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Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation

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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 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


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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 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.

20 review for Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation

  1. 4 out of 5

    Sarah Schulman

    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 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.

  2. 5 out of 5

    Judy

    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 raci 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.

  3. 5 out of 5

    Danielle W

    I listened to this on Audible. Well researched, undeniable and alarming. If I have any criticism, it is that it is offers very few solutions but we can't put it on the author to figure this one out. Her coverage of what medical schools teach (including those with clearly racist leaders) was fascinating and I agree that true change will come only when we have greater numbers of non-white doctors. Holding medical schools to quotas that reflect the US population would be a good first step. I listened to this on Audible. Well researched, undeniable and alarming. If I have any criticism, it is that it is offers very few solutions but we can't put it on the author to figure this one out. Her coverage of what medical schools teach (including those with clearly racist leaders) was fascinating and I agree that true change will come only when we have greater numbers of non-white doctors. Holding medical schools to quotas that reflect the US population would be a good first step.

  4. 5 out of 5

    Kristen C

    I have long understood that something about being Black has led to the documented poor health of Black Americans….The something is racism. I received an eARC of this title in exchange for my honest review. Thank you to NetGalley and Doubleday Books for this opportunity.One of the first books I reviewed here on the blog was The Immortal Life of Henrietta Lacks, a book that went on to be made into a movie by Oprah and that opened the eyes to some of the injustices of the medical world against Black I have long understood that something about being Black has led to the documented poor health of Black Americans….The something is racism. I received an eARC of this title in exchange for my honest review. Thank you to NetGalley and Doubleday Books for this opportunity.One of the first books I reviewed here on the blog was The Immortal Life of Henrietta Lacks, a book that went on to be made into a movie by Oprah and that opened the eyes to some of the injustices of the medical world against Black people. While that book did a lot to acknowledge past sins, I fear it was all too easy for White people reading it contemporarily to dismiss it as an unfortunate bit of history and think that it’s all different now and these things are no longer a problem. Even today the centuries-old fallacies of Black immunity to pain and weakened lung function still show up. At the same time, scientists and doctors ignore or downplay the social and environmental conditions that mar Black lives and communities, and overlook the dark history of racial prejudice based on the assumption of inherent Black inferiority. Thankfully, Linda Villarosa wrote this book, which links present day beliefs that are carried over from the days of slavery and belief of Black inferiority which allowed whites to justify the enslavement and the cruel treatment thereunder. With eye-opening clarity, Villarosa takes us on a journey of racism and its influence in modern day medicine with heartbreaking stories of people this country has long-mistreated simply because of the color of their skin.Villarosa cites study after study and uses her own experience as a journalist to investigate why one of the world’s richest countries has the world’s highest maternal and infant mortality rates. While she focuses mostly on this particular area of research, she also touches on other areas, including AIDs and Covid-19. Rich or poor, educated or not, young or old across the board, “African Americans ‘live sicker and die quicker'” when compared to their white counterparts in those same categories. The question in my mind is whether institutions as well as individuals will look at this proof and dismiss it out of hand, or whether they might take a step back and examine things again from a different perspective. After all, “denial of racial bias can be so extreme that no one believes you even when you have the evidence.”With case studies that break your heart and put a fire in your belly, this book addresses not just the implicit racism in the medical field with its outdated beliefs and blatant disrespect, but how the constant stress of battling racism medically and measurably affects the health of Black people in America. Evocative, eye-opening, and stirring, this is a must-read.-------------I hope you enjoyed this review! This review and many reviews appear on my blog, Hooks, Books, & Wanderlust, where you'll find book reviews, lists, crochet tutorials & patterns, as well as camping, hiking and travel adventures.Come hang out with me on Instagram | Facebook | YouTube | Blog | Email

  5. 5 out of 5

    James

    A cohesive and painstaking account of medical racism in the US with copious examples and examination of its history along with modern trends.I was worried when I picked this one up that it would be too dry and academic; however, that was not the case. The book is very readable and accessible, and although somewhat academic, would not require much more than an high school education for the reader to understand it. Clearly intended for the general reader. This is ultimately a good thing as the aut A cohesive and painstaking account of medical racism in the US with copious examples and examination of its history along with modern trends.I was worried when I picked this one up that it would be too dry and academic; however, that was not the case. The book is very readable and accessible, and although somewhat academic, would not require much more than an high school education for the reader to understand it. Clearly intended for the general reader. This is ultimately a good thing as the author's message needs to reach as many people as possible.I picked this up hoping to find strategies to deal with bias in healthcare that would work for a variety of identities, including LGBTQ individuals. While I did not find that, I still consider this a worthwhile read for all of the information on how racial bias is built into the US healthcare system, including into the medical instruments used, which is so crazy I can't even with that.That said, I did recognize an instrument for measuring racism as one that has been repurposed and used in the LGBTQ community to measure homophobia/transphobia, so it was interesting to see the origins of that instrument, which I've taken many times in my life.The author doesn't provide a roadmap for non-medical people to follow to help reduce bias in healthcare, which would be A LOT. I assume this is because we really can't do anything, that the changes are up to medical associations, hospitals, medical schools, etc. rather than well-meaning individuals on the outside of the system. Overall, highly recommended for healthcare providers and students and for people who want to know more about bias in medicine. Especially relevant for those interested in the COVID-19 epidemic.

  6. 4 out of 5

    AnnieM

    One of the most important books on systemic racism in medicine written this year. Linda Villarosa interrogates the dangerous myths that exist about black bodies that was perpetuated during slavery and still live on today in our current institutions. Black Americans have poorer health outcomes than white Americans and all too often because of systemic and institutional racism, the blame is put on individuals instead of understanding all of the systemic root causes contributing to these disparitie One of the most important books on systemic racism in medicine written this year. Linda Villarosa interrogates the dangerous myths that exist about black bodies that was perpetuated during slavery and still live on today in our current institutions. Black Americans have poorer health outcomes than white Americans and all too often because of systemic and institutional racism, the blame is put on individuals instead of understanding all of the systemic root causes contributing to these disparities. Some of the research she cites includes work by Dr. Arline Geronimus, who came up with the term "weathering" to explain the devastating impact racism has on health - with micro and macro-aggressions "death by a thousand cuts." Besides constant trauma and stress, there are also the myths that "black bodies are different" that black people have higher pain thresholds than white people - an incredibly dangerous assumption not supported at all by scientific evidence. There is also an important emphasis on disparities in how black women are treated in the health care system- from forced sterilization to higher risk pregnancies and higher rate of maternal death. She also has chapters on mental health and environmental toxins. I have read some of the research she cites here but what makes this book so incredibly important is how she pulls all of these challenges into one book so we can see the big picture about what is happening in this country and how racism has penetrated every aspect of our health care institutions. This book is a call-to-action for all of us who work in healthcare.

  7. 4 out of 5

    Kathy Piselli

    I got this book after reading Villarosa's piece in the NYTimes about the Relfs. Her writing is so good. The book can be read in a day if you are a person of leisure. I loved her including some lines from For Colored Girls and her mention of Ruth Bader Ginsberg, and the part about the eGFR made me run to my health file because I remembered seeing that in my labwork and wondering what is that? African American vs non African American? What if they - or you yourself - don't really know which one yo I got this book after reading Villarosa's piece in the NYTimes about the Relfs. Her writing is so good. The book can be read in a day if you are a person of leisure. I loved her including some lines from For Colored Girls and her mention of Ruth Bader Ginsberg, and the part about the eGFR made me run to my health file because I remembered seeing that in my labwork and wondering what is that? African American vs non African American? What if they - or you yourself - don't really know which one you are? (Emory apparently got rid of the difference in 2015 or so with a stern note that it is calculated taking into consideration "serum creatinine, age, and sex BUT NO RACE" (caps theirs)). The part about weathering is indeed transferrable to others, as Villarosa noted in the chapter about West Virginia - I remember something similar suggested for refugees and for just plain poor people who are looked down on. Sometimes the book made me so sad, reminding me of friends lost, the mess that has been made of the once-idealistic EPA, the non-action of our government when CoVID arrived (we had our own superspreader tragedy here in Georgia, in Albany). But interest in Trump has not gone away yet. I hope Villarosa's optimism isn't misplaced and I hope her material is read.

  8. 5 out of 5

    Untamed Publishing

    I cannot even express how important this book is and I feel that everyone not matter their race or ethnicity should absolutely read this work to not only understand how deeply health disparities are rooted in racism, but also how deeply it impacts our black community and overall society. This work shines a massive spotlight on the racism that runs rampant in our healthcare system and the very real data collected showing just how impactful it is on black americans. I guarantee that every single b I cannot even express how important this book is and I feel that everyone not matter their race or ethnicity should absolutely read this work to not only understand how deeply health disparities are rooted in racism, but also how deeply it impacts our black community and overall society. This work shines a massive spotlight on the racism that runs rampant in our healthcare system and the very real data collected showing just how impactful it is on black americans. I guarantee that every single black person that you know has experienced racism in a healthcare setting at some point in their lives and this book delves deeply into the roots of where it started, the many facets of it to include environmental factors, and why it continues. What I appreciated most was the message of hope. This book highlights so many healthcare workers that are in the trenches working to bring about real change regarding health disparities among black communities as well as the healthcare workers that are willing to receive the information in a way that is uncomfortable but still open. -S.B. for UP Book ReviewsThank you NetGalley and Double Day for providing this book in exchange for a review.

  9. 4 out of 5

    Sharon Layburn

    For thirty five years, award winning journalist Linda Villarosa has been researching and reporting on a variety of ways that racism affects the health of Black Americans. In her latest work, she gathers many of her previous article topics together and expands on her findings, educating readers on numerous trends- past and present- where racism results in deadly, sub-par medical treatment for Black people. Her writing is powerful and devastating, a perfect blend of well researched facts and perso For thirty five years, award winning journalist Linda Villarosa has been researching and reporting on a variety of ways that racism affects the health of Black Americans. In her latest work, she gathers many of her previous article topics together and expands on her findings, educating readers on numerous trends- past and present- where racism results in deadly, sub-par medical treatment for Black people. Her writing is powerful and devastating, a perfect blend of well researched facts and personal vignettes that humanize the statistics and reports. Presenting sordid, heartbreaking stories from our society's history, through our recent past, our challenging present, and hope for the future, Villarosa has crafted a must-read work that aims to open eyes and encourage desperately needed change. Highly recommended.This ARC was provided by Doubleday/Penguin Random House, in exchange for an honest review.

  10. 4 out of 5

    Tamzen

    Wow, this book had a lot of compelling and horrifying information in it. You may have heard that Black Americans have higher mortality rates during childbirth, the Tuskegee Syphilis study, and you may have heard about redlining that relegated Black people to specific areas, often at the expense of their health, but if you're like me, you haven't seen just how deep it goes. Villarosa does some powerful research and story-telling in Under the Skin. I could list all the new things I learned, but ho Wow, this book had a lot of compelling and horrifying information in it. You may have heard that Black Americans have higher mortality rates during childbirth, the Tuskegee Syphilis study, and you may have heard about redlining that relegated Black people to specific areas, often at the expense of their health, but if you're like me, you haven't seen just how deep it goes. Villarosa does some powerful research and story-telling in Under the Skin. I could list all the new things I learned, but honestly, you just really ought to read this book! It's a dense, yet short read, and has plenty of citations in the back if you are interested in learning more. Excellent read, but do be prepared to be absolutely heartbroken at what people have endured, even in the past few years. It's important to know.Thanks to Netgalley and Doubleday Books for the e-ARC!

  11. 5 out of 5

    Kim McGee

    A shocking look at racial health disparity among the African American community as well as the documents atrocities committed in the name of science throughout this country's history. From duped young girls being sterilized without their knowledge to men being withheld treatment for venereal disease as a control group in a study. When African Americans get sick they are less likely to receive solid medical advice and treatment compared to their White counterparts. When a college educated Black w A shocking look at racial health disparity among the African American community as well as the documents atrocities committed in the name of science throughout this country's history. From duped young girls being sterilized without their knowledge to men being withheld treatment for venereal disease as a control group in a study. When African Americans get sick they are less likely to receive solid medical advice and treatment compared to their White counterparts. When a college educated Black woman is more likely to die or have severe complications in childbirth compared to a White woman with only an eighth grade education, something is wrong. Hopefully enough people will read this and become angry and bring about a change. My thanks to the publisher for the advance copy.

  12. 4 out of 5

    Lisa Miller

    I wish everyone would read this book. The fact that the author has been reporting on these issues for 30+ years, is discouraging. I am amazed and respectful of her tenacity and hopefulness. She has gone down various paths regarding how to address the problems. Like her, I’m a big believer in education, and education must continue - that’s why I say read the book! Learn! But what she is pushing into is the idea that the causes are deeper than ignorance. They’re so deeply entwined in our culture i I wish everyone would read this book. The fact that the author has been reporting on these issues for 30+ years, is discouraging. I am amazed and respectful of her tenacity and hopefulness. She has gone down various paths regarding how to address the problems. Like her, I’m a big believer in education, and education must continue - that’s why I say read the book! Learn! But what she is pushing into is the idea that the causes are deeper than ignorance. They’re so deeply entwined in our culture it’s mind boggling to think how to proceed. I’m thankful for people like her who keep trying to find a way forward.

  13. 4 out of 5

    Rachel

    Even while reading this- i found my brain being lazy and complacent- systemic racism is incredibly insidious- and so reading this book is critical for tvose caregivers in the field who are responsible for serving and saving lives in healthcare.

  14. 4 out of 5

    Karen Ghiron

    Very thorough research and data on the racism that exists since the Aids Epidemic, maternal, health care and most recent COVID pandemic. Vilarossa is an excellent writer and clearly depicts the racial bias and racism that still exists.

  15. 5 out of 5

    Rebecca

    Thorough look at racism in healthcare; at times jumps around topics and can be a little dry. Overall I appreciated the historical context and present day examples of racisms impact in medicine. Important read for healthcare professionals

  16. 4 out of 5

    Beatrice Hogg

    This book confirmed a lot of what I already knew. I have often times wonder if my healthcare would be different if I were a different ethnicity. It is shocking that medical professionals still believe some of the erroneous stereotypes about black bodies.

  17. 4 out of 5

    Lanita Foley

    This is a must read; it is masterful. The stories of Americans suffering in places like Boston, Montgomery and Morgantown linger.

  18. 5 out of 5

    Hope

    A must read

  19. 4 out of 5

    Pylevinson

    Essential reading for healthcare providers in America.

  20. 5 out of 5

    Lucy

    Essential reading

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