidents of discrimination. Summing up, Villarosa writes, “The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”
A decade earlier, Villarosa stringently followed all prescribed prenatal care during her own pregnancy but had to ask herself if her “lived experience as a Black woman in America” had resulted in her daughter being born at only 4 pounds, 13 ounces. She recounts that a doctor “hounded” her with questions about her lifestyle, as if she were a habitual user of alcohol and drugs. Villarosa wondered, “Does this doctor think I’m sucking on a crack pipe the second I leave the office?”
To combat racism in health care, Villarosa advocates implicit-bias training for medical personnel and champions expanding the diversity of students, faculty and curriculums in medical schools.
Equal treatment within the health-care system, Villarosa argues, regardless of class or social status, remains elusive because of three primary obstacles: long-standing institutional and structural discrimination; implicit biases in the medical profession resulting not only in misdiagnoses but even blame for being unwell; and “weathering,” which, Villarosa writes, refers to the “struggle with anger and grief triggered by everyday racist insults and microaggressions … [which] can, over time, deteriorate the systems of the body.”
The female reproductive system is not immune. Villarosa cites a 2007 American Journal of Public Health study that demonstrates that Black women who reported experiencing racial discrimination had double to triple the rate of low-birth-weight babies compared with Black women who did not report incidents of discrimination. Summing up, Villarosa writes, “The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”
A decade earlier, Villarosa stringently followed all prescribed prenatal care during her own pregnancy but had to ask herself if her “lived experience as a Black woman in America” had resulted in her daughter being born at only 4 pounds, 13 ounces. She recounts that a doctor “hounded” her with questions about her lifestyle, as if she were a habitual user of alcohol and drugs. Villarosa wondered, “Does this doctor think I’m sucking on a crack pipe the second I leave the office?”
To combat racism in health care, Villarosa advocates implicit-bias training for medical personnel and champions expanding the diversity of students, faculty and curriculums in medical schools.
September 6, 2022
A must-read for anyone in the healthcare industry or anyone who is trying to understand how health disparities originate in institutional inequality, Linda Villarosa's Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation is an exhaustively researched treatise on the history of systemic racism in American healthcare and the ways in which living in oppression does harm to Black and Brown bodies.
Villarosa wrote the book spanning decades of coverage of health disparities, and it shows, both in the breadth of her coverage of salient diseases affecting people of color-- from HIV to Diabetes to maternal/fetal morbidity and mortality-- and in the ways in which she's documented the changes in her thinking and assumptions. She covers her days at Essence magazine where she encouraged readers to make healthier choices, to her decades-later understanding of the headwinds to health that redlining, infrastructure shortages, and ghetto-izing have caused. Even more alarming is her methodical documentation of the true toll on health that living with microagressions, limited physician representation, pollution, and the echoes of eugenics research on modern medicine does to people of color.
Frequently during the book, we'd stop at 2019, and I'd think, "Just wait, it's going to get worse." Although the book was completed in 2019, Villarosa has not skimped on the impact of COVID on these health disparities, adding a lengthy afterword to detail both the reasons and impacts of disproportionate black incidence of COVID and to explain how the color of COVID contributed to the American politicization of responses to the pandemic.
Villarosa has taken a complicated issue and found trends and insights to offer that are not frequently spoken about outside of SDOH circles. That said, it's findings are comprehensive enough that Under the Skin should be mandatory reading for medical students.
Villarosa wrote the book spanning decades of coverage of health disparities, and it shows, both in the breadth of her coverage of salient diseases affecting people of color-- from HIV to Diabetes to maternal/fetal morbidity and mortality-- and in the ways in which she's documented the changes in her thinking and assumptions. She covers her days at Essence magazine where she encouraged readers to make healthier choices, to her decades-later understanding of the headwinds to health that redlining, infrastructure shortages, and ghetto-izing have caused. Even more alarming is her methodical documentation of the true toll on health that living with microagressions, limited physician representation, pollution, and the echoes of eugenics research on modern medicine does to people of color.
Frequently during the book, we'd stop at 2019, and I'd think, "Just wait, it's going to get worse." Although the book was completed in 2019, Villarosa has not skimped on the impact of COVID on these health disparities, adding a lengthy afterword to detail both the reasons and impacts of disproportionate black incidence of COVID and to explain how the color of COVID contributed to the American politicization of responses to the pandemic.
Villarosa has taken a complicated issue and found trends and insights to offer that are not frequently spoken about outside of SDOH circles. That said, it's findings are comprehensive enough that Under the Skin should be mandatory reading for medical students.
October 16, 2022
It has been a while since I've been angry reading a book. By this anger, I don't mean hate-reading a book (a book so terrible, but you are compelled to finish it and hate yourself for doing so-because you can't allow yourself half-read books.) I mean the content angers and infuriates you, and you must keep reading. Such is the case with "Under the Skin." The mix of data and anecdotal information showing the bias, racism, discrimination and prejudice embedded in our medical profession towards black and brown people can break your spirit. It is almost to the point where you can feel nothing can be done, while black and brown people are not given the information and treatment allowing them to be healthy and live longer lives. Education, class and geography don't play a large part, or even any part. It is straight up conscious or unconscious racism. It makes me think when teenagers take health class in high school, they shouldn't just learn about biology and hygiene and other such things associated with the class. They should also know how to navigate the health care system. What questions to ask. What follow up (questions or answers) to prepare. What to look for. What health and a heathy system should be. Who to speak with if they are unsatisfied with their care or treatment. What their rights as patients are. Let's get into that and hopefully level the playing field. I'm glad I read the book and gained information about a systemic problem I wasn't even fully aware of. But beware, it is depressing to digest it all.
October 13, 2022
It’s not often I can refer to a work of non-fiction as “harrowing.” My usual book consist of crushing moments for sure, but Under the Skin consists of chapter after chapter of powerful health care brutalities and systemic failures. I had to step away multiple times from this book because of how it effected me.
Highlighting the very real racial disparity in health care in the US, Linda Villarosa takes it a step further down the journalistic path with interviews and human interest stories to accompany her voluminous evidence that supports her blunt, shame-inducing conclusion: Being Black in American is bad for your health. Forced sterilizations in the 70s, failed COVID responses in BIPOC communities, and more often than not, just the “weathering” effect racism has on Black Americans all combine to create an environment hostile for living.
Under the Skin constantly made me uncomfortable, underscored the need for me to challenge and understand my personal privilege, and left me ultimately grateful for the opportunity to empathize with so many in our national community who are denied the tools for basic healthy living. I encourage you to challenge yourself with this book
Highlighting the very real racial disparity in health care in the US, Linda Villarosa takes it a step further down the journalistic path with interviews and human interest stories to accompany her voluminous evidence that supports her blunt, shame-inducing conclusion: Being Black in American is bad for your health. Forced sterilizations in the 70s, failed COVID responses in BIPOC communities, and more often than not, just the “weathering” effect racism has on Black Americans all combine to create an environment hostile for living.
Under the Skin constantly made me uncomfortable, underscored the need for me to challenge and understand my personal privilege, and left me ultimately grateful for the opportunity to empathize with so many in our national community who are denied the tools for basic healthy living. I encourage you to challenge yourself with this book
September 16, 2022
This should be required reading for anyone in the medical field from nurses all the way up to the hospital CEOs. It should also be required for mayors, governors, and congressmen at the state and federal level. The information provided is vital to American communities and well being.
The reason I didn't give it five stars was because it didn't address some facts that also contribute to health issues in minorities, but not because it changes the argument. I believe that bringing these issues up and addressing them to shut them down is needed for naysayers. For example, addressing that in the same class blacks choose different foods (not addressed) does not change the fact that if there are a different number of blacks and whites, the percentages do not change and that the populations are still treated differently.
The reason I didn't give it five stars was because it didn't address some facts that also contribute to health issues in minorities, but not because it changes the argument. I believe that bringing these issues up and addressing them to shut them down is needed for naysayers. For example, addressing that in the same class blacks choose different foods (not addressed) does not change the fact that if there are a different number of blacks and whites, the percentages do not change and that the populations are still treated differently.
March 31, 2023
Actually a 4.5.
I think everyone in healthcare needs to read this- it’s a tough and very broad topic to cover and Villarosa does a good job of hitting some key components with well researched evidence.
Should be required reading in medical school!
My 1/2 star off is because of some of the medical stories. “Blood pressure was through the roof”, Really? Couldn’t put that in a more scientific/objective way. And the description of mucus plug- UGH! Last the author claims had a patient receive prenatal steroids it “would have made a difference”. No one can know that. I’m aware I’m picky but I felt that overall the book was SOOOOO good and she had access to obgyns I wish those fine points would have been caught.
I think everyone in healthcare needs to read this- it’s a tough and very broad topic to cover and Villarosa does a good job of hitting some key components with well researched evidence.
Should be required reading in medical school!
My 1/2 star off is because of some of the medical stories. “Blood pressure was through the roof”, Really? Couldn’t put that in a more scientific/objective way. And the description of mucus plug- UGH! Last the author claims had a patient receive prenatal steroids it “would have made a difference”. No one can know that. I’m aware I’m picky but I felt that overall the book was SOOOOO good and she had access to obgyns I wish those fine points would have been caught.
June 20, 2023
Whew, this was tough but essential reading. I appreciated the mix of storytelling and research; really brought what could have been a purely academic book alive. So much of what is captured here I've known in my spirit and by looking at the world around me...it was validating to have it all laid out in this comprehensive text. I honestly don't know how Villarosa walked away from her work feeling optimistic when we were just shown AGAIN through covid that our healthcare system ain't shit and deep health disparities continue to exist. On an individual level I agree there are so many signs of hope (increased in BIPOC doulas, advocates who can get access to $$$ and resources, etc.) but on the structural side of things? I'm just not seeing it...
December 13, 2022
So many of the statistics and stories in this book made me angry--how is is 2022 and our country is still wrecking the health of Black people without a second thought?? This book is so important and eye-opening: I knew a lot about how institutional racism's connection to the U.S. healthcare system before reading, but this book really cemented and strengthened my knowledge, and has given me indispensable insight.
June 30, 2022
This was so engagingly written that it just flew by. The author did a great job combining her personal story with other people's stories and with the history. A lot of the history was already familiar to me, but there were some new, interesting facts, as well. I wasn't sure how the chapter on Appalachia fit in with the rest of the book, especially the conclusions, but maybe that was just me.
November 23, 2024
This is gonna be a book I point back to as a signpost. It’s an important read for everyone in healthcare but also anyone can benefit from hearing her research and arguments. Currently leaning towards pursuing a masters in public health and health equity largely bc of this book.
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