Linda Villarosa and Racial Disparities in Healthcare

Under the Skin: Since working as a health editor for Essence Magazine in the 1980's, Linda Villarosa has dedicated herself to unveiling racial disparities in the health-care system. 

Linda Villarosa (Jour’81) wants you to know the story of Simone Landrum — a Black mother living in New Orleans. Now nearly 30, Landrum struggled through a devastating experience with a stillborn baby in 2016 that had her feeling like her doctor “threw [her] away.”

When Landrum went into early labor a year later, Villarosa — on assignment for The New York Times Magazine to write about maternal and infant mortality among Black women — accompanied her.

Villarosa was aghast at what she witnessed: an all-white medical team led by an attending physician Landrum didn’t know, since her doctor wasn’t available. When he left the room to put on a clean gown, he handed the reins to medical residents Landrum had never met before.

They all took turns peering between her legs and delivering her baby without addressing Landrum or looking her in the eye.

“It seemed like the height of disrespect,” Villarosa wrote in her April 2018 story. “The sometimes subtle, other times heavy-handed ways that discrimination played out, exactly the way I had been reporting about it, was just business as usual.”

She cited a national survey that noted that more than a quarter of Black women meet their birth attendants for the first time during childbirth, compared with 18% of white women.

Expanding on this article and many others she wrote for the Times on inequality in American society and within the health-care system, Villarosa compiled harrowing stories and historical context in her recently released book, Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation. Chapter by chapter, Villarosa dismantled the idea of the Black health crisis as an individual problem and revealed the origins of racism in today’s medical field.

Villarosa, who lives in Brooklyn, said in an interview, “A Black woman with a master’s, PhD, JD or MD is more likely to die in pregnancy or during childbirth or a few months after giving birth than a white woman with an eighth-grade education. It just doesn’t make sense.”

She explained that the takeaway isn’t that a woman with a higher degree is entitled to good or better health outcomes.

“In fact, education is a proxy for having the resources to create the circumstances that lead to better health and pregnancy outcomes — such as having access to health care and treatment and understanding what to do to have a healthy pregnancy,” she noted.

She asked rhetorically, “So why would a Black woman with a higher degree and all it confers still have worse pregnancy outcomes than a white woman with only an eighth-grade education? For example, the racial gap in pregnancy outcomes is wider in more educated women than it is in less educated. Which begs the question, why is race the main factor?”

Her book is peppered with a look back at medical beliefs that were once assumed to be facts. During enslavement in the early 19th century, she wrote, a prevailing mythology was that Black people didn’t suffer as much pain as white people, and that their skin was actually tougher than white skin.

Today’s health professionals should be educated enough to dismiss such silly ideas, Villarosa said, but some myths still persist. She cited a University of Virginia study in 2016 that found that a substantial number of white medical students and residents reported believing Black people are less sensitive to pain.

In medical training and schools, it’s far too rare to discuss racial disparities within health care, she said.

“We all have to say, ‘Wait, something happened in this country to harm people, and if we deny it, the problem will never be solved.’”

In the book, she also detailed the scourge of environmental racism, where Black communities are more commonly located near pollution-spewing factories and dirty rivers, creating and exacerbating health problems.

She introduced readers to an experience many Black Americans have gone through, even if they didn’t know the term for it. “Weathering” refers to how discrimination and bias wears away at the bodies of those who must continuously combat them. According to Villarosa, withstanding weathering by harnessing the positive forces of community, family and friendship is critical for Black people to undo the negative effects of this endless struggle.

Villarosa, a professor and journalist-in-residence at the Craig Newmark Graduate School of Journalism at CUNY, has long been compelled to report on stories focusing on poor health outcomes as a result of racism within health care. It was an area she learned more about as the health editor for Essence magazine in the 1980s, but she has admitted her outlook then was one-noted.

“I thought at first that inequality was due to poor people getting sick and having a lack of resources,” she said. “Yes, that’s a factor, but I became more enlightened on how the issue is bigger than poverty.”

Not long after graduating from CU, she met Dr. Harold Freeman, director of surgery at Harlem Hospital, who upended her perspective that being poor was at the root of disparate health outcomes between white and Black Americans.

As she recounts in her book, in 1991 Freeman told her being poor mattered and added, “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. They intersect and overlap, but to really understand the health of this country, you have to be more sophisticated than assuming that only poor Blacks are affected by this crisis. Look deeper, think differently.”

From Admiring Authors to Becoming One Herself 

Thinking differently has been at the heart of Villarosa’s story, thanks to her mother. She grew up in Lakewood, Colorado, immersed in a predominantly white environment that left her hungry to learn about Black culture and literature.

The Hue-Man Experience Bookstore, which her mother Clara Villarosa founded in 1984, was pivotal in Villarosa’s self-directed education on race. The largest Black-owned bookstore in the U.S. at the time, Hue-Man invited luminaries such as Toni Morrison and James Baldwin to speak about their books and Black America.

“That bookstore gave important intellectual nourishment to me and the Black community in Colorado,” Villarosa said.

Clara closed the bookstore in 2000 and moved it to Harlem, managing the wide selection of nonfiction, prose and poetry by Black authors before retiring and selling in 2006.

In fact, a key draw for Villarosa to attend CU was learning more about Black literary figures. “CU was obviously well-known for the journalism school, but I also took a minor in African American studies because authors like Baldwin were an early influence on me, and learning about all these writers really stood out to me when I went to CU,” she said. 

She added how being in the nature-soaked environment of Boulder was a key draw for her, too. “In my work, I tackle so much heavy stuff that being outdoors around such a beautiful college was valuable to me,” she said.

After graduating from CU, she was the contributing nutrition and fitness writer for Essence magazine, the premier publication for Black American women. That journey led to her become Essence’s executive editor from 2003 to 2005.

Ten years after graduating from CU’s journalism school, she took a one-year fellowship at the Harvard T.H. Chan School of Public Health, prompting her interest in health-care reporting.

Villarosa was motivated to go even further in her writing, penning her first book, Body & Soul: The Black Women’s Guide to Physical Health and Emotional Well-Being. It hit shelves in 1994, and spurred Villarosa’s deep passion for reporting on how structural racism has taken a toll on Black bodies.

She first taught at City College but then attended CUNY Graduate School of Journalism, earning a master’s, and then became a director of its undergraduate journalism program in 2010. Villarosa loves so many nuances of journalism, she said, from pitching ideas and researching to teaching her students about everything she’s learned since her CU days.

Months after she told the world about Simone Landrum, Villarosa’s 2018 The New York Times Magazine cover story “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis” became a finalist for a National Magazine Award.

Critical appreciation seems to follow Villarosa. Late last year, Under the Skin was included among The New York Times’ 10 Best Books of 2022.

She recently looked back on what she found fulfilling and important about writing her latest book. 

“This isn’t a book that has a straight chronology to it, because there is so much to piece together,” she said. “What became the throughline is myself and my own learning curve and recognizing what has worked and what didn’t work in tackling racial disparities in our healthcare system. That’s what helped hold everything together.”