Villarosa’s Under the Skin (Doubleday, June) examines the causes and consequences of the racial health gap in America.
One of the major themes of the book comes from Arline Geronimus, who uses the term weathering to explain how the stress of racism can affect people’s health. What about that concept resonated with you?
There is a false notion that racial health disparities in America result only from poverty—that they are based on class only and not race itself. Certainly, poverty makes everything worse, creating disruption, poor living conditions, and fear. We blame people for their own health problems, believing that they wouldn’t be sick if they were more educated and took better care of themselves. But that doesn’t explain why many racial health disparities persist across class lines—and in some cases the Black-white gap is wider among the most educated people. Dr. Geronimus helped me understand that wealth and education do not entirely protect Black people in America from the toxic effects of discrimination in housing, education, and law enforcement that create a kind of toxic stress that prematurely ages bodies, as well as the toll of microaggressions that grind people down and are, in some ways, killing us softly.
Your own outlook shifted from the 1980s and ’90s to today—from promoting individual self-care and better information as the solution to realizing that structural change is needed. Does this apply more broadly than the lens of health and self-care?
I get very angry when Black people are blamed for our own disadvantages with less interrogation into the long-standing discrimination that has gotten baked into the structures and institutions of America. I look at the issue of wealth disparities in America that are interwoven with the racial health gap. We blame poor people of all races for not working hard enough without enough investigation into the ways people, particularly Black people, have been systematically disadvantaged and unable to accumulate wealth as a result of institutional and structural barriers over the last 400 years—and counting.
Where do you hope this book will have the most impact?
I hope it helps shatter myths and create changes in the healthcare system, shifting the blame and responsibility from individual people who should be treated with dignity and care, and not punished and criticized. It is not fair that, from birth to death, Black Americans live shorter lives in poorer health, and it’s despicable that we are blamed for our own health issues. The big idea I want to communicate is that, yes, something about being Black has led to our poor health. But that something isn’t race per se, but racism. We know that income, education, and determination can help individual Black Americans, but also can never erase the corrosive negative effects of centuries of discriminations on our bodies.
