- People come from all over the world to access cutting-edge care in American hospitals.

But today's guest describes a different experience for black Americans who she says lives sicker and die quicker than their white compatriots.

She's Linda Villarosa this week on "Story in the Public Square".

(bright music) Hello, and welcome to "Story in the Public Square", where a storytelling meets public affairs.

I'm Jim Ludes from the Pell Center at Salve Regina University.

And I'm G. Wayne Miller with The Providence Journal.

This week, we're joined by Linda Villarosa, a literary soul.

She's a journalist, novelist, educator, editor and author.

Her new book is "Under The Skin", the hidden toll of racism on American lives and on the health of our nation.

She joins us today from Brooklyn, New York.

Welcome Linda.

- Thank you.

Good to be with both of you.

- You know, you've written a devastating account of the impact of racism on the health of America and Americans and black Americans in particular.

What drew you to this subject in the first place?

- Well, I've always been interested in health and medicine.

And I was the health editor of Essence magazine, which is really my sweet spot because I was interested in race and health.

And there's never been a time in America where black health has been equal to white health outcomes or even health outcomes of other people of color.

And I was very interested in why.

And the more I looked at it, I was looking at it from a personal sort of lens, thinking, well, if each individual does better, the whole health outcomes of all black people will be better, but it didn't work.

And I realized also that the black health outcomes being so poor and so disproportionate, were hurting the entire nation.

So it wasn't just sort of like a black thing.

It was an American thing.

- Well, one of the things that stunned me was that when you corrected for the socioeconomic considerations, outcomes didn't really improve.

It was really about racism.

Is that accurate?

- I would say that poverty and lack of money makes everything worse.

And certainly people who are at the intersection of some other marginalization plus poverty, they do worse.

But even in sometimes, especially with maternal health and infant health, when you correct for education and poverty, it doesn't erase the problem.

And that's what was surprising.

It's hard for people to believe because the longstanding idea is that poor people are less healthy, which is often true, but so are black people, even in the absence of poverty.

- So when you began reporting on healthcare issues many years ago, you had a different perspective obviously than what you have now.

And that perspective now is your book, which we're gonna get into in a minute.

Talk about where you were at the beginning of your journey as it were, and what changed and how you came to where you are today in terms of "Under The Skin" and its conclusions on racism.

- Well, I think I was one of those people who just believed that this poor health was all about poverty.

And so when I was at "Essence", our idea was sort of each one, teach one or lift as you climb.

So if everyone just does better, gets educated, just takes care of themselves, does everything right, then the whole health status of the race would change, but that didn't work.

It wasn't true entirely.

And also I think going to public health school for me, I went to public health school as a journalism fellow in the 90s.

And I think that really opened my eyes to a different way of thinking that it wasn't just this sort of individual responsibility/blame, but it was about looking at structural and institutional barriers to good health.

- So the individual responsibility and blame story, which obviously you do not embrace anymore.

That is, (coughs), excuse me, still held by a lot of people in America.

Is it not?

I mean, that is still sort of the common myth that the zip code and education level, all of those things alone are responsible for the inequities in health outcomes for people of color and African-Americans.

Is that true?

I mean, I've gone on it lengthy, but talk about where some people still are in terms of their understanding or in their beliefs.

- And the first chapter of my book is called Everything I Thought Was Wrong.

So I don't want it to make it seem like, oh my gosh, I've known everything all along.

I have had to shift my thinking.

The big shift wasn't even that long ago, it came in 2017 when I was researching maternal mortality for a cover story in the "New York Times" magazine.

And what I found out was, and it was shocking, I didn't believe it at first, America is the only country where the number of birthing people who die or almost die related to pregnancy and childbirth is rising.

Black women, or birthing people, are three to four times more likely to die or almost die.

But the twist on it was that a black person with a master's degree or more is more likely to die related to pregnancy and childbirth than a white person woman with an eighth grade education.

So that meant that education wasn't protective.

And so if that was the old lens, it's just educate people more, people highly educated are still having problems related to birth and childbirth.

Then something's wrong with the way we're looking at this.

And if something's wrong with the problem, how we're looking at it, then the solution can never be right.

- You know, those are staggering statistics.

One of the things that, and they're very contemporary.

One of the things that struck me from your scholarship and some other places too, though, is that this is not, the disparity and outcomes is not a new story.

And in fact, you document some really barbaric practices that were principally white physicians and white scientists experimented on African-American populations throughout America's history.

Can you tell us a little bit about that history and how it manifests itself today?

- Well, I'll start with, I got this information doing research for "The 1619 Project, my essay was on medicine.

And I was very surprised at how bad it was during enslavement, just because I had never looked at that history.

And the ways of sort of experimentation were framed around the idea that black people had very high pain tolerance.

so that we could tolerate pain that no white person could ever deal with.

And that was a way to justify all the cruelties that went along with enslavement.

I think I studied the through line and took the through line from, you know, 250 years of slavery to present day and was looking at studies that asked physicians-to-be, so medical students, interns and residents, about different myths, sort of that black skin was thicker than white skin.

Black people had more or fewer nerve endings, you know, different in nerve endings.

And also that black people could tolerate more pain than white people.

And something like, you know, 40% of medical students, residents and interns believed at least one of these myths, which is very dangerous, 'cause that means that they're going into their practices, thinking things that black people and white people are somehow genetically different.

And it's interesting because I think about the title of my book "Under The Skin".

And that's what it means.

That there is something that happens, whether it's belief, whether it's the way we're treated that goes beyond and it's more than skin deep.

- So Linda, do you have a sense of why those myths, for lack of a better term, persist today in 2022?

- Well, I think that they haven't been, you know, they're still in medical books sometimes, you know, like there in medical books and in medical training some of the myths still exist.

One of them is about kidney function.

There's an idea that black people have different kidney function than white people.

And there's a correction, a race correction, that still exists.

So it corrects, like I got my kidney function test, not long ago, six months ago.

And there was a white reading and a black reading and the black reading was circled for me because of I'm black.

And I thought, wait, how did they?

They don't know anything about me except my race.

And I get a different reading.

Also lung function.

Lung testing is different.

There's a race correction.

And I was asking a physician about this, it's on the machine, the spirometer, which measures, you know, lung function.

And I said, how does that happen physically in the doctor's office?

And she said, there's a switch.

You push a switch to the other side if you're measuring a black person's lung function versus a white person's lung function, that really bothered me because I'm originally from Colorado, the Mile High City.

I have excellent lung function because of growing up in that thin air and running track and being an athlete.

And I thought, wait a minute, I'm the Serena Williams of lung function, why would I get the race correction that assumes that my lungs are weaker?

- Wow.

- Currently.

- Wow.

You know, I wanna say this is unbelievable, but it is believable, unfortunately.

Historically, were there any people in medicine or even outside of medicine who are pushing back against this saying, wait a second, there's no research that supports this.

There's no science that supports this.

Why are we having these beliefs?

Why are we having machines with white and black settings?

Were there figures historically who were, you know, raising their hand and sounding loud saying this is all BS.

I can't use the full word obviously, but it's all nonsense.

Were there any people?

- I think it was difficult.

Certainly there were people.

I mean, I looked into W. E. B.

Du Bois.

So we think of him sort of as a, kind of a scholar, a scholarly person, but he was really a social scientist and did really interesting experiments and studies in the early 1900s, late 1800s.

And he was pushing back against some of these myths and by doing research sort of shoe leather research.

Currently what's really interesting is it's often medical students who are pushing back against these.

Saying, wait a minute, questioning, why would there be a different lung function or kidney function by race?

And you know, why is this in the medical book that I am, you know, learning from?

And I think that's exciting that some of the change currently is coming from the ground up, and that it's coming from medical students who want to be different kind of doctors, different kind of nurses, different kind of public policy advocates.

- Linda one of the really compelling parts of the book is the stories that you tell of people who are affected.

One of those stories is Simone Landrum.

Could you share her story with our audience today?

- I met Simone in 2017 while working on the story about black mothers and babies in America.

And she had had a, she had two children.

And then the year before I met her, she had had a stillbirth, and she almost died also, she was hemorrhaging.

She thought her water had broken, but it was blood.

And so she was rushed to the hospital and her baby passed away and she almost died.

And working backwards, she had complained to her doctor that she was having all kinds of symptoms, that point to preeclampsia, which caused the hemorrhage and he ignored her.

So next time she got pregnant again, this time she got a doula, she got a new doctor, she did everything right.

I met her, she told me the story of losing the baby before, I interviewed her and then I came back for her birth, with the doula, and I, and Simone.

I saw her get mistreated so badly.

Her baby was in distress and she was treated with unkindness and disrespect.

And it was especially striking because she had had so much trauma the year before.

So she should have been treated with extra special care.

And I wasn't expecting to see that happen.

I had been doing all this sort of scholarly research about unequal treatment and black people.

So to see her be treated badly by an all white team of medical professionals was surprising.

Even with me and the doula in the room.

- So, you know, Jim is absolutely right.

One of the great powers of your book is the stories of individuals.

Another one is Mark McMullen.

And I'm gonna ask you to give a summary of that story in a second here, but it involves a mental illness.

And this is a topic that we have explored repeatedly on the show, people living with mental illness and how they're treated differently in many contexts including, you know, medical treatment, including incarceration and so forth.

Anyway, long way of saying, tell us the story of Mark McMullen, because that captures this issue brilliantly.

- I think the big idea of that part of the book is that too often black people are not treated, sort of treated for mental illness and even substance abuse, but are policed.

And that's what happened with Mark.

Mark was suffering from bipolar disorder for many, many years.

And he and his family, his father was a college administrator.

His mother was a stay-at-home mom.

And they worked so hard to help him, but it was very hard for him throughout his life to get treatment for bipolar disorder.

And he started to medicate with narcotic, with drugs.

And his mother was always afraid that he would have some kind of terrible run in with the police.

And that's exactly what happened.

He was medicating his bipolar disorder with drugs.

He ended up in a high-speed car chase with the police in Massachusetts.

He crashed his car, it was disabled, the airbag went off and the police shot him.

It was so surprising, my daughter and I, my daughter helped me with the research because I said, I need you to read over this because it seemed like they murdered him in cold blood when he was incapacitated.

And it was really surprising.

And then the Times later did a story about traffic stops and black people in cars.

So even without the sort of lens of mental illness, black people die in sort of those kind of car chases.

But to see that happen, and I actually know his family.

So it was even more surprising to see that he was killed in cold blood, just because he was, you know, he was clearly mentally ill and he needed help and not policing and not certainly being murdered.

- I did not read the Times story about Mark, but I have read many news accounts of similar instances.

Talk about the role of the news media in perpetuating some of these myths, because I think there clearly is a role that certain media outlets do play in perpetuating these, you know, it's the if it bleeds, it leads, you throw it up there and then you move along without even getting into the underlying factors.

Talk about that.

- I think that I taught this class on race and media and I teach it at, most of my students are people of color.

And it was really interesting because I was telling them about this.

I was showing how the crack epidemic of the 80s was portrayed compared to the opioid epidemic now, which mainly, you know, the crack epidemic is mostly black people in the past.

And the opioid epidemic is mostly white people.

So the crack epidemic showed people looking terrible, looking dangerous, looking scary, that needed policing.

And all of it was about, we've got to crack down on this.

There's a war on drugs.

The opioid epidemic is we have to treat people.

We have to help them.

They need help.

They need sort of rehab and treatment.

And that alone in just showing the difference, I showed them clips from news clips of, you know, these really sweet people who were dealing with opioid epidemic, three young white women compared to black folks who looked dangerous and scary.

And it was like, we got to crack down on this when they too needed treatment and care.

- Linda, the Supreme Court overturned Roe v. Wade earlier this summer.

Do you have a sense of how that's gonna affect communities of color?

- Well, I think it's telling that the case happened in Mississippi.

Mississippi is the poorest state.

It's also the state with the highest percentage of black citizens.

It's the state with an extremely high maternal mortality.

It has extremely high infant mortality.

And then even when children are, you know, make it, then child poverty and child death are very high in that very poor state.

So that is where the last reproductive health, you know, clinic that did abortions, you know, that was at the center of this.

And I think what I think about it is, think about it through a Reproductive Justice lens.

So Reproductive Justice is a black-led movement which only asks for three things.

One, that a person has a right to have a baby.

Two, a person that has a right to not have a baby.

And three, if someone chooses to have a child, then that child should be raised in a safe and healthy environment.

This looks beyond this issue of Reproductive Justice as being about abortion only, because especially for black people, it's way beyond that.

And where Mississippi goes, that is where black America goes, and that is where ultimately America goes.

- So you used the term reproductive justice.

Many years ago, I read a book which left a lasting imprint on my understanding of America.

And that was "The Sterilization of Carrie Buck".

I'm sure you're familiar with that.

And that was the case of a white woman who was deemed at that point, the term was retarded and she was sterilized against her will.

And she did not have any mental condition, but Mary Alice and Minnie Lee Relf are in your book.

And it's a similar story.

And it's a horrifying one.

Talk about that.

Again When I got to that passage, I thought back to Carrie buck and I just went, wow.

Some things have not changed.

And tell us about those two women.

- Well, I think, just go back a little to say eugenics in America, when it first started, it was mostly, and it was poor, mostly white men in the south.

Then as the operations became more sophisticated, it switched to women.

And it was women who were institutionalized like Carrie Buck.

Then the next round was black women and other women of color in the south when sort of, they became too expensive.

So when the great migration happened and many black people were coming into cities, like Montgomery, Alabama, where the Relfs were in the 70s, that was when the government itself started using sterilization as a form of economic and population control.

And that's what happened to the Relf sisters who were 12 and 14 in 1973.

Their parents were living in public housing.

They were going to public schools and they were targeted by the public health service for sterilization.

They were taken away without, their parents couldn't read and write.

They were taken away without their parents' consent, or, you know, the parents didn't even know.

They were taken to a hospital and sterilized against their will.

The good part of that story is that the social worker that was helping them was so horrified that she found the Southern Poverty Law Center, which Julian Bond was the head of the board.

And there was a case and they sued to get justice for the Relf family.

And they won the case.

But unfortunately for the Relf sisters, you know, the Relf family six children, two daughters who were sterilized, they never got any money for it.

And they never got an official apology.

I was really happy that my story got excerpted by the New York Times magazine.

And there was some really generous people that gave the Relf sisters some money.

And just, they still live in public housing.

They're in their 60s, they live together.

They were sort of in obscurity.

They're my friends now.

I know that they're doing a little bit better, but I still am angry that they've never gotten an official apology from our government at any level.

- So you got to know them well, they became your friends as you just said, tell us about them.

How do they feel about all this now?

All these many years later, knowing what was taken from them, something so big and never replaceable.

- I think when I came in their lives, they also didn't know that they changed history because their case also uncovered that hundreds of thousands of Southern women, mostly black women had been sterilized around, you know, in the same time period as them.

And so I was trying to explain to them, you you've changed history.

You're really important.

You're in the history books.

And they couldn't quite get it.

I think they also are really sad.

They talk about, they wanted to have children.

You know especially the one that, you know, one of them is developmentally disabled, quite severely.

The other one really talked to me about she always wanted to have children.

She has nieces and nephews who she really loves.

And I see them tear up.

I see them get sad, you know, when talking about it.

But they're also so kind and so nice and so humble that I'm really glad that I got to know them.

- Linda did this history affect the black America's response to the public health initiatives around COVID?

- Well, I think what happened around COVID is when the numbers start, when COVID started happening in February, March, 2020, there weren't racial statistics.

So everyone sort of under the radar, who had studied other viruses like HIV AIDS, and who were in public health started saying this is gonna affect black people much more.

It's gonna affect people of color much more.

But should we say anything?

There's no statistics nationally yet, should we say anything?

Because we'll be blamed for this.

And it was interesting.

The statistics came out.

It was very clear that it was affecting black people, especially.

So we had higher hospitalization rates and higher death rates.

And then interestingly, not long after, we started being blamed.

So there were people who were mad about the lockdown, who were protesting and saying, wait, this is a black problem, or this is a problem of people of color, why do we have to not go to work?

Why do we have to be shut into our homes?

And it was interesting too, that also people avoided, it seemed like black people were avoiding testing.

Then when you looked a little bit closer into it, often testing wasn't available in communities of color.

So it wasn't all avoidance.

Same with the vaccine.

When the vaccine came out, there was this worry that black folks would be hesitant, I guess, or avoidant of the vaccine.

And certainly that happened.

But at the beginning, it also wasn't as readily available in communities of color.

So I think it's not all about vaccine hesitancy or medical avoidance, but on the other hand, I try to think about it historically.

It's not shocking that we would be afraid of the medical system, not necessarily because of the Tuskegee Experiment only, not because of eugenics and what happened with the Relfs, but what happened to someone in the health system yesterday?

What happened to you in the health system yesterday?

Because that kind of unequal treatment still happens.

- Linda, we've got literally about 15 seconds here.

Is there hope that we can finally slay some of this?

- I believe that we are undergoing a change and I'm really cheered up by those medical students who are trying to make a difference by health commissions, state health commissions, that are trying to make a difference and change the way they operate.

So I think this is a good time right now, and it's, you know, coming off the heels of a pandemic, but it's also a time where we have a choice to make a change and to do things differently and to go into a better future.

- Well, your book is an important step in that direction.

It is "Under the Skin", Linda Villarosa thank you so much for being with us.

That is all the time we have this week, but if you wanna know more about "Story in the Public Square" you can find us on Facebook and Twitter or visit pellcenter.org where you can always catch up on previous episodes.

For G. Wayne Miller, I'm Jim Ludes asking you you to join us again next time for more "Story in the Public Square".

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