Author shows how centuries of discrimination leave deadly legacy

REVIEW: UNDER THE SKIN: THE HIDDEN TOLL OF RACISM ON AMERICAN LIVES AND ON THE HEALTH OF OUR NATION by Linda Villarosa.

The urgent tone of Linda Villarosa’s Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation is a necessary call to arms. Villarosa’s clear-eyed and authoritative reporting proves a stark reality: Racial disparity is not just hurting Black Americans, but killing them. 

Villarosa is particularly well-suited to address these issues. A journalism professor at the City University of New York and an award-winning writer for New York Times Magazine, her 2018 article on maternal and infant mortality rates among Black women and babies was revelatory. Meticulously researched, the piece presented the unrelenting link between the ingrained racism of our medical systems and their continuous threat to Black women.

Under the Skin continues this tradition with a broader lens, with Villarosa’s deft hand guiding us through a powerful union of history, scientific studies, and real-life examples. In simple but effective prose, she details not just how the racism built into America’s long-standing social structures permeates the world of healthcare, but on the ground realities of those experiencing it. When under her examination, salt shakers and other everyday trivialities take on new and profound meanings. 

Her talent for research and uncanny sense of narrative make statistics speak, allowing facts that might fall flat in lesser hands to have the resonance they deserve. It is impossible to turn away from descriptions of the Relf family, whose daughters were sterilized at a federally funded clinic without consent. At the time, they were only 12 and 14 years old. Unflinching in her confrontation of America’s past, Villarosa’s work contains an unspoken subtext that whispers an insistent truth with each page: we must look injustice in the eye before we can change it.

Villarosa knows how to read the room that is contemporary America. Under the Skin is acutely aware of those who diminish the need to correct racism’s hurtful effect on healthcare equity. Years of scientific studies have already proven her thesis, yet ignorance ensures that these facts remain outside the grasp of public consciousness. Villarosa knows the heartbreaking truth that it is not enough to state that Black women are at a higher risk of mortality when giving birth. To combat this, Villarosa delivers information that often serves as a rebuttal to common misconceptions about how race alters healthcare. To those who might say it is a matter of education or poverty, she reminds the reader that a Black woman with a college education is as likely to die or nearly die in childbirth as a white woman with an eighth-grade education.

Under the Skin is a lesson in suffering and our nation’s refusal to acknowledge the mechanisms that continue its momentum. The facts speak this truth: Black Americans receive lesser healthcare as a result of ingrained racism and systemic bias, altering and shortening their lives. While Villarosa uses the story of individuals to portray that truth, she does not let the reader forget that this is not a case of localized discrimination but a series of systems that must be dismantled. Her gift to us is her tone of knowledge and optimism, and such irrefutable facts of injustice come with a challenge. It is time to get to work.

Anchor Paperback /Penguin Random House, $18, published May 9, 2023 | 288 Pages