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Melissa Harris-Perry: In this country, Black people are less likely to survive infancy, more likely to die young, and far more likely to live with illness than any other racial group. Indeed, the differences between Black and white health in America, it's more of a gulf than a gap. The COVID-19 pandemic of the past two years has once again, laid bare for the nation the deadly consequences of race and racism in American health and brought renewed attention to addressing this fundamental inequality.

On the front line of reporting and analyzing these issues is Linda Villarosa, contributing writer to the New York Times Magazine, associate professor at CUNY's Craig Newmark School of Journalism, and author of the new book--

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

Melissa Harris-Perry: Professor Villarosa began by talking about where we see disparities in American health.

Linda Villarosa: The American narrative has long been you are in complete control of your health. If you make the right choices, if you're educated and also, if you have health insurance coverage that you can live more years, it's less likely that your baby dies, it's less likely that you have a lot of the illnesses where you see this discrepancy.

However, if you look at Chicago, where my family's from and where people live to only age 60, it was redlined. People couldn't get mortgages. It was devalued. The land was devalued. It was also subject to contract buying. When my grandfather bought a house there in the ‘40s, he could not get a mortgage. He had to buy it on contract, which meant if he missed a payment, he could lose that at any time.

If Black people could not own property in many cities across the country, that just meant that the area itself is devalued. Then that meant that industry is more likely to move in and pollute the area. There's less healthy food. Even though if you wanted to make the choice, it might be difficult, it might be unaffordable, there's less safety, there's worse schools. All of these factors make a difference in your health outcome.

Melissa Harris-Perry: Your father got sick. How did that affect your understanding of the healthcare system?

Linda Villarosa: My father was highly educated. He cared about how he looked. He was a very calm, courtly person. He was a bacteriologist in the ‘90s. I was working at the New York Times Newspaper. My mother said, “You need to come to Denver.” I was in New York. “Your father needs you. Get on a plane, get dressed up, put your New York Times business card in your pocket.”

I'm pregnant, so I get off the plane, there's my mother really dressed up and she's a former hospital administrator. I'm like, “Mom, what is happening here?” She said, “Your dad is really ill. He's in the hospital and he needs us to go there.” We go to the hospital, there's my dad. Remember he's a scientist by training, always dressed to the nines. He was wearing a soiled hospital gown. He was restrained to the bed. I leaned down to hug him and he said, “Get me out of here.”

My mother realized, “Oh, we need to make the hospital folks see him beyond the ravages of his disease.” He had colon cancer. He was in a veteran's hospital so we brought his medals, we brought pictures of him pre-illness. What my mother said was really meaningful. She told them, “If you explain things kindly as though he's going to understand, which he will, he won't be agitated.” I just realized that we played the respectability card, but why did we have to? Why was he not getting the same treatment everyone in America deserves?

Melissa Harris-Perry: What are some of the other ways that we've seen federal government or state governments actually implicated in these health disparities?

Linda Villarosa: I think in a general picture thing, is well, one is in pollution. If communities of color, especially Black communities, are redlined, which is something that should never happen, if they're subject to contract buying, that means the industry is-- because the land is devalued, industry comes in and pollutes the area. That means the people still living there-- When I've reported on this, I remembered each time there’s always somebody saying, “Well, why didn't the people just move? Why didn't they move once the polluting industry came?” It's like, “Well, why should they move from their home?”

Many people of color, and especially Black people came up from slavery into cities where they-- or just moved into cities so why should they leave their home because industry comes in? Why is that polluting of a community that makes it less helpful sanctioned by our government? That's one clear way when the air is polluted, the water's polluted and it makes people sick.

Other ways are just not everyone is covered by health insurance and so not everyone has the means to do that. Even though health insurance and health coverage, medical coverage should be a right. That is one of the big things. In my family, we have three generations. My mother, who is like 91 and she's old school, and then my generation is progressive, thoughtful about these things and then my children are abolitionists and they're like, “Just overthrow the whole thing.”

I love to have these intergenerational conversations where we just sit around, and we talk, and we grapple with, through our generations of how do we solve these problems that-- and many times they are initiated by our government.

Melissa Harris-Perry: Can we talk a little bit about mental health and emotional health, and how we see racial disparities playing out there, and maybe the ways that we have misidentified the causes of those disparities?

Linda Villarosa: What happens is there's a through line from the past that Black people are invulnerable to pain, and that includes emotional pain. Of course, anybody pushing that idea back in the 1800s had a stake in it to say, “Oh, this is why it's okay to enslave and hurt people and make them work from sunup to sundown because they don't experience pain.” It's also okay to take their children away and to kill their family members in front of them because we don't experience the same emotional pain.

If that idea is still embedded in American society and institutions, it makes sense. Then when there's a mentally ill person or a person in emotional pain, then that person is seen as dangerous rather than ill. A white person is looked at with more compassion than a Black person who needs incarceration, needs restraining, needs something else. I think about that with my father, because my father was having such a hard time with being ill when things weren't explained to him that he was acting out. Instead of talking to him in a compassionate way, they were restraining him. I think about that a lot.

The other thing is there's such a lack, a dearth of Black mental healthcare providers so that it's hard to find somebody who understands your experience, which is very important to be understood in the context of getting professional help for mental health issues.

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Melissa Harris-Perry: Beginning in 1932, the US Public Health Service and the Centers for Disease Control conducted a study about syphilis. Their subjects were hundreds of Black men living in a rural Alabama near Tuskegee. Most of the men were impoverished sharecroppers. Few were literate.

When the study began, there were no known cures for the deadly contagious disease, but by 1947, the federal government knew that penicillin was highly effective, readily available, inexpensive, and being used widely to cure syphilis. Still, the study directors withheld treatment from the men in the study so that they could observe the progression of the disease including a descent into madness, blindness and debilitating illness.

The study continued until 1972, four decades. The Tuskegee Study is often cited as tangible, contemporary evidence of how America's public health systems have contributed to the deep and enduring racial health inequalities we continue to experience this today. I've been speaking with Linda Villarosa about her new book, Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of our Nation. We’ve been talking about how racism and bias within the healthcare system contributes to the disparities in life expectancy, chronic illness, and maternal and infant mortality rates.

How does that fit with the language we often have of, “Oh, there's just so much stigma in Black communities? That's really the cause of why you don't see Black folks seeking help for example,”

Linda Villarosa: I think that is real, but I tend not to look at that individual personal responsibility, blame the community lens. There is also not a lot of stigma. There are places where mental health and certainly right now, there's a lot of discussion about Black pain right now, about Black joy about that kind of thing. That speaks to our emotional health but that thinking keeps us out of the healthcare system in general and out of the mental healthcare system.

However, we're doing that for nothing. Something has happened to us. There's proof that we have a different experience in the healthcare system, including with mental and emotional health than other people. If the experience is bad, not because of something like the Tuskegee experiment or what happened during slavery, but what happened to you yesterday, you weren't treated well, whether- -you were going into the hospital to have a baby, whether you were seeking treatment for emotional health, then it makes sense that you would want to stay away from that very system that has harmed people like you or people that you love.

Melissa Harris-Perry: You mentioned Black pain and Black joy. Can you zero in on pain for a moment? What's going on with the perceptions of pain for Black folks?

Linda Villarosa: The perception that we were invulnerable to pain during slavery, so we could endure any kind of pain. That should have gone away when enslavement ended, but the through line to today is that-- I looked at this study that many people have cited. It was a 2016 study out of the University of Virginia. It looked at medical students’ and residents, and interns’ perception of pain. It was white medical students. They listed a lot of myths about pain, including the idea that Black people had thicker skin, had different nerve endings, but the key one was that had higher pain tolerance.

Something like about 40% believed at least one myth. That's scary because these are not doctors currently. These are the ones of the future. I tried to understand how did they perceive pain? One of the ways that these studies describe pain is if a Black person got their hand slammed in a car door and a white person got their hand slammed in a car door, which really hurts, who would feel the most pain? It was like, “Well, the Black people wouldn't feel as much pain.” These were from medical students thinking this, and the white people would feel more pain.

There was an update, a different kind of study a couple of years ago out of the University of North Carolina. It looked at pain during a cesarean section. Clearly, a C-section is major surgery. Again, the medical students thought that white women would endure more pain and needed more pain management than the Black women, even when the Black women's complaints about pain were worse.

Clearly, there are myths still floating around our society that are left over from the days of enslavement and that affect everyone, including doctors, other medical personnel and providers, and the ones of the future. That bodes poorly on our medical system and also our society.

Melissa Harris-Perry: Is the problem here the absolute problem of health or the overall position of health is okay, but there's still this gap? Is that the real injustice? Just maybe help me walk through that a little bit.

Linda Villarosa: I think that what you're speaking to is the problem of inequality and talking specifically about HIV/AIDS. Clearly, HIV/AIDS was killing people up until 1996, so large amounts of people were dying. Then in 1996, there became this kind of way to avoid dying from it. There became a cure to keep from dying. Then that is the first time when the racial disparity changed. There were more Black people who were continuing to die because there was an inequality of getting access to the medication.

For me, I’m equal opportunity healer. Let's just get this stuff figured out. Also, you have to focus more on the marginalized communities where it's harder to get access to certain kinds of drugs or even testing and so you can't just do a blanket solution. You have to look at where the gaps are. That's not asking for much. I remember I was talking to this friend of mine, Steve, about HIV/AIDS. I was talking about how Black people have to do this for ourselves. HIV/AIDS is really affecting us disproportionately. This is a problem of the Black community. We have to do it.

He said, “No, it isn’t, it's an American problem. This is an American problem because if you look at these racial health disparities, they're dragging down the health status of our country as a whole.” That's why we have higher infant mortality and lower life expectancies than many other, most other wealthy nations. We have great healthcare. We have really brilliant technology, but if it's unequal and people don't have equal access to it, partially because of class, but also because of race, then something's wrong with the country as a whole and we have to attack that problem wisely.

Melissa Harris-Perry: Linda Villarosa, author of Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of our Nation. Thanks so much for joining us.

Linda Villarosa: Thank you. Nice talking to you.

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