Under the Skin by Linda Villarosa is a powerful work of narrative nonfiction that investigates how systemic racism—rather than genetics or individual behavior—drives the persistent racial disparities in health outcomes across the United States. Combining investigative journalism, historical analysis, and personal narrative, Villarosa exposes the deep and ongoing effects of structural inequality on Black Americans’ bodies, minds, and lives.
The book begins by challenging a long-standing myth in American medicine: that racial health differences are rooted in biology. Villarosa dismantles this misconception through rigorous reporting and case studies, showing that social, economic, and environmental racism—not genetic predisposition—creates and sustains unequal health outcomes. From maternal mortality to chronic illness, she traces how centuries of discrimination continue to shape medical systems and determine who lives and who dies.
Central to Villarosa’s narrative are the stories of Black patients, mothers, and families navigating a healthcare system that too often fails them. She recounts harrowing experiences of women whose concerns were dismissed during childbirth, resulting in preventable deaths—echoing a national crisis in which Black women are three times more likely to die from pregnancy-related causes than white women. These stories illuminate the human cost of bias and neglect, grounding the book’s larger critique in lived experience.
Villarosa also examines the experiences of Black physicians, researchers, and public health experts who fight to expose systemic injustice while operating within institutions shaped by it. Their work underscores a central paradox: that progress in medicine often coexists with enduring racial prejudice. By drawing connections between contemporary inequality and historical practices—such as forced experimentation on enslaved people and eugenic medical theories—Villarosa situates today’s injustices within a long continuum of exploitation.
Throughout the book, Villarosa explores the concept of weathering, a term coined by public health researcher Arline Geronimus to describe how chronic exposure to racism erodes the body over time. This insight transforms the discussion of race and health from one of individual responsibility to one of collective accountability—revealing how the constant stress of discrimination physically manifests in premature aging, disease, and mortality.
The book’s structure moves between historical documentation, scientific research, and narrative testimony, mirroring the complexity of the problem itself. Villarosa’s writing blends clarity with moral urgency, urging readers to recognize how racism is literally “under the skin”—embedded not only in institutions but also in the physiological toll it exacts on those forced to endure it.
In the end, Under the Skin is both exposé and call to action. Villarosa reframes the American healthcare crisis as a moral reckoning, demanding that medicine confront its own history and that society acknowledge racism as a public health emergency. By connecting past injustices to present realities, the book insists that healing—individual and national—can only begin with truth.
