Under the Skin Quotes

“In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.”
― Linda Villarosa, Under the Skin

“Over the next few months, I set out to understand why in our country with the most expensive and advanced medical technology in the world, growing numbers of American women, disproportionately Black women, were dying as a result of pregnancy and childbirth, including African American women whose income and education should protect them.”
― Linda Villarosa, Under the Skin

“Louisiana, where I had spent so much time reporting on maternal and infant mortality, had become the first state to release data by race, and the numbers showed a vastly unequal distribution in deaths. While African Americans were 32 percent of the population, they made up 70 percent of the dead.”
― Linda Villarosa, Under the Skin

“Bias and discrimination in medicine—and resistance to believing that they are real—may be receding, but they seem to be going out ugly.”
― Linda Villarosa, Under the Skin

“Most acts of racism and bias arise in people with blind spots, not Proud Boys memberships.”
― Linda Villarosa, Under the Skin

“A quotation by Goethe included in the first pages of the report would prove telling: “Knowing is not enough; we must apply. Willing is not enough; we must do.” The”
― Linda Villarosa, Under the Skin

“Heather learned from her immigrant parents not to complain, not to look back, not to blame others, not to be weighed down by regret, but instead to put her head down, work relentlessly, and soldier ahead.”
― Linda Villarosa, Under the Skin

“Polluting facilities tend to be located in areas where residents are least able to fight back against them—communities where people of color live and where poor people reside. Stokes County is mostly white. Residents Black and white, middle class and poor, have been exposed to Duke Energy’s pollution and poisoned by it since it first located the Belews Creek Steam Station in Walnut Cove the year Danielle and Caroline were born. But the county’s poor and Black residents live closest to the plant, the landfills, and the pond and are least able to relocate.”
― Linda Villarosa, Under the Skin

“In the 1930s, the Home Owners’ Loan Corporation (HOLC) used color-coded maps that encouraged mortgage lenders to withhold credit from certain communities in 239 cities. These maps graded areas—A (“best”—green), B (“still desirable”—blue), C (“definitely declining”—yellow), and D (“hazardous”—red)—encouraging lending in predominantly white and more affluent areas and discouraging lending in areas with residents of color, especially “Negroes.”
― Linda Villarosa, Under the Skin

“2018, researchers from the Environmental Protection Agency (EPA) proved that though poverty matters as far as who is exposed to pollution, race plays an outsized role. A study conducted by the EPA’s National Center for Environmental Assessment looked at facilities emitting air pollution, along with the racial and economic profiles of surrounding communities, and found that Black Americans are subjected to higher levels of air pollution than white Americans regardless of their wealth.”
― Linda Villarosa, Under the Skin

“African Americans are 75 percent more likely than the average American to live in so-called fence-line communities. These are defined as areas near facilities that emit hazardous waste. Breathing air poisoned by emissions is the most direct, unavoidable consequence of life in a fence-line community, depriving residents of their most fundamental right, the right to breathe. Installing facilities that inflict negative health, social, and economic outcomes on communities that generally didn’t want them has been called a new kind of Jim Crow.”
― Linda Villarosa, Under the Skin

“Black and poor communities shoulder a disproportionate burden of the nation’s pollution, which has been well documented for decades, thanks to a pileup of evidence that scientists and policy makers began gathering beginning in the 1970s.”
― Linda Villarosa, Under the Skin

“Chicago has the country’s widest racial disparity in life expectancy—a gap of thirty years between Streeterville (nine miles north), where people expect to live to ninety, and my mom’s old neighborhood, Englewood, where people live to only age sixty.”
― Linda Villarosa, Under the Skin

“Living in safe communities, with adequate health-care services, outdoor space, clean air and water, public transportation, and affordable healthy food—as well as education, employment, and social support—contributes to longer, healthier lives. And the opposite is true: when residents lack a healthy environment and basic services and support, their lives are cut short. When I returned to the South Side of Chicago in 2020 to see where my Mississippi-born grandparents and their siblings settled during the Great Migration—and which my immediate family left in 1969—I could see the outsized effects of race and place on health.”
― Linda Villarosa, Under the Skin

“school showed Geronimus something else. The girls weren’t losing out on higher education, careers, and other opportunities as a result of pregnancy. Those advantages didn’t exist in their communities. Plus, getting pregnant wasn’t necessarily a drag on the young women; many of them were experienced with raising children, having helped care for siblings and other family members. Inspired by the book All Our Kin, the anthropologist Carol B. Stack’s ethnography of three years in a low-income Black community, Geronimus understood that many of the young women lived in a warm embrace of family and community support, or kin, in stark contrast to the popular image of the “ghetto” as deficient and dysfunctional. She started to see that societal barriers, inequality, and lack of choices, not teen pregnancy, were the origin of the socioeconomic problems the Black community was struggling against.”
― Linda Villarosa, Under the Skin

“Arline Geronimus, a professor at the University of Michigan School of Public Health, provides the best current explanation of how lived experiences can become biology. Her concept of weathering explains that high-effort coping from fighting against racism leads to chronic stress that can trigger premature aging and poor health outcomes. It works this way: stress, the body’s response to a perceived threat, prompts the brain to release hormones, including adrenaline and cortisol. This, in turn, causes blood pressure to increase and the heart rate to speed up. Short, infrequent bursts of this fight-or-flight response are normal, but when it happens again and again, it can turn deadly, eroding health and accelerating aging. Also, as the stressors pile up and feed on each other, they can lead to unhealthy coping mechanisms—drinking, smoking, poor food choices, and drug use. Those who are economically disadvantaged have added stressors in their day-to-day fight for survival, but even educated, well-off African Americans struggle with”
― Linda Villarosa, Under the Skin

“the end, BWHS research showed higher levels of diabetes, obesity, asthma, and preterm birth among women who reported the greatest experiences of racism.”
― Linda Villarosa, Under the Skin

“2011, writing in the Yale Alumni Magazine, Ron Howell, Murphy’s classmate, noted that forty-one years after their graduation, nine of thirty-two Black men who entered Yale in 1966 were dead, a death rate three times higher than that of the class as a whole. Williams offered a sliver of hope and a broad set of suggestions to attack the problem. Even as he spoke of that sliver, I couldn’t shake the thought”
― Linda Villarosa, Under the Skin

“Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health and chair in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health, created this set of questions in 1995, basically on a dare, after having been told that there was no way to measure racism. His scale has now been universally accepted, and also adapted and amended and used all over the world to measure the ways in which discrimination hurts health and shortens lives. Like many researchers in the area of health disparities, Williams has been beating the same drum for decades about race and health: that yes, as far as health goes, socioeconomic status and education matter, but they are not the whole story. The lived experience of being Black in America, regardless of income and education, also affects health.”
― Linda Villarosa, Under the Skin

“You are treated with less courtesy than other people are. You are treated with less respect than other people are. You receive poorer service than other people at restaurants or stores. People act as if they think you are not smart. People act as if they are afraid of you. People act as if they think you are dishonest. People act as if they’re better than you are. You are called names or insulted. You are threatened or harassed.”
― Linda Villarosa, Under the Skin

“Finally, in 2007, Drs. David and Collins combined their previous studies into one deep dive that appeared in the American Journal of Public Health. For this study, they not only considered the effects of race but also looked at the more provocative question of what impact racism had on Black mothers and their babies. The pair spoke with Black women who had babies with normal weights at birth, comparing them with those whose babies were born under three pounds. They asked the mothers if they had ever been treated unfairly because of their race when looking for a job, in an educational setting, or in other situations. Those who experienced discrimination had a twofold increase in low birth weights. For those who reported discrimination in all three areas, the increase was nearly threefold. The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”
― Linda Villarosa, Under the Skin

“The genesis of some of this thinking might have been the words of Thomas Jefferson in his influential and widely circulated 1785 book Notes on the State of Virginia. Though he was not a doctor or scientist, Jefferson cataloged the physiological ways Black bodies differed from white bodies in this 244-page document.”
― Linda Villarosa, Under the Skin

“the denial of racial bias can be so extreme that no one believes you even when you have the evidence.”
― Linda Villarosa, Under the Skin

“My mantra was “health care is our right and we have to stand up for ourselves and others and get the care we want, deserve, and pay for.” I tacked some version of it onto almost everything I wrote—in articles and books—and it was always my coda in lectures about Black health empowerment. I also championed Black physicians and researchers and stressed the importance of having a health-care provider who looked like you. It would take a family medical crisis for me to understand that this advice was insufficient and that our medical system is broken.”
― Linda Villarosa, Under the Skin

“If you really care about these issues and want to make a difference, you must not use race as a proxy for poverty or poverty as a proxy for race. They intersect and overlap, but to really understand the health of this country, you have to be more sophisticated than assuming that only poor Blacks are affected by this crisis. Look deeper, think differently.”
― Linda Villarosa, Under the Skin

“I met Dr. Freeman in 1991 when he came to Harvard to talk to my fellowship program about his New England Journal of Medicine article. With calm deliberation, this tall, elegant physician disrupted my vision of Harlem and other Black communities throughout the United States. He detailed a cascade of health conditions triggered by inadequate facilities, lack of access to health insurance, and a shortage of medical personnel, healthy food, safe neighborhoods, and basic education. He called the problem a national tragedy, an emergency analogous to a hurricane, flood, or other ruinous natural disaster, yet one for which no one was sounding the alarm.”
― Linda Villarosa, Under the Skin

“Heckler lay the blame bluntly at a press conference following the release of the report: “Progress depends more on education and a change in personal behavior than it does on more doctors, more hospitals, or more technology.” Within this largely well-meaning report lurked the assumption that Black people, individually and collectively, were irresponsible, careless, uneducated, and making thoughtless choices that led to this health crisis in the first place.”
― Linda Villarosa, Under the Skin

“These factors create physical vulnerability and systemic disadvantages that education, income, and access to health care cannot erase. This inequality, born more than four hundred years ago and embedded in every structure and institution of American society, including the health-care system, is driving our country’s poor national health outcomes relative to the rest of the developed world. It has taken me three decades of reporting on the health of African Americans and several disturbing personal medical crises to understand the ways discrimination and bias contribute to poor health outcomes primarily in African Americans, but in reality in all oppressed people.”
― Linda Villarosa, Under the Skin

“To put it in the plainest terms, from birth to death the impact on the bodies of Black Americans of living in communities that have been harmed by long-standing racial discrimination, of a deeply rooted and dangerous racial bias in our health-care system, and of the insidious consequences of present-day racism affects who lives and who dies.”
― Linda Villarosa, Under the Skin

“in recent years I have come to understand that much of what I believed about health disparities and inequality in the United States was wrong. 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.”
― Linda Villarosa, Under the Skin