Lessons From the Intersection of Race, Inequality, and Health
An award-winning scholar brings her own lived experience to searching for solutions to the broken healthcare system.
Few moments in an individual’s life are as pivotal as when a parent falls ill. We find, suddenly, that the people who made us are as mortal as we feared. We all want them to be cared for with love and dignity at the end of their lives—it is the least we can offer.
But America’s health and healthcare system is broken. The barriers to quality care and fair medical treatment are far greater for Black people, framed by the subhuman origins of a medical system that treated Black men and women like chattel. Understanding the cracks in the foundation of this $4.3 trillion system—which invests more heavily and responsively in some while ignoring or humiliating others—is part of the work all of us can do to make lasting change that will improve health and wellbeing for all in America. It’s why the Foundation is committed to learning from those who are informing and shaping solutions.
When racism hits home
Award-winning author and health equity expert Linda Villarosa, a professor at the City University of New York, has been a leading scholar documenting gaps in health equity for more than two decades. She is the author, most recently, of Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation. Her insights are featured in Necessary Conversations, by RWJF’s chief science officer, Alonzo Plough. She has also been a health editor for The New York Times and Essence Magazine.
As we commemorate Black History Month and look toward Women’s History Month, her contributions to increasing our knowledge of the lived experiences of Black people are invaluable. They provide important perspective on the intersection of healthcare and race, convey the urgency of dismantling medical myths, and give us language to describe the solutions we might explore together to fix things.
In Under the Skin, Professor Villarosa writes that her father’s hospitalization in 1999 was a turning point in her understanding of the danger of scathing racial myths, despite evidence of Black humanity. Her father was a biology major in college, had earned medals in the military, and worked as a manager at a federal agency until he retired. He was always impeccably dressed. And like any Black man in America, he had to be both smart and sharp to win any respect in society. Later in life, he started to suffer from mild dementia.
But at the veteran’s hospital where he was hospitalized for complications from colon cancer, he was just another random Black guy—and he was treated as such. He was clad in a dirty hospital gown and had restraints on his legs. An attendant spoke to him in a disrespectful hiss.
Professor Villarosa’s mother had pleaded with her to come urgently to his bedside to help rectify this situation. When she arrived and leaned in to hug her father, he whispered to her to get him out of there. Both mother and daughter were in their most professional attire. Professor Villarosa brought cards from her job at the New York Times. She brought her father’s military medals, photographs of him before he fell sick and his college degree.
The experience of needing to fight to have her father be seen affected her deeply. So did the racial bias she saw firsthand in her reporting on the weathering—the impact of racism—on Black women’s bodies, which is a central factor in the current Black maternal health crisis, with Black mothers three to four times more likely to die during childbirth than white women. These experiences led Professor Villarosa to expand her groundbreaking 2018 article for the New York Times Magazine, The Hidden Toll: Why Black Mothers are in a Life-or-Death Crisis, into her book, Under the Skin.
A profound shift brings hope
The core idea of the book is that while there are many reasons for why health equity eludes our country, the main factor is racism. Racism connects all the barriers that Black people have historically faced interacting with the medical system in the United States, living in unhealthy conditions and being blocked from building wealth that would help our families to thrive.
“…The denial of racial bias can be so extreme,” she writes at the outset of the book, “that no one believes you even when you have the evidence.”
Professor Villarosa has spent decades acquiring evidence and using it to dispel myths and stereotypes, to bring attention to AIDS/HIV, environmental racism, mental health treatment, medical education disparities and more. “Despite decades of social, economic and educational progress, and what has unquestionably been the rise of a robust Black middle class, racial health disparities have remained intact. Yes, something about being Black is creating a health crisis, and that something is racism. It is the American problem in need of an American solution.”
Professor Villarosa has been at the forefront of this conversation and discussion for years. Only now does she feel a profound shift in receptiveness to her ideas about calling out racism as the public health crisis that it is. The shift came during the summer of 2020 after the death of George Floyd, Breonna Taylor and too many others. People are finally open to discussing racism unlike before. And she is energized by medical students, community health workers, patient navigators and others who are “putting kindness into healthcare.”
Continuing to name the truth—“it’s not race, something about being Black, or something wrong with the Black body, but racism that makes people sick and shortens their lives”—is part of how we move toward building solutions to implementing change. In Under the Skin, she writes that she is optimistic we will get there. So are we.
About the Author
Joshunda Sanders is Senior Executive Communications Officer to Rich Besser, MD, President and CEO at the Robert Wood Johnson Foundation.