Can Racism Make you Sick?
Some thoughts on the history of medicine
How can we understand why some individuals become ill and what life circumstances impact their health? This is the central theme of Linda Villarosa’s Pulitzer-finalist book, Under the Skin. The New York Times Magazine writer and City University of New York professor aim to challenge superficial claims about medicine while demonstrating how stereotypes inflict physical harm. More importantly, she reflects on why and how African Americans, including herself, experience higher rates of morbidity and lower life expectancies than other groups in the United States. Villarosa argues:
The something that is making Black Americans sicker is not race per se, or the lack of money education, information, or access to health services that can be tied to being Black in America. It is also not genes or something inherently wrong or inferior about the Black body. The something is racism.
Despite her discomfort, she dives deeper into medical research, disentangles medical claims from the evidence presented, and examines how racial identity influences this dynamic in the United States. Villarosa shifted from viewing health discourse as an individual choice to considering more profoundly what happens to the body and mind when someone is treated as a second-class citizen in a settler colonial state. The inquiry is unglamorous and poised to reveal the darkest aspects of American history, yet Villarosa sheds light on a significant question: how can a nation hold itself to a higher standard in caring for Black lives?
While writing about the history of medical racism isn't entirely new, nor does it reveal anything that most historians of medicine don't already know, Villarosa occupies a space focused on storytelling with unwavering candor. In the mid-1980s, she was a contributing writer to Essence Magazine, a publication dedicated to African American lifestyles emphasizing beauty, fashion, and culture. For Black Americans like me, who never saw themselves represented in Vanity Fair or Vogue, Essence was a constant resource for cultivating charm, trimming one’s Afro, and navigating art spaces. As a science writer, Villarosa faced a unique challenge: to provide groundbreaking information about nutrition, fitness, and medicine to promote better health for her readers. Her initial mission was grounded on self-empowerment: “If we—Black Americans—know better, we do better.” As an upper-class African American woman, she believed that class alone—not race—held Black women back from leading healthier lives until she encountered medical racism during the birth of her premature child. This experience led to deep reflection.
Today I’m chagrined to think I believed that the impact of insidious discrimination tied to the lived experience of being Black in America could be washed away in a bubble bath or soothed with journaling, meditation, or self-care.
Since the nineties, various medical books have been written by Black scholars addressing health in North America and Europe. They have sparked conversations about premature death, such as in Dorothy Roberts’ Killing the Black Body, and the separate and unequal medical system, highlighted in Harriet Washington’s Medical Apartheid. Relying on archival, legal, and statistical data, these authors aimed to show how inadequate and harsh medicine has been toward African Americans. Since the onset of the COVID-19 pandemic, new books have expanded the dialogue, revealing how this cruelty continues, echoing similar yet contemporary themes found in older texts, including Annabel Sowemimo’s Divided and Steve Thrasher’s Viral Underclass. Under the Skin takes a slightly different approach, serving as part memoir, part history, and part journalism. For Villarosa, personal experience acts as a gateway to illustrate how inconsistent medical discourse is in its assumptions about Black health while also creating conditions that perpetuate premature death.
Health outcomes in America regarding race are not straightforward. The life expectancy of a university-educated and upper-middle-class African American person is worse than a working-class, high school-educated white person in the US. That is to say, upper-class Black people are more likely to have healthcare and can afford it. She notes, “Since the first African enslaved men, women, and children reached American shores, there has been a Black-white divide in who survives, how they live, and who dies, from the birth to the end of life.” She surmises that centuries and centuries of racism are engraved into the foundation of US society, which impresses itself onto people who are bred in the society. However, her case studies reveal how these crises are currently occurring and their direct link to eugenics and sterilization.
The book details the troubling and harmful policies that destabilize Black communities, including the non-consensual sterilization of two African American girls during the early 1970s, Minnie Lee and her sister Mary Alice Lee. In 1973, the US government sterilized them without their or their parents’ consent, at the ages of fourteen and twelve, respectively. Born and raised in Alabama in a cardboard shack, they faced financial insecurity and depended on government assistance for most of their lives. Every day, the Relf sisters are reminded of the inescapable truth that they were never able to have children and were never given a choice. This may seem like an extreme case in reproductive health, but it is not. Racism as a category may not map onto different countries in different ways, but doing the investigative work is precisely why Under the Skin reveals a broader set of solutions that must be addressed. As Sowemimo has written in Divided:
As a global community, we must establish a detailed understanding on how colonialism and race science operate within healthcare if we are to achieve more equitable health outcomes.
The mechanisms and reasons behind the sterilization programs are distinct; however, the unavoidable moral concern leaves the reader questioning how and why the state determined who was deemed worthy of reproduction.
For Villarosa, the U.S. sterilization campaign, primarily aimed at people of color, was not a state of exception but rather connected to a broader issue where medical bias permeated every pillar of American society and needed to be dismantled. One of the most significant assertions is that physicians today harbor bias, with some of their beliefs mirroring those of nineteenth-century enslavers and physicians. Citing the works of British physician Benjamin Moseley, a member of the Royal College of Physicians who believed that Black people could endure more pain than white people, or referencing Thomas Jefferson, who assumed that Black people were intellectually inferior, Villarosa also examines contemporary medicine. A recent study from The Proceedings of the National Academy of Sciences revealed that 40 percent of first-year medical students and 25 percent of residents believed that Black people have thicker skin than white people. This admission by medical community members may appear as a disassociation from the field, yet these outdated perspectives have become normalized.
For Villarosa, it goes beyond merely recognizing the bias; it involves understanding what this does to the body. As she emphasizes throughout various parts of the book, the concept of race is not an avatar for biology. However, the patterns of racial discrimination are not merely a slight inconvenience; they represent a tangible issue that can take a toll on the body, a concept she adopts from Arline Geronimus known as weathering. According to the sociologist, weathering—defined as “high-effort coping from fighting against racism—results in chronic stress that can trigger premature aging and poor health outcomes.” In this context, it’s not solely about the actions of the medical community but also how this work creates conditions for exhaustion and premature death.
Under the Skin was published during the pandemic but is not a COVID-19 book. It is a testimony and history. Many factors shape our physical and mental health: where we are born, our social class, educational factors, gender, genetic issues, and environmental factors. The US is a particularly harsh place to grow up and die, and life expectancy has fallen by three years since 2020. Yet, some of the issues the US has implemented, including public-private partnerships in health, closing hospitals, and busting unions, are being exercised today.
Some News
The first reviews of A History of the World in Six Plagues are in, and I’m honored to announce that my book has received some publicity. Scientific American listed it as one of the 10 most anticipated microhistories published in 2025. Bookbub listed it as one of the best nonfiction books of 2025. I will keep you posted about more book-related news. Pre-orders are so crucial for authors, so if you’re thinking about getting a copy, I’d be grateful if you’d place yours today!
Moreover, I’ll be hosting a book event with Dr Terri Francis in Miami on 5 March to celebrate the publication of The History of the World in Six Plagues. To reserve a spot, you can contact Books & Books.
Finally, I interviewed Shon Faye for Frieze Magazine about her latest book, Love in Exile. Faye is such a brilliant thinker. If you read the interview, you will learn why the celebrated British author on why her new non-fiction work, ‘Love in Exile’, is her most revealing book yet.
Some Recommendations
Eve L. Ewing recently published a book, Original Sins, which describes precisely how Black and Native American people struggle to attain social mobility even when they are highly educated. (As someone from the working class with a six-figure student loan debt, Ewing’s latest book beautifully evokes the contradictions of having cultural capital but lacking material capital.) Years ago, I debated with someone about the difference between wealth and income and why both should be considered when considering a person’s value under capitalism. Professor Ewing agrees with my sentiments and writes:
Employment discrimination impacts a person’s income—how much money they take home in their paycheck every month. But to truly understand economic inequality, we have to think about gaps in wealth—the assets a person has in the form of not only their income but their savings, home, and other things of material value, as well as the amount of debt they’ve accrued. And we have to think not only about how that one person is faring, but about how things are likely to pan out for their kids and grandkids.
I cite Ewing’s work because people often forget how class and power are reproduced through family wealth (which frequently be hidden), but not entirely so. Madeline Leung Coleman wrote a story about how some New Yorkers are subsidized by their parents. Leung Coleman writes:
Likewise, many of those getting parent money won’t look rich. If you believe that being middle class means owning a modest home, they will look middle class — until you find out how much that home costs. Since one of the most common ways for parents to give money is through real estate, Realtors have a front-row seat to who’s getting how much. “Homeownership is sort of the capitalist report card, right?” says Corcoran agent Andrew Schwartz. “If you have made it to a level where you can purchase a home, especially here, then that’s the hallmark of success in our society. But when push comes to shove, someone who isn’t generationally wealthy probably cannot buy a property in New York City.”
You might be interested in reading Tao Leigh Goffe’s book, Dark Laboratory, a nonfiction book discussing the ongoing climate crisis and how we can achieve climate and racial justice. Her revelatory book posits that the Caribbean is ground zero of climate change. She argues that we must reckon with this colonial and racial history to address the crisis. Her book is not only descriptive in its account of the climate crisis but also a directive for people who want to take some action.
Journalist and critic Sarah Jaffe documents how people mourn in her memoir, From The Ashes, with significant reporting on public memorialization. Jaffe also considers the art of rendering grief to be about capturing its awkwardness and how it fits into the momentum of our days. I believe that this book review would provide some insight into immeasurable ways that people cope with death even when they are not fully allowed to grieve.
Angela Long Chu’s essay “Goodbye, Pamela Paul” in New York Magazine: The author beautifully sketches the sclerotic fragility of liberal writers and their alleged aloofness of protestors.
Local bookstores in Los Angeles are still dealing with the blow from the fires and trying to stay afloat. Speaking of which this is a fund for Black families displaced by the fires in LA and a Trans Defense Fund in LA. If you can, please donate to these causes.
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