Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation - A Conversation with Linda Villarosa

April 19, 2024

Information

4/17/24

The Kenneth and Georgia Barwick Lecture

Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation - A Conversation with Linda Villarosa

Moderated by Randi Hutter Epstein, PHM Writer in Residence

5:00 PM – 6:00 PM

Hope 103-Amphitheatre

Linda Villarosa

Professor of Journalism

Contributing Writer, New York Times Magazine

Author, Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation. One of New York Times Book Review Top 10 Books of 2022

Finalist, 2023 Pulitzer Prize

ID11594

To CiteDCA Citation Guide

00:00Humanities and medicine, Hello
00:02to those of you on sale
00:05and yeah, I'll say
00:06a couple of words about borrow
00:07lecture and then we'll introduce
00:09Randy and Linda and turn
00:11there with that. So this
00:14is the borrow lecture and then the
00:17Kenneth and Georgia borrow endowment
00:19on established by friends and
00:21former colleagues of Kenneth George
00:23Barwick today walking downstairs
00:26as we speak.
00:29Doctor Hannon Barwick who died
00:31in 2001, was a gastro and
00:33pathologist on back of the
00:35shearing down out of the school
00:37in the 1970 eighties and he
00:40was committed to sharing
00:41the value and importance
00:42of the humanities medicine.
00:44He received the Leo Owenstein Award
00:46in 1986 for promoting humane and
00:49egalitarian medical education.
00:52George Barwick of the name
00:54lecture is here tonight.
00:55Welcome back. Thank you.
00:58Glad to be back. A
00:59fellow humanist, fellow professional was
01:01a deep regard on how the humanities are
01:06questions. So welcome and
01:08thank you all who are here,
01:11our works and everybody else and
01:15very much look forward to this
01:17and all today. So Under the Skin,
01:19the Hidden Total Reasons on
01:21American Lives and Our health
01:23information conversation.
01:26And there's an earlier
01:27title of slowing ramps.
01:30They will work
01:33So Linda at the Gregory
01:36Mark Graduate School of Journalism
01:37and she named with a joint appointment
01:39at the City College of New York
01:41as well as the tributing writer
01:42at the New York Times Magazine,
01:44which she covers the intersection
01:45of grades and health.
01:47She also scored as executive of
01:49her Essence magazine and as a
01:51science editor at New York Times
01:53from article on the journal from
01:55the totality of the Violence of
01:57our National Magazine Award.
01:59She contributed her to the 1619
02:01project and her book Under the Skin
02:05that I just mentioned was a bias
02:07for the different department of
02:12the and I have asked
02:16for this, I mean in person.
02:19And I also want to thank Randy
02:20I've seen for serving as moderator.
02:24Again, Randy is my favorite moderator.
02:28She is a graduate of Yale Library
02:31School and health journalist.
02:34She is a graduate of medicines
02:36for the pro and Medicine.
02:38She also teaches English Yale
02:40undergraduates in the English
02:42department here and teaches journalism
02:44at Columbia University of Journalism.
02:46And she'll be automatically
02:48both on her and on on.
02:58I'm so not stressed. OK, so welcome and
03:03thank you for being here. And
03:07those of you on Zoom, I know
03:08this room is a little tricky,
03:10so just throw it in the chat.
03:13We have trouble hearing.
03:17So what we're going to do is
03:20when is in three to few people
03:22yes in the mode of what of her style.
03:26Then I look these questions and
03:28then we do want to break it
03:30up for people here in person.
03:32And I think Anna's gonna monitor the Zoom.
03:34So people on Zoom, feel free to
03:37send in your questions in the chat.
03:43Well, first, thank you everyone who's here.
03:46Thank you. To the our family.
03:48Thank you Randy and Anna.
03:51It's really nice to be here again.
03:55And the part I'm gonna read is
04:00a part about my father and a lot
04:03of what I write about, I mean,
04:04basically everything is I kind of figured
04:08out partially through doing research,
04:10partially by doing reporting,
04:12and partially through my own
04:15personal and lived experience.
04:17And this is one of those spots.
04:21In 1999, my father, a college educated
04:24man who had retired from his job
04:27as a manager in a division agency,
04:30became critically I'll.
04:31In his early 70s,
04:33he was diagnosed with colon cancer,
04:35and as the disease worsened,
04:37he also began to suffer from mild dementia.
04:40I lived in New York City, across the
04:43country from my hometown of Denver,
04:45so though my parents had been divorced for
04:47years, my mother agreed to manage his care.
04:51One day she called me and said,
04:53you need to come home.
04:54Your father needs you.
04:56He's in the hospital.
04:57She instructed me to dress in
04:59professional attire and to bring my
05:01business cards from the New York Times,
05:03where I was the editor of the health pages.
05:06When she picked me up at the airport,
05:09dressed in extremely corporate attire,
05:11looking like the hospital
05:12vice president she used to be,
05:14I asked her, what are we doing?
05:17Her reply was one They're treating
05:20your father like a inward.
05:22We need to let them see who he is.
05:26We. When we arrived at the veterans
05:29hospital he had insisted on,
05:30I was shocked by what I saw.
05:32My father, courtly sophisticated
05:35and always impeccably dressed,
05:37was frighteningly thin, dishevelled,
05:39wearing a dirty hospital gown,
05:41his hair uncombed as we walked in.
05:46An attendant was speaking to
05:48him in a disrespectful hiss.
05:50When I pushed past the attendant and leaned
05:52down to hug my father, he whispered.
05:54Get Me Out of here.
05:57Everything changed once we arrived.
05:59My mother,
06:00flipping into an ambitious
06:01mode I didn't recognize,
06:02sent everyone straight.
06:04Doctors, nurses, and hospital administrators.
06:07We showed them my father's college degrees,
06:10medals from military service,
06:12and photographs of him free illness.
06:16I let his caregivers know that he
06:18had studied biology in college,
06:20so explaining things in a respectful
06:22way would help him understand
06:24what was going on and prevent him
06:27from feeling afraid and angry.
06:29My father, who died several months
06:31after my mother and I visited,
06:32didn't deserve special treatment
06:34because of his class and education.
06:37Class was the only part my mother
06:39and I had to play,
06:40so we played it.
06:43But like everyone else,
06:44he should have been treated with dignity.
06:48I tell that story and it's you know,
06:53upsetting and it was interesting
06:56because where the Veterans hospital
06:58is now is a medical school at
07:01the University of Colorado.
07:02So.
07:03But I didn't realize that when
07:05I went to speak there that last
07:07year and I got out of the car
07:11and these really well dressed,
07:13professional looking black women
07:14ran to the car and they took me,
07:17took my arms and and I'm like,
07:19what's happening?
07:20They're just being so nurturing.
07:22Is this how they treat all
07:23their guest speakers?
07:24And then I looked over and saw the
07:26barracks and I realized they had
07:28figured out that that was where I
07:31had this big terrible thing happen.
07:33And they were just trying to look out for me.
07:35But that, you know, moment.
07:38I never forgot that.
07:39Why did why does anyone have to play
07:42a respectability card just to get
07:44treatment and care in a hospital?
07:48Well, one of the questions I have,
07:50and I know some of you might not have
07:52read the whole book.
07:55Well, one of the things I
07:56actually do want to say,
07:57as I was working on my questions,
07:58I kept saying things like you say, you say
08:01because reading this is a
08:04a the easiest book to read
08:06because you feel like
08:07Linda's just chatting to you.
08:09You feel like you're just talking to you.
08:11You don't even feel like you're
08:12you just feel like you're having a
08:13conversation with a really smart friend.
08:15And we're gonna get to that.
08:17How you pulled that off.
08:18But one of the things,
08:20because you teach journalism,
08:21you've been at the New York Times,
08:23you've been at the premier
08:24places as an editor
08:25and a writer. You taught
08:28both in your magazine
08:29piece on Simone Landrum, and you
08:32also hear a woman whose first child
08:36died at birth, and then you
08:38were with her during labor.
08:41And you talk about you did errands
08:43for her, you became a friend,
08:45you hugged her. I mean,
08:47sort of in journalism school, you learned
08:50that you're supposed to be a family
08:51on the wall. You're not supposed to affect
08:53story. So I'm just curious what your thoughts
08:57are as a journalist. And then
09:00you were like this writer,
09:01caregiver, friend also.
09:05Well, let me feel like you broke this rule.
09:07Oh, definitely.
09:08I broke that rule so many times. And why?
09:11And it's so funny because I teach
09:14journalism and my journalism students
09:15are listening to me talk about how I,
09:18you know, do interviews and kind of,
09:22I guess, get into people's lives.
09:24And one, I remember when a student raised
09:26his hand and he turns to me and says,
09:27do you have no boundaries?
09:29And it's like, well,
09:32boundaries are not my best thing.
09:34But I think with Simone Lantrum,
09:38I ended up being more of a humanist.
09:41Because one thing is to read about research,
09:44even read interviews of people who have
09:48been treated badly in the medical system
09:51and then to see how badly she was treated.
09:54And I and I also she I really like her.
09:59And the first interview I did with her
10:02was just to hear about she was pregnant.
10:04She was working with a doula.
10:06And she told me about her losing
10:09a child the year before.
10:11And still it was, you know, a nightmare.
10:14And when I was leaving, I asked her,
10:17who's gonna be with you when
10:19you have this baby?
10:20And she said, just the doodle.
10:23And then she looked at me and
10:25all of a sudden I just stopped.
10:26Like, she'd come back as she
10:29came back and be with her.
10:30I've had two children.
10:31I've been at birth,
10:33some other people.
10:34Plus, you know,
10:34the journalist part is like, well,
10:36I'll be at the birth and then I can just
10:38have a nice happy ending on my story.
10:42I ended up coming back,
10:43but too early because she had false labor.
10:47But I was already on the plane,
10:48so I ended up spending quite a bit.
10:50I stayed, spent a lot of time with her.
10:53When she went into labor I was not expecting.
10:56I thought it would be smooth.
10:59I thought they'd intrigue her kindly.
11:01But they didn't.
11:02And I was.
11:03I was basically she had a pneuma there,
11:07but when they kept asking her the
11:09worst part was when they asked
11:11her how many children do you have?
11:13She said two but I had a still birth
11:16and then they said to her when was the
11:19demise And she named that baby Harmony.
11:21She loved her even though you
11:23know she passed away and they
11:25asked her that several times.
11:26At each you could see the, you know her.
11:30When she was hooked up to a monitor.
11:32You could see the monitor go like
11:34this because she was upset and it was
11:37the doula who said please stop that,
11:38put it,
11:39make a make a note in her medical
11:41records and stop asking her that
11:44horrific question over and over.
11:46And then the rest of it was
11:48very touch and go,
11:49and she was treated quite badly
11:52by the people attending her.
11:55Me,
11:56Simone and Abdullah were the
11:58only black people with
11:59any color single room in New Orleans.
12:03And the doctor was rushed and
12:06not kind, barely introduced
12:07himself and replied to him. So
12:12I had to rewrite the story so
12:14that this part was, you know,
12:16that's the part where your heart
12:18starts beating really hard.
12:20And that was not at all.
12:23And I'm asking this,
12:26did you hear from
12:26any of the doctors in the
12:28hospital or any feedback after
12:29you wrote the stories that actually
12:31maybe have a different memory
12:32and we remember things different?
12:34Did you get any pushback from?
12:35No, They were totally scared of me
12:38and I'm sad, but what I did do was
12:40I went to the hospital, you know,
12:42they got in trouble and there was a session.
12:46So they had to, some of them
12:47had to go through, you know,
12:49anti racism training and it
12:51was quite elaborate.
12:52So I was in the zoo room
12:56and there was another patient who had
13:00been treated quite unkindly and and
13:03badly and had her child was disabled.
13:06So she came in to the room to
13:09the Zoom and told her story.
13:11And I asked my friend who had let me in.
13:14I said was anybody who treated her,
13:17listen, did they hear her story?
13:19And they said yes and that that and they
13:21but they were smart because they also
13:23brought in someone who had a good experience.
13:26And that person said, you know what,
13:28This, this worked well for me.
13:29Thank you for the care I got so that
13:32it wasn't all just you know shade.
13:35Well what they ended up doing was they
13:38realized they needed an obstetric
13:40emergency room and they opened it and
13:43that was not cheap and they had they had
13:46to hire four people and I don't know,
13:49I don't think they built anything new
13:51but they moved things around because of
13:53these people telling their story and
13:55they were calling it like Co design.
13:57So they were changing the hospital based
13:59on the experiences of people from the
14:01community who had been served by them
14:03both in a good way and not so good way.
14:07Now, I want to go back in time a
14:09bit because you talk about your own
14:11journey and one of the things you
14:13write about is this Heckler report from
14:171985. And I know I told you I
14:19practically memorized the book.
14:20So if you don't remember
14:20anything in your book,
14:21you can ask me because I know it.
14:24It's kind of like page 12 or whatever.
14:26But so you write about the
14:28Heckler report between that 1985,
14:30which looked like it was
14:33positive and going well.
14:33And then it kind of veered left and didn't.
14:36And I thought maybe you can just for
14:38the audience that might not remember
14:40or know what this report was,
14:42explain what the report was and what
14:44was like, wow, this is great. I'm glad
14:46it came out, but actually
14:49it wasn't as good as you
14:50thought. And then I'm going to add on top.
14:52Then, how did that sort of start
14:53to sink into you as a health?
14:57Well, the Heckler report was amazing
15:00for its time because it was the
15:02first time that people of color,
15:04mainly black people's experiences, had
15:07been documented by the federal government.
15:10And Margaret Schuyler was the head of
15:12Health and Human Services at the time,
15:14and she was like a Reagan Republican.
15:17And what I think I read,
15:19I don't even think I put this
15:20in the book that it was,
15:21she had some black friend or black
15:23person who worked with her who said,
15:25you know, you really should look at this.
15:27And I've had this experience happen.
15:30And so she ended up doing that.
15:32And when the report came out,
15:34people were quite amazed at,
15:36you know, health of the health,
15:38racial health disparities,
15:40people's complaints about treatment.
15:42And it was an important document.
15:45It got a lot of media coverage,
15:46but the only thing that was
15:48missing was any solutions.
15:50So it did not offer to do anything
15:52about it in it didn't put any
15:55more money toward the problem.
15:57But what it basically said was we
15:59see that there's this problem.
16:00You, you, the people who are,
16:03you know,
16:04being having problems need to
16:05take care of yourselves better.
16:08So it ended up being this kind
16:10of weird blame situation without
16:13any responsibility from the,
16:15you know,
16:16the hospital systems but especially
16:18from the federal government.
16:19So Speaking of blaming,
16:21you had a sort of evolution
16:22in your way of thinking.
16:24And you talk about in the
16:25beginning of the book that,
16:26I mean you were a major player at
16:29Essence New York Times big time
16:31editor and helping promote self
16:33help and all this wonderful advice.
16:36And can you just explain, like,
16:37how you thought about health
16:39then and how your journey changed
16:42that led to this book or maybe
16:44because of the research?
16:47Well, I got to Essence magazine in the
16:51late 80s, and I was, it was my dream job.
16:55I just wanted to be at Essence magazine.
16:57I wanted to have an audience of black women.
16:59And in my head I was like, I see that
17:02there are racial health disparities.
17:03I've read the Heckler report and I
17:05know I can solve this problem because
17:07if you know better, you do better.
17:10And I'm saying I'm gonna give
17:12everybody the information in a way
17:14that people the readers of Essence.
17:17And at the time there were a million
17:19subscribers and and with a pass around
17:22of 8 million because basically hair
17:24salons 'cause it was always there.
17:26And I'm thinking they're gonna
17:27people are trapped in the hair salon.
17:29They're gonna turn to the health pages.
17:30I'm gonna make them really, you know,
17:33interesting to read and just just
17:35basically tell people this is
17:37what you do if you're pregnant.
17:38You take care of yourself.
17:40You take prenatal vitamins,
17:42you eat well, drink a lot of water,
17:45you exercise all the stuff.
17:46So this is what I was doing.
17:48And then I got someone said on a flyer,
17:52you should,
17:53you should apply to this health fellowship
17:55at the Harvard School of Public Health.
17:57It's for journalists.
17:57And I was like, OK, well,
17:59I'm sure I will not get that.
18:02And I did.
18:03So now I shift because I'm in public health,
18:07but I'm also starting to
18:08do more serious articles,
18:10not just sort of self help,
18:12but more serious stories about I had
18:14done a piece about environmental justice.
18:17I had done a piece about the
18:20emergency room and how people are
18:23using it just as their primary care.
18:26But then I so I get out of Harvard School
18:28of Public Health and I was kind of like,
18:30OK,
18:30wait a minute,
18:31this is not what I'm talking about,
18:32is not all I I hadn't made a
18:36total shift and sometimes I beat
18:38myself up a little bit about it.
18:40I wrote a book called Body and Soul,
18:42which is a black women's self
18:44help guide and did great.
18:45It was supposed to be like the black
18:47women's our bodies, ourselves.
18:48It did really well.
18:50So I was thinking about it.
18:51I was like, I wish I hadn't been so,
18:53you know, so Elvish.
18:55And then I looked at the foreword.
18:58I forgot this. Angela Davis.
19:01In June, Jordan wrote the foreword.
19:03So hello.
19:05It was pretty radical if it had Angela
19:09Davis writing the foreword talking
19:11about injustice in the healthcare system.
19:13So, but even you know,
19:16after that book I continued to look at,
19:20he started to think this is not the
19:21way I'm talking about self help.
19:23I was calling it self help is not all
19:26right and but it took me a while.
19:29I'm very slow as a thinker and
19:31sometimes as a writer, to be honest,
19:34to shift and then, but now,
19:37you know,
19:37I see that telling people what to do
19:40and changing individual behavior
19:42without looking at systemic
19:45and institutional issues is not
19:47gonna solve the problem of racial
19:49inequality in health in this country.
19:52And a lot of the
19:53book that you talk about is the
19:56racial inequalities and what that
19:58does to your physical health and
20:00what that does to your mental health.
20:02And there are in this audience people
20:05with a very scientific background
20:06and on zoom and we're learning
20:09about Physiology and we're learning
20:10about genetics and they're learning
20:12genetics in a way that I never did.
20:15But I think that's baked into our DNA like
20:18here's a germ and this is what it does.
20:20You have a faulty gene or.
20:23You know, it's just
20:24everything's very sciencey
20:25and your book, you're bringing up
20:27a whole other perspective.
20:30And I'm interested in because you start,
20:33you were at the science section of the
20:35New York Times, your own evolution.
20:37And if you can explain to this audience
20:39of scientists like how that makes sense,
20:41that something like that's so abstract,
20:44like injustice, like how does
20:46that affect you physically and
20:48how did you come to incorporate?
20:51Well, when I was writing about
20:53black mothers and babies,
20:55about Simone Landrum's story, I still
20:58hadn't figured out everything because.
21:00And the the number that struck me was
21:05why is a black woman, black birthing
21:08person with an advanced degree,
21:10a master's degree, APHDAJD, an MD?
21:14Why is she more likely to die or almost
21:17die in childbirth or in pregnancy,
21:20childbirth and the time after than a white
21:22woman with an eighth grade education?
21:24So that is going against everything
21:27that most people believe.
21:29And it's also going against what
21:31I was trying to do by saying
21:32just take good care of yourself.
21:34So people who are highly educated and now
21:37the research has expanded to people who are,
21:40I mean, I say wealthy,
21:42but the New York Times itself last
21:44year said childbirth is dangerous
21:46even when the black family is rich.
21:48OK, The New York Times doesn't
21:50use the word rich much.
21:51So putting a fine point that even if
21:53you have money and even if you know
21:55what to do and have an education
21:57and have access to health care,
21:59then still why are black mothers dying?
22:05And then if you look at the statistics,
22:07the upper end of the education,
22:12you know the the the white death rate is
22:14here and the Black Death rate is here.
22:17It's wider than at the less educated,
22:19less wealthy end.
22:20So why is it just race and not
22:23having to do with education and
22:26money and access to healthcare?
22:28So that's when I started saying,
22:30well,
22:30this isn't the something wrong
22:33with the healthcare system
22:34isn't totally explaining this.
22:36That's when I started that.
22:37That's when I ran up against
22:39doctor Arlene Geronimus,
22:41who coined the term weathering.
22:43And weathering is her.
22:44She's been, she's been worked.
22:46I guess she's almost 70 or around that age.
22:49She's been working on this theory
22:51since she was an undergrad at
22:53Princeton to explain infant mortality.
22:55And that's what she started.
22:57And what she found out was during
23:00the time when there was, you know,
23:03high rates of infant mortality and
23:05the blame was on teen pregnancy.
23:07And so it was always babies having babies.
23:09That is what is causing this
23:12infant mortality problem in among
23:14black people in the United States.
23:16So this is basically in the 90s,
23:18but what she found out was
23:20actually infant mortality.
23:22If you look at the numbers,
23:24it's worse or it's not as bad for teenagers.
23:26It's worse for women who
23:28are slightly older than,
23:30you know, teens,
23:31So in their late 20s and sometimes early 30s,
23:33but it's before, you know,
23:35sort of like the 40s when you start
23:36to see something different going on.
23:38So she coined this term,
23:40weathering to to explain how the lived
23:45experience of battling discrimination
23:47creates a kind of premature aging
23:50by raising the allostatic load.
23:52And what how I explain it to
23:55my undergrads or my students.
23:58It's like recently one of my
24:02colleagues came into the office
24:03and said there's no such thing
24:05as a microaggression.
24:06And I was like, OK, yes, there is.
24:10Yes, there is. And then she kept on.
24:13And then I felt my body changing.
24:16I felt my heart racing.
24:19I'm sure, you know,
24:20my blood pressure is OK,
24:22but I'm sure it was rising.
24:24I felt tense.
24:25I felt my whole body changing.
24:28And I turned to her and I said,
24:30what you're doing is called microaggression.
24:34And it's making me feel And then,
24:39you know, so to explain that,
24:40it's like if that happens
24:42to you occasionally, like,
24:44you know, she doesn't do that
24:46anymore because I told her.
24:47But if that happens to you over
24:49and over because of what's
24:51happening to you in society.
24:53And David Williams,
24:54who's a wonderful position at the
24:57Harvard School of Public Health,
24:59has this scale of everyday racism.
25:02And the everyday racism
25:04is pretty is not terrible.
25:06But if it happens to you over and over,
25:08it's like,
25:08do people move away from you in the elevator
25:10because they think you're dangerous?
25:12Do people sit you in the back of the
25:14restaurant because they think you're lesser?
25:16And then do you experience discrimination?
25:18Those are the kind of everyday things.
25:20But then do you,
25:22have you dealt with discrimination
25:24in housing at work or by the police?
25:27So the more of these instances where
25:29your body kicks into this kind of high gear,
25:32raises your allostatic load and
25:35makes your body age prematurely,
25:38She calls it weathering at when
25:40I first interviewed her in 2018,
25:43we have this great conversation.
25:44We're on the phone for like 2
25:45hours and finally I was like,
25:46you know I'm from the New York Times, right?
25:48We're not just chit chatting.
25:50I'm interviewing you and I realized
25:52she doesn't get interviewed much
25:54because no one believes her.
25:56Now she is a, you know,
25:59a an expert and you know we fly her
26:01into New York City to talk about
26:03maternal and infant mortality.
26:05She has a book herself all weathering
26:08and she's considered,
26:09you know her theories are now not
26:11so much theories but you know
26:13believed and but it.
26:15But that helped me understand why
26:17it wasn't just what happens to
26:19you in the hospital.
26:21It happens to you before and and
26:24actually some people believe that
26:26and including Doctor Geronimus,
26:28that it's in many ways worse for the
26:31more educated of us because we have more,
26:35you know,
26:36we have more,
26:36I guess we bump into more people
26:39who are outside of our community at work,
26:43at school.
26:44So if you're in predominantly white spaces,
26:46you probably are more likely to
26:48have these microaggressions happen
26:50to you as I just did.
26:53I have just
27:04take five, I have a lot more questions,
27:08but should we open it up for a
27:10bit And then I do the view that
27:12I do want to sneak back in,
27:13but maybe should we see if
27:15there's any in the audience
27:16or are there any coming in on
27:20soon? Let's give it to the people here first,
27:24about the right anchor.
27:28I like questions someone asked us.
27:32OK.
27:35So I I finished your book yesterday and
27:38this book could have been, it's so good
27:43but it's like you covered so much and
27:46yet there's so much more you could other
27:49areas that you could have covered.
27:50And I just wondered how you chose
27:52the broad areas that you just have
27:54in there and what didn't make.
28:00I tried to cover everything.
28:02I knew that I, you know just
28:06everything about this topic,
28:07and I really tried to do all that.
28:10And then I was late and so I was
28:13starting to get in trouble because
28:15I had already missed the deadline.
28:17It was in the middle of COVID.
28:18So I got assigned a piece to write
28:21about racial disparities in COVID.
28:24I ended up writing about life expectancy.
28:27I was part of the 1619 project,
28:29so I was taking all these
28:32side detours and my editor,
28:34who's really nice and my
28:35agent who's not so nice,
28:39fine, that's good in an agent,
28:41not on a zoom call.
28:43And you know you're in trouble when
28:44both of them are on and they're like,
28:46you need to finish this book.
28:48And the next 6 something,
28:50I think it was like 6 weeks and hurry up,
28:52stressed. Yeah, I know.
28:54See, my allostatic load is
28:57going on talking about this,
28:59and I realized I needed to just
29:02figure this out and end it.
29:04What I feel like I left
29:06out was I wish I had had.
29:09I wish I had been known that abortion was
29:11going to go down in the dog's decision.
29:13So that happened in my book,
29:15came out in June.
29:16That happened in July.
29:17I would have written much more
29:19about reproductive justice.
29:20I'm really interested in that.
29:22My family,
29:23my grandparents and my aunts
29:25and uncles are from Mississippi,
29:27and I think about that.
29:29The dog's decision happened in Mississippi.
29:32And I think so much of the
29:34conversation that we have in this
29:37country about abortion is only about
29:39abortion and not about a broader
29:42lens of reproductive justice,
29:43which is the right to have a baby,
29:46the right not to have a child,
29:49and the right, if you have your child,
29:51to have that child grow up in a healthy way,
29:53in a in a safe and healthy environment.
29:55And that is what Mississippi is,
29:57a place where much of that does not happen.
30:00So I had a lot to say about that,
30:02but I realized,
30:03stop now before you get in trouble.
30:06So I wish I had, you know,
30:08been able to put more of that in the book.
30:13Want to introduce yourself when you ask,
30:16I'm a post doc here, you know,
30:20thanks for coming. I really
30:22appreciate your your perspective,
30:24especially being able to
30:26travel through several
30:28different worlds. Speaking
30:30of that, I wanted to ask you if
30:34you know, in talking about
30:35your book and presenting your
30:37results throughout the country,
30:39what have you noticed
30:41in terms of like resistance
30:43from people when
30:44you when you communicate these results?
30:45Have they been, Have attitudes
30:48changed over the last like 18
30:50months or so? And if so, how?
30:53I think attitudes have changed because it's
30:56there's so much more conversation about,
31:00you know, racing in the medical system.
31:02It's, you know, racism as a public
31:05health threat is something that
31:07I used to be wary of saying,
31:09but now people do say it.
31:11There's been other books,
31:12there's been more discussion about this.
31:14There's definitely been discussion
31:15at the medical school level,
31:20which has been really exciting.
31:21I think that there's still
31:24people and it's hard.
31:26I just got into a quite vigorous
31:30debate with someone who was saying
31:33still giving some kind of genetic
31:35explanation for infant mortality.
31:38So. And it wouldn't.
31:39And he wouldn't let it go.
31:41And you know, I'm pretty good.
31:42I'm like,
31:42I can play the dozens with research.
31:44OK.
31:44So And he was just like kept on a note,
31:47Don't you think there's something
31:49different about the black body?
31:50And I'm like there's something
31:53different about everyone's bodies.
31:54But there is as a demographic,
31:56there is no gene that is causing our,
32:00you know, the fact that we have 2
32:021/2 times higher in black people,
32:04infant mortality.
32:05And I have my favorite study
32:08of this is so great,
32:11it's these two guys,
32:13They are neonatologists in Chicago,
32:15at the University of Illinois in Chicago.
32:18So they looked at birth certificates,
32:2010s of thousands in four groups.
32:23So it was black American women,
32:26White American women lack new immigrants
32:28from some of the poorest areas and
32:32then white immigrants from Europe.
32:34And the round one was they looked at
32:37the birth weights of of thousands of
32:40babies so and divided them in this way.
32:42So what they found was three groups had
32:45the same birth weights and it was you
32:48know basically normal birth weights.
32:50So it was the white women,
32:51the white immigrants,
32:52and the the women from the Caribbean
32:55and African countries newly here.
32:58And then the only one that had small
33:00babies were black American women.
33:02So then they looked at the next round,
33:04if it was a, you know,
33:05woman who had the next round of babies.
33:08And now the white women babies were normal.
33:12The black American babies were still small.
33:15The European babies were a little bigger,
33:17but now in one generation,
33:20the babies from Africa and the
33:22Caribbean had now matched what
33:24the African American babies,
33:26you know,
33:27the black American babies look like.
33:29And I remember the reason I was
33:31interested in this is I know the two
33:33researchers now and they're like, you know,
33:35they're not like out there people,
33:36they're very serious.
33:37But I remember that the quote that
33:40went with this study said something
33:43about being a A growing up black
33:46in America is bad for your baby.
33:49What it is is racism.
33:50And you know people aren't really saying
33:52that kind of thing in medical journals.
33:54So I latched right on to them and
33:56and had them explain my research.
33:59When I went to Chicago,
34:00they one of them appeared with
34:02me and it was
34:03really great. But you know,
34:04but still I'm still arguing about this. We.
34:07I was arguing about the kidney function test.
34:10We no sorry. It was the lung a pulmonary
34:13function test and it was like, no,
34:15we still have to race correct.
34:16I was like, can we get off of this?
34:19No, we don't.
34:20And I I give the example of myself.
34:23I am from Colorado, all right?
34:25I ran track there.
34:26I ran track in college.
34:28I have the lung function of Serena Williams.
34:30So why do I?
34:32Why is there rate correction for me
34:3410 to 15% of if I'm being measured
34:37in this parameter Still why we have
34:40to look at individual people and not
34:42look at people as demographic groups.
34:44But this, you know,
34:45we're really getting into it about this.
34:47He's like we still have to
34:48have this race correction.
34:49I believe that black people's lungs are
34:51smaller. I'm not or less efficient.
34:53I'm just like I don't and no one
34:56does except even the, you know,
34:58American Jurassic Society of which you
35:00should probably belong as a pulmonologist is.
35:03Cheney said that this isn't right.
35:05So please so that. So that's what
35:07I'm still pushing back against.
35:09Thank you for that.
35:10Appreciate it.
35:10Yeah I think may all static
35:12load might have ticked up there
35:17that's the so sorry
35:22I'll get back here and I'm and
35:26I am a first year student of
35:28the year school public health.
35:30My question is, you mentioned that there
35:34have been conversations in medical school.
35:36So do you have any connections
35:38or any place where you could be
35:40able to express your own research
35:42specifically to even met students in
35:45common or even those that have will
35:47be going on to actually practice?
35:49Yes, a lot.
35:51I get invited quite a bit and it's really,
35:54really wonderful because you see
35:57that there's this kind of swell
35:59of interest in these things in
36:02medical school and nursing school,
36:04in public health school.
36:07I want you specifically or anyone
36:09here to look at the Institute for
36:12Healing and Justice of Medicine.
36:14So these are a group of medical
36:16students who are getting the their
36:19degree from 2020 from UCSF in San
36:21Francisco and they were getting
36:23a joint degree at Berkeley in
36:26public health and they took a class
36:28that is in medical inequality.
36:30They got really excited.
36:32They started this institute and
36:34someone told me about it when they
36:37were launching their launch had like
36:39several thousand people on Zoom in May
36:422020 and they wrote this manifesto
36:45that sounds a lot like my book.
36:47I'm just like, Oh my God,
36:48these kids really did a good job here.
36:50They're so smart.
36:51And so I called them and I was,
36:55I mentioned them here and and I
36:57was interviewing them and I said,
36:58I notice you have an address.
37:01Where is your given office?
37:03And they're like, oh, like, no,
37:04it's our, you know, student lounge.
37:06And I'm like, does the school give you money?
37:09And they're like $600 a year or something.
37:13And I said, oh, you buy pizza with that.
37:15So these students have managed
37:17to pull together.
37:18They have conversations on Zoom about how
37:21to make change in their medical schools,
37:23which I find thrilling.
37:25One of the best times I had speaking
37:29at at a medical school was at Temple
37:33and the all of the second years had to.
37:36It was my book is a sign.
37:38So you know, this is like the jackpot for me.
37:40Then they all come and we have a
37:44conversation and one woman raised
37:46her hand and she had just started her
37:49some kind of clinical training and she,
37:52she was really upset and she said I was in,
37:56you know, I'm, I want to be an OBGYN.
37:58And I,
37:59we had a patient who was in distress
38:01and everyone else in the room,
38:03I was the lowest ranked person.
38:05I was just a student.
38:06Everyone else was down here,
38:09you know,
38:09not by her head and focusing on this,
38:12but she was trying.
38:13She was really upset and this woman
38:15started tearing up and she said
38:17I did not know what to do.
38:19And because I felt so bad.
38:20And I said what did you do?
38:22And she said I held her hand and
38:24I hugged her and everyone was
38:27crying and I
38:28just thought, will you be my doctor please,
38:31once you get your training?
38:32And I just was so moved by that.
38:35And I think that there is a
38:37lot of interest in empathy.
38:39There's a lot of interest in learning,
38:41of course, everything you need to know in
38:43medical school and in nursing school and,
38:45you know, to practice.
38:47But also there is a sort of
38:50urge and a groundswell of trying
38:52to do things differently.
38:58Can I introduce you? So I'm
39:02glad to the university of law.
39:07So when we think about the
39:09prejudice that occurs on site,
39:13what are your thoughts
39:14about how you deal with it?
39:16I have an idea, but I'd be interested
39:18in what's your thoughts on what do you,
39:20what do you mean on site?
39:21Well with the patients you
39:23cited who was ignored,
39:25who was condescent,
39:26you know all of those anti therapeutic sort
39:31of happens in a debate customs.
39:35I think it's hard and I think back to
39:38what happened with Simone Landrum.
39:42I don't think anyone realized that
39:44they were doing anything wrong.
39:45No one was thinking that the way
39:49they were treating her was wrong
39:52because that's how they were trained.
39:55I think that someone has got
39:58to speak up in in the moment.
40:01I also think so much, but I really do
40:05think so much of it is unconscious.
40:08I was speaking at here.
40:11I guess it was a maybe it was Zoom.
40:13It was at the School of Nursing.
40:15I've been talking about my stuff
40:18and a woman raised her hand.
40:19She was a nursing.
40:20She was quite far along in her education
40:22and she looked kind of upset and we were,
40:25she said,
40:26I think that I have been doing white woman.
40:30I've been doing things that weren't
40:32exactly right given how you describe this.
40:35And I said give me an example.
40:36And she she was really hard.
40:39I'm sure this was hard for her to say,
40:42she said.
40:43Sometimes when I look at
40:44patients that aren't like me,
40:46whether it's language, education,
40:48skin color, whatever it is,
40:51I think I don't know if they can
40:53be compliant.
40:54So let me do,
40:55let me give them a treatment that
40:57may be a little bit harsher because
40:59I know I can save their life or I
41:01know I can save their leg or I know
41:03you know and she and she said that
41:07non compliant is a thing and and I'm
41:11I have to check myself and I was
41:14so moved by having her admit that.
41:17But you know,
41:18I think one of the solutions that I see is,
41:21you know,
41:22I am excited by medical students
41:23who are saying we want to have,
41:25we want to have a different
41:26kind of medical education,
41:27we want to practice differently.
41:30I don't think anti racism training
41:33is the answer to everything.
41:35And some of it is really, you know,
41:38some implicit bias training is not very good.
41:41But I think getting people
41:44to talk about this,
41:45the Department of Health in New York City,
41:49they're all 7000 employees.
41:50Several years ago when Mary
41:53Bassett was the commissioner had
41:54to go through anti racism training
41:57like it was like a week long.
41:58It was not a sort of like computer thing.
42:02And I and I always think that was good.
42:06So that's that's what I have.
42:09We just had an anecdote when I
42:12was a surgery intern,
42:14one of the the director of the
42:17emergency department fairs was renowned,
42:19was really laying into any healthcare
42:23provider who exhibited any sort of
42:28bias and inappropriate treatment.
42:30And this was at the county healthcare
42:33hospital where many people come
42:35in they they disheveled,
42:36they're homeless and so forth.
42:39And so any any healthcare provider
42:43who is disrespectful in in a
42:46degree would just be
42:50totally pivotal board and so that
42:52was an example I thought of that
42:55the effect of one-on-one and
42:58there's not a lot of forces between
43:00really change someone for the way.
43:03I think that for that, it's not
43:06very efficient. But one-on-one,
43:08it would have an effect
43:10certainly on the invention.
43:12And that's tough. Didn't do it.
43:14Tough to implement.
43:15But we all had that.
43:18When we call out,
43:20we have a physical.
43:25Yeah, I think I I agree with
43:27you and I think it is hard.
43:29It's hard to you have to figure
43:30out how to say it so the person
43:33doesn't just shut down and get mad.
43:37Yeah. So I was Rita.
43:43Hi, I'm Melissa. I'm an M1.
43:46I was wondering, you talked a bit
43:48about your own transition between self
43:50help and then looking or self help and
43:53then looking at more systemic issues
43:55and also the dodgy Jackson decision.
43:58And I was wondering if that the
44:00conversation you've been having moving
44:02to static issues is more difficult
44:05or more challenging in reproductive
44:07justice versus other health issues
44:10inherently because reproductive justice
44:12comes at intersectional identities.
44:14So have you seen those same conversations,
44:17have less push back and let's say
44:19like cancer and other identities
44:21or different things like that?
44:23That's interesting.
44:24I think with reproductive justice
44:31it's too old because people,
44:32I'm not a doctor,
44:34but it's so personal having a baby.
44:37You know what I mean?
44:38It's like people are really scared
44:40because they know what is going on with
44:43maternal mortality and black women and
44:46are saying I don't want to have a baby,
44:48which is not a conversation that I want
44:52to continue, you know what I mean?
44:53I don't want to advance that.
44:54I want to say in a self help way,
44:57you have to take really good
44:59care of yourself.
45:00Of course you may have to
45:02bring someone with you, you.
45:03There's certainly there's a
45:05rise of social justice doulas.
45:08Maybe you need you can get one of
45:10those and who won't charge you.
45:13And it's really interesting.
45:15But I find that talking about
45:18reproductive justice is such
45:20a basic broader lens and gets
45:23the conversation away from the,
45:26you know,
45:27sometimes toxic debate around abortion
45:29when you're talking about just you know,
45:32you're speaking about it more broadly.
45:34Is that what you were kind of thinking about?
45:37Yeah.
45:37I I really was trying to understand
45:41if people are more open to having
45:44systemic conversations about
45:45institutionalized racism with other
45:48kind of health challenges more or less
45:51than they are with reproductive health.
45:53I think I was asked to speak
45:55about breast cancer recently,
45:57and I find that one hard because
46:00it's so unclear why black women
46:03get that really aggressive,
46:05you know,
46:05form of breast cancer.
46:06So I kind of backed away from that
46:09because I didn't like I I think
46:12reproductive justice not in maternal
46:14infant mortality is clear to me.
46:16Breast cancer,
46:17I don't quite know why that is.
46:20I'm working on a story right now
46:22about black women in hair relaxers
46:25and cancer and it's super interesting,
46:27but also it's been working on it for
46:29like 9 months because it's hard.
46:31This isn't all about, you know,
46:32this is not so much about my,
46:36what I know most about,
46:37which is sort of having racial
46:40health disparities come in
46:42three-way because of three things.
46:44One is the weathering effect
46:47and discrimination in society.
46:492 is discrimination in the healthcare system.
46:52And then three is discrimination,
46:55state sanctioned segregation that
46:56has made black communities and other
46:59communities of color less helpful.
47:00So those are my better areas,
47:04but some areas are harder.
47:05And I try not to step too far out of
47:08my comfort zone as I'm not a physician and,
47:11you know,
47:12I'm not a researcher.
47:13So it takes me a long time to
47:16understand things and to make sure
47:17that what I'm saying makes sense.
47:23I just want to give another,
47:24ask another question or
47:25a question from the chat.
47:27And this is from Julie Rosenberg,
47:28who's a pediatrician. A researcher.
47:31She wrote that she recently learned
47:33that in Texas were there new laws
47:34against EI in education,
47:36Pediatrician was told she should
47:38remove prereadings about the history
47:40of segregation and medicine for her course.
47:42She may decide to risk her job to keep it.
47:45What has been happening for your work in
47:46the setting of this type of censorship?
47:48What do you think we can do
47:49about this for you in censorship?
47:52This is real.
47:53I'm the most positive person ever.
47:56And last year around this time I went
48:00to ADEI in education conference.
48:02So this was the people who were the
48:05DEI representatives at colleges.
48:06And they were so afraid.
48:09And I'm thinking, wow,
48:10they're really so dramatic.
48:11They're really talking about this.
48:13They're so scared.
48:14Now I see exactly what they're talking about.
48:17And there has been so much pushback.
48:20And there's this guy,
48:23Stanley Goldfarb.
48:24Yeah.
48:25And he it's so funny because I interviewed
48:28him two years ago and he was just like,
48:31he just sounded kind of crazy
48:32and took my call.
48:33He didn't know who I was.
48:35He's telling me that maternal
48:37mortality is completely overblown
48:38and not that many people die and
48:40we shouldn't be focusing on this.
48:42And you know,
48:43I didn't enjoy interviewing him,
48:45but now I next thing is he has this
48:49book and now he has this organization
48:51called Do No Harm and he's been
48:54recruiting more and more people,
48:56more and more positions,
48:57mostly to his organization.
48:59I'm pitching a story about this
49:02because it's getting really big and
49:05I am scared about what's happening.
49:08And I think this group of people
49:10who are pushing back against,
49:12you know,
49:12sort of the the progress we've made
49:15by talking about these issues have
49:19gotten much stronger and much louder.
49:22There was just, I think it was the ER docs.
49:27The ER docs have.
49:29I think it it's it was just,
49:32it was Tuesday,
49:33it was their annual convention and
49:36there was a Doctor Who was on the
49:39Mainstage who was talking about,
49:41you know,
49:42like we shouldn't be having
49:44these conversations.
49:45And he had,
49:46he's also a A a politician of some sort.
49:49And he introduced a bill that was saying
49:52you can't have this conversation anymore.
49:54So the ER docs were protesting.
49:56Why does he have to be on stage?
49:58And the head of the organization ironically,
50:01is a black woman who said,
50:02yes, we want to have him there.
50:04But I was reading about this.
50:05I wanted to go,
50:06but I was like,
50:07I had to teach that day and it was
50:10in DC But I think this has gotten
50:12much more aggressive to say please.
50:15You know,
50:17Doctor Goldfarb's editorial was
50:21take two aspirin and call me
50:23by my by your pronouns.
50:25And then the other one,
50:26his other editorial the Wall
50:29Street Journal loves him,
50:31was about how students are so busy being.
50:34I'm just using so many quotes woke that
50:37they aren't learning how to treat COVID.
50:39And because they're not,
50:41they're so focused on social issues
50:43and they're going to be bad doctors.
50:45And I was like, really?
50:46Oh my goodness, this is so insulting.
50:50But this? These voices are getting stronger.
50:54My friend who works at the AMA
50:56said she wrote a piece in the
50:58New England Journal of Medicine.
50:59You should look it up.
51:01Althea Maybank.
51:02Dr.
51:02Maybank is does help equity and she
51:05wrote about this push push back
51:09against DEI in medicine and she's
51:12herself gets death threats.
51:22Sure I'll do the 11 other one
51:23and then maybe we have time
51:24for one more line question.
51:28This question is why do you
51:30think race is still being used
51:31as a factor
51:32in formulas such as the vaginal birth
51:34FT section even though it's known that
51:36there's no biological market for race?
51:38How can perspective physician's best work
51:39towards changing this?
51:42I think that it when something gets
51:46entrenched and I think that whole C-section,
51:50the EGF, the kidney function,
51:53the spirometer and the pulmonary function,
51:56these are old.
51:58In the 1619 project I traced back the,
52:01you know, the fact that the the
52:03idea that black people have reduced
52:05lung function may have come from
52:08Thomas Jefferson was definitely
52:10popularized in medical journals and
52:14in medical practice and education in
52:16the 1800s by a physician who was the
52:19first person to use a spirometer.
52:21So if this just keeps not getting changed,
52:25it just keeps moving along.
52:27And you know if I'm still debating a
52:30position about lung function last week,
52:33this is very entrenched which is,
52:37but I think that it's there's been
52:39movement certainly some of the
52:41medical societies are saying please
52:43stop correcting for you know,
52:45kidney function, please stop correcting,
52:47we need to stop correcting this.
52:50One of my favorite things was I
52:52was speaking at the Columbia School
52:54of Nursing And so this instructor
52:56raises her hand and she says I this
52:59is the textbook I use and so much
53:01of it is not correct.
53:02And it had the EGFR correction and it
53:06had the long auction correction and so
53:09she held up the textbook and it was read.
53:11She said, I just scratched this
53:13stuff out and keep teaching.
53:15Why don't you just get a new textbook?
53:16And she said, oh,
53:17so I get this whole, you know,
53:19it's very hard to revise the textbook.
53:22It's really expensive that
53:23you don't revise that often.
53:24You update,
53:25but you don't make big revisions
53:27because it takes a lot.
53:28So I think some of this is just
53:30embedded and it's hard to shake it out.
53:32OK,
53:42And into these years. My name is Rita.
53:44I'm a first year pass.
53:47Well, I thought student and I
53:50was just wondering while you
53:51do all of this thing for you,
53:52if you ever decide is something
53:56And so I don't like this, you
53:59just keep going. Like as
54:00you hear story after story,
54:02I I can imagine it just takes
54:06advantage. I think that, you know,
54:09people have like a kind of a
54:12thing that they're good at.
54:14I'm good at this thing,
54:16so I'm good at not having this. Literally.
54:19The name of my book is Under the Skin.
54:22It doesn't really get under my skin.
54:24It's more like a mission,
54:26Like I don't get upset.
54:28I see, you know, other people when
54:31they're doing this kind of work,
54:33getting really super upset.
54:34And, you know,
54:35it's it's kind of like medical providers.
54:37In the same way,
54:39you can't fall apart when you're
54:41when someone's ill and you feel bad,
54:44and I just don't do that and I
54:47just really do this thing well.
54:49The other thing is I'm really
54:52into two things,
54:53soccer and fishing and on the all
55:00genders intergenerational soccer group.
55:02I am quite competitive and good and crazy
55:06out there, running off all my energy.
55:09And I'm also really into fishing.
55:11And last week I was at the
55:14University of Colorado.
55:15I was with no Colorado College.
55:18I was with Rita Sharon,
55:20who is the mother of narrative medicine,
55:23Wonderful woman.
55:24We did a panel together and
55:25we were together for two days.
55:27It was really intense.
55:28And afterwards I stayed two extra
55:30days and I went trout fishing
55:31and I killed it and I had a
55:34hiking and I just felt great.
55:37So I am one of those people
55:40who takes good care of myself
55:42in the ways that nourish me,
55:47the poor fish. But I had a good time.
55:51I think it's a wonderful way to think. So we
55:54all need to, like, burn off some stress
55:56at some point or get into nature.
55:59And this was so wonderful. Thank you.
56:01We're so appreciative in your busy schedule,
56:05but you've found time for us
56:06here. Of course. Thank you.
56:08Thank you for listening.
56:10Thank you for reading.
56:11And it was funny when you said no,
56:14You had just finished my book.
56:16So on the launch,
56:17my launch was June 2 years ago.
56:20And I had a great launch.
56:22It was at a church and my best
56:25friend was the moderator.
56:27And so she's so funny, she says.
56:29Who in here has not read Linda's book?
56:33Everyone in the front row,
56:35I had my last name, my mother,
56:37both of my children like, pick it up.
56:41Come on, get that book, read.
56:43It was really funny.
56:45So read it as when you can.
56:48Some of it's hard,
56:49but you know, it's
56:50not hard to read. The information might
56:53be difficult to swallow, but it's an easy
56:56read. I mean, you write so beautifully.
56:58It's easy. Well, thank you.
57:00And that was the goal,
57:01to get people thinking about these
57:03issues and to really make change.