Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Uncovering the truth about racial health inequities in America: a book review

John Paul Mikhaiel, MD
Policy
May 29, 2023
Share
Tweet
Share

When I started my intern year, that is my first year of training in medical residency, I noticed something peculiar about the epidemiology of disease in our hospital. The Black patients on the medical wards would often present with the morbidity of their diseases almost ten to twenty years earlier than their white counterparts. A Black person with leg swelling and shortness of breath who presented with advanced heart failure would be in their sixties, whereas a white person with the same symptoms would be in their eighties. Of course, my observations are anecdotal, the n is not high enough to constitute evidence, and one person’s perception does not constitute reality.

Still, those individual observations and patient experiences may represent a few dots on a stipple drawing. Each patient and their experience are integral to the larger whole. Rather than dismissed as anecdotal, they should be both highlighted for their individuality and aggregated to form a cohesive and complete narrative. In her book, Under the Skin, journalist Linda Villarosa does just that. Specifically, she demonstrates how racism at both a systemic and local level affect Black people, causing them to “live sicker and die quicker.”

Villarosa is no stranger to the intersection of race, health, and inequality. She began her career writing for Essence, where she served as executive editor, and published numerous award-winning articles. She went on to work as the health editor for the New York Times. Her illustrious writing career includes seminal pieces on reproductive inequality for Black mothers and babies, the toll of the HIV epidemic on Black lives, and the disproportionate and unequal effects of pollution, among many other critical and insightful pieces.

Under the Skin covers these topics and many others. The book opens with Villarosa’s turn from her own previous misconceptions on race and health. The year is 1991 and Villarosa is in her Harvard journalism fellowship, attending a lecture by Dr. Harold Freeman, the director of surgery at Harlem Hospital and co-author of groundbreaking article, “Excess Mortality in Harlem,” published in the New England Journal of Medicine. When she questions that the racial inequities described are a result of poverty, Dr. Freeman looks her straight in the eye and says, “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 … Look deeper, think differently.” And look deeper is exactly what she does.

At its core, Under the Skin takes the reader through a journey where racial health inequities are not solely attributed to poverty. Certainly, poverty plays a role, but there is something deeper. There is an inherent flaw in the system that cannot be fixed with money. While the claim seems bold on the surface, Villarosa provides a plethora of evidence through her meticulous research.

The book follows Black lives from birth to death and demonstrates the injustices throughout. Even when income, education, and access to health care are matched, African Americans remain disadvantaged. For example, college-educated Black mothers are more likely to die, almost die, or lose their babies compared with white mothers who haven’t finished high school. Court cases and media, as recently as the 1970s, have unearthed an estimated 100,000 to 150,000 poor, mostly Black women sterilized each year in the U.S. under federally funded programs. Aside from reproduction, during their lives, African Americans are 75 percent more likely than the average American to live in so-called fence-line communities, that is, areas near facilities that emit hazardous waste.

Through nearly 300 pages of detailed research, Villarosa enumerates the many aspects of living in the U.S. that harm African American health. She explains the concept of weathering, first introduced by scholar Arline Geronimus, in which struggling against discrimination routinely frays a person’s mental and physical health. Black women, for instance, suffered the highest “allostatic load” scores – a measure using a set of biomarkers, such as blood pressure, heart rate, cholesterol, and body mass index, that become disrupted when the body releases hormones in the face of sustained stress. Such stress may manifest in lower birth weight for Black infants. Disheartening statistics show that infants born to college-educated Black parents were twice as likely to die as infants born of similarly educated white parents.

Under the Skin is unflinching in its analysis on the impact of race on health. Through Villarosa’s grounded journalism, the reader is introduced to hard data on health inequities in the U.S., as well as the implications of this data on the lives of individuals. In medicine, we only get full knowledge of a disease by understanding both the reductive biologic pathophysiology, as well as the effects of that pathophysiology on an individual’s subjective experience. Diseases do not happen in a vacuum; they happen to living beings. Villarosa gives us both the data and the experiences. In this way, the reader is meant to understand what is at stake, and how we must all work towards a more equitable future.

John Paul Mikhaiel is a neurology resident.

Prev

Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

May 28, 2023 Kevin 0
…
Next

Physician entrepreneurs offer hope for burned out doctors

May 29, 2023 Kevin 2
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]
Next Post >
Physician entrepreneurs offer hope for burned out doctors

ADVERTISEMENT

More by John Paul Mikhaiel, MD

  • An ethical approach for clinical trials during the COVID-19 pandemic

    John Paul Mikhaiel, MD
  • A medical student reviews Eric Topol’s Deep Medicine

    John Paul Mikhaiel, MD

Related Posts

  • Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes

    Nina Cloven, MHA
  • A health economist acknowledges how financing experiments failed our health system

    James G. Kahn, MD, MPH
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • New proposals for universal health care in Oregon and Washington

    Roger Collier
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • How social media can help or hurt your health care career

    Health eCareers

More in Policy

  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Choosing between care and country: a dual citizen’s Independence Day reflection

    Kathleen Muldoon, PhD
  • How fragmented records and poor tracking degrade patient outcomes

    Michael R. McGuire
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...