This is an important piece that highlights the ways structural and institutional racism impacts Black communities today.

Thanks to NetGalley and Doubleday for sharing this with me

I comprehensive primer on the way that race impacts the healthcare system. It is well thought-out, well-presented and well-argued. While I sometimes wanted a little more depth from some of the ideas, I generally think was successful and would recommend to others!

This is a timely and important addition to the other great pieces that have highlighted the ways structural and institutional racism impact people of color especially Black communities today (even bringing up the covid-19 pandemic's disparate impact on communities of color). Villarosa's book focuses on the healthcare system and includes chapters about access to healthcare, disparities in treatment among different groups. She also goes back further into how segregationist policies from decades ago continue to impact individuals and communities today. I appreciate her optimism that there has been progress made. If only this knowledge was more widespread, maybe we'd see greater change. Thanks to NetGalley and Doubleday for sharing this with me.

UNDER THE SKIN by Linda Villarosa documents "The Hidden Toll of Racism on American Lives and on the Health of Our Nation." Villarosa is a journalism professor at the City University of New York and she has done an excellent job illustrating, as her publicist says, how Black people "live sicker and die quicker" compared to their white counterparts. Villarosa begins by arguing that "poverty is not the sole factor in who gets sick and who doesn’t ... Even when income, education, and access to health care are matched, African Americans remain disadvantaged and racial disparities in health cut lives short." Subsequent chapters focus on both physical and emotional impacts as well as offering suggested solutions. This important, moving work contains copious notes (more than ten percent of the entire text) and a helpful index with numerous sub-points under topics like maternal mortality and mental illness. UNDER THE SKIN received starred reviews from Booklist, Library Journal, and Publishers Weekly. We will be adding it to the list of recommended reading for student researchers; in the past, those interested in discrimination in health care have read Seeing Patients by White, Black Man in a White Coat by Tweedy and/or Just Health by Matthew. Those interested in inequities in health care for women have read works like Doing Harm by Dusenbery and/or Sex Matters by McGregor.

This book is an absolute must read!! I can't stop talking about it! I could not wait to get this book on my shelves. The imbedded racism in our healthcare system and the continued teaching of racist medical practices toward Black people is unbelievable.

I have heard so many disturbing and horrible stories from Black mothers who were treated so poorly by white doctors during delivery, and here is the proof as to why. To see the actual research and stories in black and white is deeply concerning. We knew the Black mortality rate was much higher for Black births, but to see why and how far back the racial disparities actually go (AND continues to be taught) is mind blowing to say the least.

Villarosa did an amazing job researching and telling this important story that needed to be told!

Wow, this book had a lot of compelling and horrifying information in it. You may have heard that Black Americans have higher mortality rates during childbirth, the Tuskegee Syphilis study, and you may have heard about redlining that relegated Black people to specific areas, often at the expense of their health, but if you're like me, you haven't seen just how deep it goes. Villarosa does some powerful research and story-telling in Under the Skin. I could list all the new things I learned, but honestly, you just really ought to read this book! It's a dense, yet short read, and has plenty of citations in the back if you are interested in learning more.

Excellent read, but do be prepared to be absolutely heartbroken at what people have endured, even in the past few years. It's important to know.

Thanks to Netgalley and Doubleday Books for the e-ARC!

"I have long understood that something about being Black has led to the documented poor health of Black Americans….The something is racism."

One of the first books I reviewed here on the blog was The Immortal Life of Henrietta Lacks, a book that went on to be made into a movie by Oprah and that opened the eyes to some of the injustices of the medical world against Black people. While that book did a lot to acknowledge past sins, I fear it was all too easy for white people reading it contemporarily to dismiss it as an unfortunate bit of history and think that it’s all different now and these things are no longer a problem.

"Even today the centuries-old fallacies of Black immunity to pain and weakened lung function still show up. At the same time, scientists and doctors ignore or downplay the social and environmental conditions that mar Black lives and communities, and overlook the dark history of racial prejudice based on the assumption of inherent Black inferiority."

Thankfully, Linda Villarosa wrote this book, which links present day beliefs that are carried over from the days of slavery and belief of Black inferiority which allowed whites to justify the enslavement and the cruel treatment thereunder. With eye-opening clarity, Villarosa takes us on a journey of racism and its influence in modern day medicine with heartbreaking stories of people this country has long-mistreated simply because of the color of their skin.

Villarosa cites study after study and uses her own experience as a journalist to investigate why one of the world’s richest countries has the world’s highest maternal and infant mortality rates. While she focuses mostly on this particular area of research, she also touches on other areas, including AIDs and Covid-19. Rich or poor, educated or not, young or old across the board, “African Americans ‘live sicker and die quicker'” when compared to their white counterparts in those same categories. The question in my mind is whether institutions as well as individuals will look at this proof and dismiss it out of hand, or whether they might take a step back and examine things again from a different perspective. After all, “denial of racial bias can be so extreme that no one believes you even when you have the evidence.”

With case studies that break your heart and put a fire in your belly, this book addresses not just the implicit racism in the medical field with its outdated beliefs and blatant disrespect, but how the constant stress of battling racism medically and measurably affects the health of Black people in America. Evocative, eye-opening, and stirring, this is a must-read.

I will start by saying that this book is very heavy. It has a lot of heavy topics, and it may leave you upset and wanting to burn down a hospital. Also, this isn’t a quick weekend read, but it’s a very much needed read. I’ve personally always carried a soapbox for the Healthcare field as a Black Woman, and I appreciate someone dedicating the time to the research and writing for this topic within this book. Personally, I would recommend this book to every healthcare provider, and I think it should be required reading for anyone in/pursuing medical/nursing school.



I voluntarily read and reviewed an advanced copy of this book. All thoughts and opinions are my own.

Thanks to Netgalley and Random House for the opportunity to read this ARC: This book needs to be read by all health care providers--both in training and in practice. As a physician, I was familiar with the author not through medical education but through adult education. I have taken the California mandatory training in racial bias and obstetrics, for adult education and found it critically important. As recently as 2021, JAMA tweeted: "No physician is racist, so how can there be structural racism in healthcare?' Yet, structural racism in health care is rampant. The author writes clearly, with careful and expensive research about the issue and ends with proposed solutions. She addresses the disparities in healthcare, the myths that never seem to die about Black health and predispositions, and the fact that although systemic racism may be finally dying in healthcare--it's dying "ugly". I consider this book an essential text and reference. It's powerful, important and deserves wide readership. It should be required in all medical school and continuing medical eduction curriculum. A tour de force.

This book is extremely well researched and incredibly informative.

The topic is depressing and dry. Unfortunately, so is the book. It's fact after fact about the continued mistreatment of Black people, but OTHER Black people. I don't feel like I get Villarosa's experiences or humanity through it, but instead am looking through the lens with her. I wish she had put more of herself and her own experiences into it, as the book would have been far more compelling. Even at ~27% in, when Villarosa talks about her own baby being born at a low birth weight, it's so factual and disconnected. But sharing yourself is hard. I get it.

Thank you to NetGalley and Doubleday books for the ARC.

One of the most important books on systemic racism in medicine written this year. Linda Villarosa interrogates the dangerous myths that exist about black bodies that was perpetuated during slavery and still live on today in our current institutions. Black Americans have poorer health outcomes than white Americans and all too often because of systemic and institutional racism, the blame is put on individuals instead of understanding all of the systemic root causes contributing to these disparities. Some of the research she cites includes work by Dr. Arline Geronimus, who came up with the term "weathering" to explain the devastating impact racism has on health - with micro and macro-aggressions "death by a thousand cuts." Besides constant trauma and stress, there are also the myths that "black bodies are different" that black people have higher pain thresholds than white people - an incredibly dangerous assumption not supported at all by scientific evidence. There is also an important emphasis on disparities in how black women are treated in the health care system- from forced sterilization to higher risk pregnancies and higher rate of maternal death. She also has chapters on mental health and environmental toxins. I have read some of the research she cites here but what makes this book so incredibly important is how she pulls all of these challenges into one book so we can see the big picture about what is happening in this country and how racism has penetrated every aspect of our health care institutions. This book is a call-to-action for all of us who work in healthcare.

I cannot even express how important this book is and I feel that everyone not matter their race or ethnicity should absolutely read this work to not only understand how deeply health disparities are rooted in racism, but also how deeply it impacts our black community and overall society. This work shines a massive spotlight on the racism that runs rampant in our healthcare system and the very real data collected showing just how impactful it is on black americans. I guarantee that every single black person that you know has experienced racism in a healthcare setting at some point in their lives and this book delves deeply into the roots of where it started, the many facets of it to include environmental factors, and why it continues.

What I appreciated most was the message of hope. This book highlights so many healthcare workers that are in the trenches working to bring about real change regarding health disparities among black communities as well as the healthcare workers that are willing to receive the information in a way that is uncomfortable but still open.

Thank you NetGalley and Double Day for providing this book in exchange for review.

This is a very important, well-researched book on how racism, biases in our health system, and discrimination in our institutions and structures lead to poorer health outcomes for Blacks. The disparities are not due to lack of self care or poor choices or genetics; this is well documented yet resisted by policy makers and the medical field alike.

Full of stories that make the injustices come alive, carefully gathered evidence, and examples of how some individuals and programs are making a difference, this book is needed.

Thanks, NetGalley, for an advance copy in exchange for an honest review

Racism is classified as a public health threat by the American Medical Association (just one of the facts I learned from this book). I highly recommend this book to anyone who wants to become more informed about the relationship between racism and health.

This was such an important look into the ways society has failed and continues to fail the black community when it comes to physical and mental health (and lots of other ways too but that’s for a different time)

Under the Skin was a tough book to read but clearly very well researched and very informative. The book dives deep into exploring different aspects of race and how it influences every corner of life.

This was not an easy book to read (it will make you upset and angry), but it's full of essential education about the impact racism has on health and healthcare for Black people in the US. The author has done a huge amount of research over many years about a variety of areas within this topic.

A lot of the book discusses medical treatment for pregnancy, childbirth, and infant health. Other topics include the intersection of mental health and racism, the ways that geographical area can impact health, and the perpetuation of myths. Each chapter is thoroughly explained, with a mix of research studies and personal stories collected from interviews with individuals. The afterword brings up COVID and how Black people have been unfairly harmed by the pandemic.

Racism is classified as a public health threat by the American Medical Association (just one of the facts I learned from this book). I highly recommend this book to anyone who wants to become more informed about the relationship between racism and health.

As is to be expected, this book has a lot of pretty strong content warnings to be aware of when picking it up. It discusses racism in great detail with examples. It also has a lot of description of medical emergencies and some of the stories end in death. There is some talk about suicide.