Under the Skin: a book about racism and the American healthcare system

By Teresa Williams Zhang

Over the years, I've gotten to know so many members of the American TCM community who found their calling in Chinese Medicine after they or their loved ones were failed by the conventional American healthcare system.

With this sadly common experience in mind, I’d like to highlight a book that documents how failures of the American healthcare system fall even more frequently on people of color. I hope that greater awareness will help all of us - practitioner and patient - recognize and fight patterns that may unnecessarily cause harm to ourselves or to others.

The topic of racial health disparities is discussed beautifully by Linda Villarosa in a book called Under the Skin: The Hidden Toll of Racism on American Lives and the Health of our NationVillarosa is a long-time health writer and editor for The New York Times, Essence Magazine, and many other periodicals. She’s an award winning author of books on health and race whose writing on black maternal mortality helped to usher in new legislation allowing doulas into hospitals in New York State.

In Under the Skin, Villarosa introduces the historical context of many misconceptions, including that Black Americans don’t feel pain as acutely as others or are genetically predisposed to higher sodium consumption. She connects history to the modern day, to many shocking statistics, especially in regards to environmental health and maternal health/infant mortality for Black Americans.

Today, a Black woman with a college education is 3-4 times as likely to die in childbirth compared to her white peers. Black women in impoverished Caribbean nations have a much lower infant mortality rate than black women in the US. 

Villarosa discusses how, for so many years, she attributed the poor health outcomes of the Black community on poverty, lack of education, and genetics. While health outcomes in the US are highly correlated with wealth and education, the story is much more complicated for Black Americans. She explains how other factors dramatically depress health outcomes for even the wealthiest and most educated Black Americans.

Among these factors is one she calls “weathering,” which is the “struggle with anger and grief triggered by everyday racist insults and microaggressions [that] can, over time, deteriorate the systems of the body.” Villarosa illustrates with hard statistics and with vivid story telling how pervasive and damaging weathering is in the US.

Under the Skin sheds light on the systemic racism in the American healthcare system, and challenges us to respond with awareness and empathy. Read an excerpt of the book HERE or hear Villarosa speak about it here: