February 4, 2023
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The Hidden Toll of Racism on Health

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The Hidden Toll of Racism on Health

Linda Villarosa, author of The NY Times best seller Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation.



KAREN: IT IS A NEW YEAR AND THAT OFTEN MEANS NEW YEAR’S RESOLUTIONS THAT OFTEN INCLUDE HEALTH GOALS, EATING BETTER, DRINKING LESS, EXERCISING MORE. WHAT ABOUT THE HEALTH FACTORS THAT ARE BEYOND OUR CONTROL. A NEW BOOK EXPLORES THE FULL STORY OF RACIAL HEALTH DISPARITIES. IT IS CALLED UNDER THE SKIN, THE HIDDEN TOLL OF RACISM ON AMERICAN LIVES AND ON THE HEALTH OF OUR NATION. IT IS ONE OF THE NEW YORK TIMES TOP 10 BOOKS OF 2022. JOINING US NOW IS AUTHOR AND JOURNALIST LINDA VILLAROSA. HI, LINDA. WELCOME TO THE PROGRAM. TELL US THE INSPIRATION BEHIND THIS BOOK. LINDA: I STARTED WRITING IT BECAUSE I SAW THERE WAS A MISMATCH IN HOW WE THOUGHT ABOUT RACIAL HEALTH DISPARITIES. FROM THE BEGINNING OF LIFE, ALL THE WAY TO THE END, LIFE EXPECTANCY, BLACK PEOPLE IN AMERICA HAVE POOR HEALTH OUTCOMES. USUALLY WHEN WE TALK ABOUT IT, IT WAS ALWAYS SOMETHING WE ARE DOING WRONG OR SOMETHING WRONG WITH OUR BODIES, WHICH SUGGESTS GENETICS. OR SIMPLY THAT SO MANY OF US ARE POOR, WHICH IS A PROBLEM IN THE COUNTRY. BUT WHAT I FOUND IS THAT EVEN WHEN ACCESS TO HEALTH CARE, EDUCATION AND INCOME ARE MATCHED, WE HAVE POOR HEALTH OUTCOMES, WHICH SUGGESTS SOMETHING DIFFERENT THAN JUST WE ARE DOING SOMETHING WRONG OR THERE IS SOME KIND OF INHERENT IN FOR YOUR ALREADY — INFERIORITY IN OUR BODIES. KAREN: YOU SUGGESTED IT WAS SYSTEMATICALLY BIASED BUT YOU HESITATED TO CALL IT RACIST. BUT NOW YOU HAVE USED THE WORD RACIST. TELL US ABOUT THE EVOLUTION IN YOUR THINKING. LINDA: I THINK FOR ME, IT WAS HARD BECAUSE I HAVE SUCH RESPECT. MY BEAT AT THE NEW YORK TIMES MAGAZINE AND EVEN AT ESSENCE WAS HEALTH AND MEDICINE. I WAS ALWAYS IN TOUCH AND USING SOURCES AND PEOPLE THAT I TRUSTED. SCIENTISTS, PHYSICIANS, NURSES, MIDWIVES. IT WAS HARD TO THINK THEY ARE RACISTS. BUT WHAT I NOW HAVE CORRECTED MYSELF TO SAY IT IS NOT THE INDIVIDUAL BIASES THAT ARE THE PROBLEM. IT IS WHAT IS BUILT INTO THE SYSTEM THAT GOES BACK VERY FAR. SOME OF THE DECISION-MAKING MAY BE BASED ON STEREOTYPES FROM THE PAST. AND IT IS NOT THE FAULT OF INDIVIDUAL PROVIDERS. IT IS A PROBLEM WITH THE SYSTEM IN GENERAL. AND WITH OUR SOCIETY, THAT ALL NEEDS TO BE CHANGED. KAREN: THE RECENT DEATH BY SUICIDE OF CELEBRITY DANCER AND TV PERSONALITY STEPHEN, TWITCH, BOSS, SPARKED A LOT OF CONVERSATIONS ABOUT BLACK MEN AND MENTAL HEALTH. YOU SAY THERE ARE MILLIONS OF AFRICAN-AMERICAN STRUGGLING WITH MENTAL ILLNESS AND 33% RECEIVED TREATMENT, COMPARED TO THE AVERAGE OF 44% OVERALL. WHAT ARE SOME OF THE REASONS FOR THIS AND TALK ABOUT THE DISPARITIES IN TREATMENT FOR BLACK MEN WHO NEED MENTAL HEALTH SERVICES. LINDA: I THINK WHAT IS INTERESTING IS WHEN I TALK ABOUT WHAT IS CALLED HEALTH-CARE HESITANCY OR A HESITANCY TO ENTER THE HEALTH CARE SYSTEM, PEOPLE START TO SAY, I REMEMBER LEARNING ABOUT TUSKEGEE AND WHAT HAPPENED TO BLACK MEN WHO WERE DENIED TREATMENT FOR SYPHILIS AND STUDIED INSTEAD AT THE — AND THE ILLNESS PROGRESSED. THAT HAPPENED WAY IN THE PAST. WHAT DRIVES PEOPLE AWAY FROM THE HEALTH CARE SYSTEM IS WHAT HAPPENED TO THEM YESTERDAY, WHAT HAPPENED TO FAMILYMEMBERS, THINGS THEY HAVE HEARD. THAT GOES ESPECIALLY FOR BLACK MEN. THE IDEA THAT BLACK MEN ARE SUPPOSED TO BE STRONG, ALWAYS, AND INVULNERABLE, DRIVES THEM AWAY FROM THE HEALTH CARE SYSTEM ITSELF. AND THEN ADMITTING THAT YOU HAVE SOME KIND OF MENTAL ILLNESS IS VERY DIFFICULT. KNOWING THAT SO FEW MENTAL HEALTH CARE PROVIDERS ARE GOING TO LOOK LIKE YOU IS ALSO A DETERRENCE TO THE SYSTEM. THEN, WHEN YOU INTO THE SYSTEM AND YOU DO GET TREATMENT THAT IS NOT EXACTLY RIGHT BECAUSE OF STEREOTYPES, THE ASSUMPTION BLACK MEN ARE DANGEROUS OR VIOLENT OR OUT-OF-CONTROL. AND, YOU KNOW, I SAW THAT HAPPEN WITH MY OWN FATHER. HE DID NOT HAVE A MENTAL ILLNESS BUT HE WAS ILL, IN THE HOSPITAL. WHEN I WENT TO VISIT HIM, HE WAS RESTRAINED. HE IS A MILD-MANNERED PERSON WHO WAS A BIOLOGIST BY TRAINING. ALWAYS DRESSED REALLY NICE. SO, TO SEE HIM SO UPSET AND RESTRAINED TO THE BED, HE WAS AN OLDER MAN. I DON’T UNDERSTAND WHY HE WOULD EVER BE RESTRAINED TO THE BED, EXCEPT WITH THIS IDEA FLOATING AROUND IN THE AMERICAN IMAGINATION THAT BLACK MEN ARE DANGEROUS. KAREN: WHAT CHANGES DOES THE MEDICAL PROFESSION NEED TO RID ITSELF OF THE STEREOTYPES THAT SEEM TO PERSIST? LINDA: I THINK THERE IS GREAT FIRST IS ADMITTING THAT RACISM IS A PUBLIC HEALTH CRISIS. IT HAS BECOME MORE WIDELY ACCEPTED, NOT JUST BY ME BUT BY OTHERS. I THINK THAT LEANING INTO THE FACT THAT THERE IS A PROBLEM, INSTEAD OF RUNNING FROM IT AND FEELING LIKE OH, YOU ARE ACCUSING ME OF BEING A RACIST, BUT TO SAY WAIT, WHAT IF THERE ARE UNCONSCIOUS BIASES THAT ARE AFFECTING HEALTH CARE TREATMENT? CERTAINLY, I AM PROUD THAT IN THE NEW YORK CITY DEPARTMENT OF HEALTH, I LIVE IN NEW YORK CITY, WHERE A FEW YEARS AGO, ALL 7000 MEMBERS OF OUR DEPARTMENT OF HEALTH HAD TO GO — UNDERGO SOME KIND OF ANTIRACISM TRAINING. THAT HAD TO — THAT IS HAPPENING MUCH MORE WIDELY. PROVIDERS HAVE TO UNDERGO SOME KIND OF ANTIVIRUS TRAINING. I THINK THAT IS AN IMPORTANT MOVEMENT IN THE COUNTRY. KAREN: WHAT ARE OTHER STEREOTYPES THAT PERSIST ABOUT AFRICAN-AMERICANS IN THE MEDICAL PROFESSION? LINDA: I THINK ANOTHER ONE IS THAT WE ARE NOT HEALTH CARE COMPLIANT, WHICH MEANS WE WON’T FOLLOW DIRECTIONS. ALSO, FOR BLACK WOMEN, OUR BIRTHING PEOPLE, SOME OF THE OLD STEREOTYPES ABOUT BEING DANGEROUS OR ANGRY ARE A PROBLEM. AND THAT IS WHAT YOU SAW WITH SERENA WILLIAMS, WHEN SHE GAVE BIRTH IN 2017. SHE HAD HER BABY, BUT AFTERWARDS, SHE HAD AN EMBOLISM, WHICH SHE KNEW WAS HAPPENING WHEN SHE WAS SHORT OF BREATH. SHE ASKED FOR TREATMENT AND NEW WHAT THE SIDE EFFECTS — KNEW WHAT THE SIDE EFFECTS OF HER PROBLEM WERE. SHE WAS IGNORED. THAT SENT HER INTO A COUGHING FIT WHICH CAUSED HER C-SECTION STITCHES TO BREAK OPEN AND SHE WAS ON BED REST FOR SIX WEEKS. KAREN: EVEN SOMEONE WITH SO MUCH ACCESS AND MONEY LIKE MISS WILLIAMS HAD ISSUES. I WANT TO BRING UP ANOTHER ISSUE, TOMORROW HAMLIN SUFFERED CARDIAC ARREST ON THE FOOTBALL FIELD. WE KNOW ABOUT THAT. HE RECEIVED CPR FROM A TEAM OF NFL PROFESSIONALS ON THE SIDELINES, WITH STATE-OF-THE-ART EQUIPMENT THAT WAS THERE. A RECENT STUDY FOUND IF A BLACK OR HISPANIC PERSON COLLAPSED ON THE STREET, BYSTANDERS WOULD BE LESS LIKELY TO PERFORM CPR THAN IF THE CARDIAC PATIENT WAS WHITE. WHAT DOES THAT — WHAT DO YOU THINK THAT SAYS ABOUT THE — RACE AND SOCIETY? LINDA: WHAT WE THINK ABOUT IS WHAT HAPPENS IN THE HEALTH CARE SYSTEM AND WE FORGET ABOUT WHAT HAPPENS IN SOCIETY. IN MY BOOK, I JUST — DISCUSS THE CONCEPT THAT BECAUSE OF BEING BLACK IN AMERICA, WE HAVE A PREMATURE AGING THAT COMES FROM THE DAY IN, DAY OUT TOXIC STRESS OF FIGHTING AGAINST THAT DISCRIMINATION THAT WE EXPERIENCE. THAT HAS NOTHING TO DO WITH THE HEALTH CARE SYSTEM. THAT HAPPENS TO US BEFORE WE GET IN. IT CERTAINLY SHOWS UP, IT SHOWS UP WITH COVID. WHERE OUR COVID RATES WERE — OUR OUTCOMES OF COVID WERE MUCH WORSE AT YOUNGER AGES. I THINK THAT SAYS SOMETHING ABOUT OUR TREATMENT IN AMERICA, IT CAUSES NOT ONLY EMOTIONAL HEALTH PROBLEMS WHICH SEEM OBVIOUS, BUT ALSO PHYSICAL HEALTH PROBLEMS. KAREN: WE ARE ALMOST OUT OF TIME. WHAT DO YOU SAY TO AFRICAN-AMERICANS, PEOPLE OF COLOR LISTENING, SO THAT THEY CAN GET BETTER CARE FROM OUR HEALTH SYSTEM? LINDA: I THINK WHAT I BELIEVE IN WHEN I TALKED TO MY LOVED ONES AND FAMILY MEMOS IS IF YOU’RE ENTERING THE HEALTH CARE SYSTEM, GO IN EDUCATED. EDUCATE YOURSELF ABOUT WHY YOU ARE GOING IN AND WHAT TO EXPECT. BE BRAVE, BOLD AND STAND UP FOR YOURSELF AND BRING SOMEONE WITH YOU. BRING SOMEONE WITH YOU WHO CAN HELP YOU UNDERSTAND WHAT IS GOING ON. BEING IN THE HEALTH CARE SYSTEM, NO MATTER WHO YOU ARE, IS FEARFUL. YOU ARE SCARED, YOU ARE NOT DRESSED. YOU ARE AFRAID OF WHAT YOU MIGHT HEAR. GO IN PROACTIVE. KAREN: AND DON’T LISTEN TO “NO.” LINDA VILLAROSA, THANK YOU FOR JOINING US. YOUR BOOK, UNDER THE SKIN, THE HIDDEN T

The Hidden Toll of Racism on Health

Linda Villarosa, author of The NY Times best seller Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation.

Linda Villarosa, author of The NY Times best seller Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation, discusses systemic disparities in health care delivery to communities of color and the stereotypes that still exist in the medical field about the medical needs of people of color.

Linda Villarosa, author of The NY Times best seller Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation, discusses systemic disparities in health care delivery to communities of color and the stereotypes that still exist in the medical field about the medical needs of people of color.



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