Book Review of Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of our Nation by Linda Villarosa

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My wife was 20 weeks pregnant when she had a spurt of pink fluid and we felt our first child was not moving inside her. A panicked call to 911 brought paramedics. While examining my wife, the paramedics had a casual conversation with us about our work as graduate students at the University of Iowa. The tenor sounded strange at the time, but he offered hope; the paramedics would surely not speak if our child was in trouble.

Once the review was over, we had even more hope; we were advised to go to the hospital “for observation”, but no need to rush. An hour later we drove ourselves and learned, contrary to what the paramedics were suggesting, that our child had died. We were told to go home and ‘let nature take its course’ – meaning my wife was to deliver our lifeless child home in a bucket we had been given.

Two days later, my wife went into labor. When she had a fever and chills, I called our doctor; he told me to give him an aspirin. But she got worse. I called the paramedics. I was terrified that along with our child, I would lose my wife, who was now in our tub, unconscious and bleeding, alongside “the death” she had delivered. She was rushed to hospital for emergency surgery in an attempt to save her life.

Thank God my wife survived, but 30 years later, she and I remain haunted by our experience and the belief that race played a role in this story. If we had been white, like all the medical personnel who treated us, rather than black, perhaps the first paramedics would have equalized us. And maybe in the hospital we would have had the option of surgical evacuation instead of being sent home to suffer a risky fetal death in the second trimester. According to the Department of Obstetrics and Gynecology at the University of California, Davis, a fetal death delivered at home during the second trimester is at high risk for significant bleeding. When we told hospital staff that we had strong apprehensions about seeing and handling our child’s remains at home in the grip of our grief, maybe – if we had been a white couple – we would not have received the insensitive and false answer: “There ‘ll be nothing to do with the disappearance, other than the gray matter. And when I called our doctor when my wife had chills and a high fever during her delivery, I might have been asked to take her to the hospital immediately.

In a searing 2018 New York Times Magazine article titled “Why America’s Black Moms and Babies Are in a Life-and-Death Crisis,” Linda Villarosa wrote, “People of color, especially people black, are treated differently when they enter. the health system. Race, in other words, in terms of health care in this country, is the story. Villarosa, a journalism professor at the City University of New York, reported on studies that show, for example, that black people are less likely than white people to receive kidney dialysis or transplants, coronary bypass surgery, heart medications appropriate or painkillers, but they are more frequent amputations for diabetes.

In her brilliant and 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 healthcare system is an aggravating factor in racial bias in America. Meticulously researched, sweeping in its historical breadth, damning in its lucid assessment of the facts and yet hopeful in its outlook, “Under the Skin” is a must read for anyone who argues that black lives matter. It will be especially telling for anyone who believes that wealth, education, and access to quality medical services are the great equalizers, the feasible means by which black Americans can achieve health care parity.

Equal treatment within the health care system, argues Villarosa, regardless of class or social status, remains elusive due to three main obstacles: long-standing institutional and structural discrimination; the implicit biases of the medical profession resulting not only in misdiagnosis but even blame for being sick; and “aging,” which, Villarosa writes, refers to the “struggle with anger and grief sparked by daily racial slurs and microaggressions… [which] can, over time, damage body systems.

The female reproductive system is not immune. Villarosa cites a 2007 study from the American Journal of Public Health which shows that black women who reported experiencing racial discrimination had two to three times more low birth weight babies than black women who did not. did not report incidents of discrimination. In summary, Villarosa writes, “The researchers’ conclusion: low birth weight among African American women has more to do with the experience of racism than with race.

A decade earlier, Villarosa rigorously followed all prescribed prenatal care during her own pregnancy, but had to wonder if her “lived experience as a black woman in America” ​​had left her daughter at just 4 pounds, 13 ounces. She says a doctor “harassed” 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 a crack pipe the second I leave the office?”

To combat racism in health care, Villarosa advocates for implicit bias training for medical personnel and champions expanding the diversity of students, faculty, and curricula in colleges of medicine. medicine.

However, racism cannot be fought if its existence is denied. Signs of its persistence were apparent in comments made by the associate editor of the prestigious Journal of the American Medical Association in a Podcast 2021. “Structural racism in an unfortunate term,” said this editor. “Personally, I think taking racism out of the conversation will help. Many people like me are offended by the implication that we are somehow racist. JAMA’s Twitter account tweeted about the podcast: “No doctor is racist, so how can there be structural racism in healthcare?” The podcast and tweet were deleted and, Villarosa writes, “the associate editor and editor – both Caucasian doctors – have resigned.”

Some people are offended by what the extensive research shows about health care disparities. Villarosa provides the facts galore, perhaps none more alarming than this: Black women, including those “whose income and education should protect them”, are three to four times more likely than white women from dying of pregnancy-related causes.

Tennis star Serena Williams was almost one of those victims. The day after her daughter’s delivery by caesarean section section, Williams had difficulty breathing and knew from experience that she was suffering from a pulmonary embolism. She told the medical staff what was happening and the treatment she needed, but she was ignored. Her persistent cough eventually broke her C-section sutures, sending her back to surgery; it was then that a large hematoma was discovered in his abdomen, which required further surgery. Villanova documents a number of equally harrowing stories, if the facts alone weren’t enough to convince us of the current crisis.

But some don’t need convincing. Alas, we have our own stories.

Jerald Walker is Professor of African American Literature and Creative Writing at Emerson College. His latest book,How to Make a Slave and Other Trialswas a nonfiction finalist for the 2020 National Book Award.

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

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