Under the Skin

Linda Villarosa grew up in a high-achieving Black family in a mostly white suburb of Denver. When she began writing about Black women’s health for Essence in the mid-1980s, her articles were all about self-help and self-improvement, based on the assumption that poverty and poor education were the reasons for detrimental health conditions among Black people.

But then she discovered that well-educated, upper-middle-class Black women were also having underweight babies and higher rates of maternal death than white women. She found herself wondering, “Why is the current Black-white disparity in both maternal and infant mortality widest at the upper levels of education? And what was it about our health-care system that exacerbated this problem?”

Under the Skin: The Hidden Toll of Racism on American Lives and the Health of Our Nation answers these questions and many more. In one of the most interesting chapters, Villarosa writes about “weathering,” a concept developed by Dr. Arline Geronimus, a professor at the University of Michigan School of Public Health. Weathering is the idea that “high-effort coping from fighting against racism leads to chronic stress that can trigger premature aging and poor health outcomes.” It draws the throughline from systemic failure to a harmful bodily response.

Villarosa, who now writes for The New York Times Magazine, explores many more aspects of American prejudice and health in this book. In a chapter recounting a visit to Appalachia to write about the addiction crisis among poor white people, she suggests that many of these people suffer from the debilitating effects of class discrimination, with similarly negative health repercussions. She examines myths about Black genetics—that Black people are less sensitive to pain than whites, for example—that persist within the medical community to the detriment of Black Americans. She looks at how racism in housing forces many Black families into environmentally hostile neighborhoods. And, based on her reporting, she offers several ideas for improving community health that she believes will change American health care for the better.

Under the Skin is wonderfully written. It’s not an inaccessible academic work or a polemic. Rather, its points are made amid moving narratives of real people’s experiences. The book also serves as a stake in the ground for Villarosa as she powerfully discloses what years of reporting have led her to understand: “The something that is making Black Americans sicker is not race per se, or the lack of money, education, information, and access to health services that can be tied to being Black in America. It is also not genes or something inherently wrong or inferior about the Black body. The something is racism.”

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