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When Equal is Not Equitable with Linda Villarosa

Linda Villarosa is a brilliant storyteller, a journalist author, editor, and educator. She's a New York times magazine contributing writer where she covers race, inequality, and health. She joins us today to talk about just how far our public health system has to go on issues of equity and inclusivity.

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Linda Villarosa is a brilliant storyteller. In addition to her work as a journalist, author, editor, and educator, she’s a New York Times Magazine contributing writer where she covers race, inequality and health. You may have come across her 2018 cover story for the magazine titled ‘Why America’s Black mothers and babies are in a life or death crisis,’ which was nominated for a national magazine award.

It was that article that first prompted us to reach out with Linda to participate in a Mission Forward. She returns to us today because of a story she recently published called ‘Black Lives are Shorter in Chicago: My family’s history shows why.’ Reading that story, a very personal account of her own family’s journey through Chicago transports the reader through time, while reinforcing some of the most essential public health issues of our time.

As you’ll hear in this episode, this country has turned an important corner on the fight against COVID, a fight to return some semblance of life as we once knew it, with an approach of equality. But we do not suffer, nor do we heal equally. This is a fight which must be waged equitably, acknowledging the decidedly unequal contributions to our collective suffering shouldered by Black and Brown people in this country.

Linda Villarosa is uniquely experienced to help Carrie Fox and Natalie S. Burke navigate this conversation, confronting just how far our public health system has to go on issues of equity and inclusivity.

Links & Notes


Episode Transcript

Carrie Fox: Welcome to the Mission Forward Podcast, where each week we bring you a thought provoking and perspective shifting conversation on the world around us. I’m Carrie Fox, your host and CEO of Mission Partners, a social impact communications firm and Certified B Corporation. A lot of people listening to this episode will know the name and the work of today’s guest. But for those who don’t, Linda Villarosa is a brilliant storyteller, a journalist, author, editor, and educator. She’s a New York Times Magazine contributing writer where she covers race, inequality and health. Her 2018 cover story for the magazine titled, Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis was nominated for a National Magazine Awards. And it was that article that first prompted me to connect with her, to participate in a mission forward conversation we had a few years back, I invited Linda back to Mission Forward because of a story she recently published called Black Lives Are Shorter in Chicago. My Family’s History Shows Why. Reading that story, a very personal account of her own family’s journey through Chicago transported me through time, but it also reinforced some of the most essential public health issues of this time. And just as this episode is being released, folks across the country are trying to make sense of new CDC mask guidelines. And it’s clear just how far our public health system has to go on issues of equity and inclusivity. I can’t think of many folks better than Linda, especially paired with our cohost Natalie Burke, to dig into this conversation. Stay tuned. Like many reporters you have spent the last many years digging into public health disparities, but I will say your reporting is unlike any other. You draw people in to your narrative and your story. I have often said that any work of Isabel Wilkerson should be required reading, but I would like to go on the record to amend that and say that any work of Isabel Wilkerson’s and Linda Villarosa’s should be require reading.

Linda Villarosa: Well, thank you for packaging the brilliant Isabel Wilkerson with me and one of the books that’s holding up my computer is The Warmth of Other Suns because I have two copies. So one can just be near me all the time.

Carrie Fox: But it’s true. Your article, the article that came out in, it was the April, the most recent edition of the New York Times Magazine, Black Lives Are Shorter in Chicago. My Family’s History Shows Why. Gosh, it felt like an extension of Isabelle’s writing and how much you brought us in to this journey with your mom and what an amazing journey through Chicago and through time that was. And I’d love you just to tell us a little more about that.

Linda Villarosa: Well, thank you for that question. My mother and I have been doing a little bit of a journey for the past few years, and we went to our family reunion in Mississippi, I guess, two summers ago. And we drove through the various towns where our family had migrated from, from Mississippi to Chicago. And it was really moving for me. And that really stuck with me. Then last year, we went to Chicago where I lived until I was 10 and our family moved, but seeing my mom where she was raised and where she settled, was settled with my father when they were first married was very moving and to see how much of that community was gone. So I never would expect a community to look exactly the same, but to see so much of it disappeared from this sort of nostalgic look and feel that she had given me and reminded me of was alarming. Then when I saw that the largest racial gap in life expectancy was between the community where she went to high school and the neighborhood nine miles north was shocking. So it was sort of all synthesized when I saw that number. And I thought, "How could people live 30 years less in the same large city, nine miles apart?" And that’s what really shaped that article for me, my own family experience and the number.

Carrie Fox: Natalie, I may ask you to prompt and stepping here, because this is what we were talking about this morning of this disparity.

Natalie Burke: Working and moving in public health circles, I am often frustrated and Carrie has heard me talk about this, about the narrative as to why those inequities exist. And I would love to hear you talk a little bit about what you think the narrative is and what you actually think it should be with regard to those inequities in black health.

Linda Villarosa: I feel the same frustration and I’ve spent a long time sort of behind the scenes or between the lines trying to fight against the narrative that black communities and black people have poor health outcomes, because we’re all poor, uneducated, don’t care, it’s our fault. It’s your fault that health and wealth are related and since your communities don’t have wealth that it’s your fault. So with this story, I spent a lot of time showing what happened to that community and those communities in Chicago. That was not our fault, that was institutional and structural racism that it started quite a while ago. And it destroyed communities. And when a community loses wealth, it loses hope, there’s no chance to own your home, it’s stubbornly segregated. That’s when the health outcome shows up and there’s a lowered health outcome that ended with lowered life expectancy. And that also ended with a lot of COVID. When COVID happened, it really struck that community. And the beginning narrative of COVID was, "Oh, it’s a virus. It doesn’t discriminate." Well, like you, all of us in public health know that viruses do discriminate. And of course you can say those words, but there is a lot of explanation that goes on behind that.

Natalie Burke: This balance, delicate balance between what we talk about as social determinants of health and this idea of personal responsibility and the way that we even view what health is and how health happens. So I would love to hear you talk a little bit about what do you think we need to do to shift people’s consciousness about the production of health? How do we get people to get that piece of it?

Linda Villarosa: I’m not sure because a lot of us have been spending a long time trying to do this. So my maternal and infant mortality story in 2018, I wrote that with the idea to show, this is a problem of race. Okay? It not has nothing to do with poverty. Poverty makes everything worse, but this race on its own is killing black mothers and babies, even middle-class and people with advanced degrees, women with advanced degrees like myself can have a low birth weight or preterm birth baby, which raises the risk of infant and maternal mortality. So that’s what I was really trying to show in that story. And then in this story, I was trying to show that the social determinants of health, that in Inglewood and other communities on the south side of Chicago, they lack healthy food, they lack safety, they are very segregated. People don’t own their own homes. It’s hard to get a job. Jobs have gone away. There’s pollution. The environment itself has been destroyed in many ways. And that affects health outcomes and life expectancy. So then I try to take it a step [inaudible 00:08:48] to say, "Well, if the community is red line, then it gets systematically destroyed. If the community like my family, 75% of black people bought homes on contract where you had no equity, you didn’t really own it, you could lose it at any time that destroys people’s… The big asset that people can have is their home." So if you can’t own a home because of the systemic problem it started a century ago, then it’s really not people’s fault. And I usually don’t read the letters. I kind of sneak and do sometimes, but they really annoy me. And many of the letters on this story were about, "Well, their personal responsibility." Somebody was talking about genetics, vitamin D, all these things. And I’m like, "Did you not read. This is crystal clear?" If you don’t have the resources and the assets in a community that encourage good health, then health declines, and that is intertwined with wealth and money. So that’s what I tried to show in the story. And I just tried to show it through this sort of lens of my family and lens of people I knew, including Eric Whitaker, who is President Obama’s really close friend, we have the same experience. Our families came from Mississippi. His mother was a single mother, a nurse who scraped her way to send her son to medical school. And he went back to the community to help out. And he realized, "No matter what I do here, the wealth has to change. There needs to be a new investment in this community. Otherwise, the health status isn’t going to change."

Carrie Fox: How much of this history of your family did you know before writing the story?

Linda Villarosa: I knew a lot of it, but my mother built in many blanks and she had been doing that beginning with our family reunion and sort of getting an ancestry.com page. But she really filled it out. Also, I’m a person that likes to see a thing. So when we went back, I remember our house, I remember my elementary school, but I had never seen her elementary school. So she often talked about the importance of going to this wonderful elementary school, Betsy Ross, and that she went with Lorraine Hansberry to that school. So then to go back and see it boarded up and just a shadow of itself, it was sad, the paint chip and this special place where not just my mom, but the playwright, Lorraine Hansberry, that’s where they went, that’s where they learned. I had her Inglewood High School yearbook. So I looked at her page and there she was Clara Alexander. And then turn a few pages there’s Lorraine Hansberry. And then we found out [inaudible 00:11:36] also went to that school. And then I have a really close friend of mine who’s also from Chicago, lives in LA and I said, "Did your dad go to Inglewood High School? I see [inaudible 00:11:49] in the yearbook." So there’s a lot of us who followed that South Chicago trajectory, but to see what has happened to a place that was a promised land for so many is really sad to me.

Natalie Burke: When you talk about Inglewood, you touched on this at the top, but to give folks a little more context that in Inglewood, very specifically in the Streeterville neighborhood, nine miles north of Inglewood, 73% white residents live on average to 90 years old. In Inglewood where nearly 95% of residents are black people live to an average of only 60. Natalie was commenting on this this morning around how we think about how the CDC guidelines, how the US responded to COVID, how they thought about who is eligible immediately for the first vaccine and they started with individuals over the age of 75. And what that meant right at the top about who was forgotten or left off of the ability to have access to that vaccine.

Linda Villarosa: I also think it’s important to note that we know that black people in the United States end up with worst cases of COVID younger. So in other words, if you require hospitalization or you die from COVID, for white people, the bulk of the cases are in the 10 year older age than they are in black people where it’s 10 years younger. So we have worse COVID cases at a younger age. So right there, you’re seeing the results of how this works. And I also think if you have a community where there aren’t a lot of health resources, because the community has been stripped, then you don’t have a lot of clinics to get testing. You don’t have a lot of testing sites. So then you don’t even know that you have COVID and then on the flip side, then you don’t have treatment, a lot of treatment in your community if you don’t have good transportation. It all is a spiral. And then the vaccine, African-Americans without a doubt and justifiably have had vaccine hesitancy, it makes people nervous because we don’t trust the healthcare system, not because of Tuskegee or whatever, partially because of that, because what happens to you in the current healthcare system. We know that there’s racism, there’s discrimination against people of color, especially black people. So the hospitals have closed health, healthcare clinics had closed. So then you don’t have a lot of resources to even get a vaccine. So it all sort of adds up. So it’s no wonder that there’s a number that shows this 30 year gap in life expectancy.

Natalie Burke: Well, I also think when I looked at the CDC recommendations and Phase 1a was for your first responder folks and people who were living in care facilities. Well, what do we know about who is disproportionately underrepresented in long-term care facilities because of socioeconomic status, but also because of cultural decisions about where we care for seniors. So what’s the likelihood that black people were going to be vaccinated older, black people were going to be vaccinated in Phase 1a and then for 1b to be 75 and older and life expectancy pre COVID with 74.7 for black people. So you’re saying 75 and older, well guess what? A lot of black people are already dead. And the fact that chronic conditions and that piece that you talked about 10 years younger makes so much sense because chronic conditions are kicking in at a younger age. So they took a very equal approach, but there was no equity lens analysis on how they set those phases. And to be honest about it, it seems as though state by state life and death was being decided because some states said, "Well, CDC says this, but guess what? We’re going to drop the bar." So do you have any reflections about how that policy or how those policies have rolled out and what have you noticed or heard even with regard from state to state.

Linda Villarosa: I am really impressed with the way you laid that out and it’s very true. And this isn’t a conversation that often happens. And I think it’s really, really important what you’ve said. And I think how it rolled out. Well, first of all, you’ll remember who was the president at the time. So at the top, there was complete chaos. And I was surprised at how bad it was. And I went back, I was reporting about New Orleans, the Zulu club, and how many of those wonderful group of black men were dying of COVID or getting really sick from COVID and many of them dying. So I looked back at what was happening at the top in the Trump administration and our offices of public health, and it was chaotic, it wasn’t coordinated. So then it became a state-by-state situation. And it also is political, that personal responsibility lens, it depends on the state. And you were seeing that in a lot of states where it’s like, "Well, why should we shut down? It’s your fault that you’re getting sick." And that was the fear. When the first statistics about racial disparities in COVID came out, there was so much fear, it’s like, "Oh, this is going to be used against us." And that’s exactly what happened. And even you remember is the idea that there are these underlying conditions. Underlying conditions became almost a dog whistle that it’s like, "Oh, it’s your fault because you’re not taking care of yourself. And it’s your fault because you have diabetes, it’s your fault because overweight. But why should we be punished because we have more self-control, we have more education, we know how to take care of ourselves? And I cannot tell you how enraging that was and hurtful.

Natalie Burke: Well, because part of it too, and as I’m listening to you talk about it if you had a blood pressure cuff on me, I’m sure you would see the numbers ticking up. Because in that there’s almost this underlying message that black people are genetically inferior and black bodies are broken. And black bodies are not broken. So when we look at infant mortality and maternal mortality, and sort of bringing it back, it’s the same type of thing, this idea that there’s something wrong with black women’s bodies and that’s why we see the infant and maternal mortality. And there’s no little to no consideration for these larger things. It does a disservice more broadly, but it does a disservice within the minds of black people about their own health and their own expectations with regard to health. Right. So I don’t know if you’ve encountered it or not, but it’s almost as though sometimes I encounter black communities where I’ve worked and even, especially in Mississippi, where I worked extensively, where it’s almost like, "Yes, I’m going to be diabetic. Yes, I’m going to be hypertensive. That’s just the way things kind of happen here. And it becomes this expectation." What do you think is necessary to change that mindset so that black people recognize that there is something else available to them?

Linda Villarosa: I think the first thing when I have this conversation that I want to say, and this is not anything you don’t know, but just to say it out loud, that everyone here, all three of us understand and we know that it’s really important to take care of yourself. It’s really important to eat right, it’s really important to do your best to exercise and to be engaged with the medical system. These things are all really important to deal with our stress. And that must be said and it’s a given. But most of us know that, and sometimes when I hear this sort of personal responsibility lens, it’s like, "We know that." This has been the drum beat, and your doctor will tell you that, your friends will tell you that, everyone knows that your family wants you to stay healthy. But this other thing is really under reported, it’s under talked about, the idea that something else is going on that it is not a genetic defect. This has been proven time and time again by scientists and that this is not all our fault, that there is something going on in our society itself that where there’s a way, the bodies of those who are discriminated against and treated badly, and that there’s something that happens in the healthcare system that’s unfair, that treatment is unfair, that we live in less healthy communities which is not our fault. A. So these conversations, I think it helps if people understand the larger context. And I do talk, I teach at a college with mostly black and brown kids and first day I can hear them saying, "Well, in my community, people, this and that, they don’t take care of themselves." And I’m like, "All right, we’re going to start from a different [inaudible 00:21:09]."

Natalie Burke: Mm-hmm (affirmative).

Carrie Fox: I’ve heard you both talk about this. And I would like to pause and go one layer deeper on it, on the concept of weathering, accelerated aging by the effect of racism, the role that our environment plays on us. I’d like you both to talk a little more about that, because I do want to reinforce the importance of that point in reality.

Linda Villarosa: Well, Natalie, I’m not sure what your lens of it is, but mine is through Dr. Arline Geronimus who is a professor at the University of Michigan. So she coined the term weathering to refer to what the lived experience of being black in America. Most of her scholarship has been around black women and infant mortality. But it’s the idea that because of everything from hardcore discrimination to the microaggressions that you have to deal with day in day out, and anything that makes life worse, including being poor causes even more harm. But that weather’s a way the systems of the body so that you have a kind of a premature aging. So at first her ideas when she was first talking about them, mostly in the 90s, she was roundly criticized. But now, because we see what’s happening with COVID, we see these life expectancy, this divergence, people are much more interested in open to her really wonderful, smart theories. The flip side of weathering is the resilience of black and brown people to say that, "Although our bodies get weathered, we also weather the storm like a house in a storm." That’s why I love her work, because it has this these twin themes of being hurt by what happens, but also being able to survive it.

Natalie Burke: Well, t’s funny because Carrie will tell you I’m a little bit fixated with this whole thing around language and the power of language, the importance and the value of language and narrative. And in the book Words Can Change Your Brain, they talk about how oppressive language over time actually creates that weathering effect. And in fact, it has the ability to turn on genetic expression for chronic disease illness and early death. And one of the things that as time goes on, what I recognize is that how we talk about black and brown populations, how we label black and brown populations is also problematic. The language, even the word vulnerable, which this is one of the things that I talk about all the time. I was in Mississippi in a Saturday program in Sunflower County and I had a twelve-year-old say, "Why does everybody come in here and keep calling us weak?" And I said, "I never said you were weak." And she said, "But you said vulnerable and vulnerable means weak. That’s the synonym." Okay, from the mouth of babes. So let’s not label people and let’s figure out what it means to actually change the language and change how we think and talk about these things. So I really appreciate the idea even of weathering more broadly, because it comes through microaggressions. It comes through the commentary on hair, or how articulate we are. It comes through when you’re in the store and you’re being followed, it comes through when you’re looking for books for your children and can’t find ones that are representative of your kids. And it’s throughout the course of a lifetime. And the fact that that’s passed from generation to generation, whether you’re talking about generational trauma or whether you’re talking about that stress, that allostatic load and how that then manifests one generation to the next, that’s real, the science exists to support it. I think what we have to figure out how to do over time is how to make that science accessible to people who don’t do what we do and who don’t read what we read so that it’s easier for them to incorporate into their conversations and into the way that they understand the world.

Linda Villarosa: I love that. And that’s what I like about the term weathering, it’s easy to understand. And I remember the first time I heard it from, I was interviewing Dr. Geronimus and I said, "I don’t really know what that’s like for me." So she took me through it. She said, "Aren’t you in an assistant professor at a college?" I said, "Yes." And she said, "Well, you’re like a little old to be assistant professor." I was like, "Okay. Yeah." So then she said, "Who is your supervisor?" I said, "A white man." "Who’s his supervisor?" "Oh, a white man." "Who’s his supervisor?" I said, "Oh, Oh, white man." Then she said, "Well, tell me about your students." And I told her about a lot of my students I’m not never going to call them vulnerable again, but they have many struggles. And then she said, "You have to be a mentor for all those students." And then she said, "What about your level? How many people of color in your department?" "It’s like so few." "And how do you deal with them?" So she started talking about this and she said that is high effort coping, because you’re lifting up a lot of people, you’re having to deal with people above you who are not the same as you and I had told her a few little microaggressions. And then when she sort of laid it out and made me feel that during an interview, I felt teary because I felt kind of understood by her. And it felt like, "Yeah." And I had had a conversation with a colleague who said, "There’s no such thing as microaggression. I don’t believe in microaggression." And I had to spend my time explaining this to her. And I said, "I want to tell you something. As I’m having to explain this to you, I feel my face getting hot, I feel my heart beating, my heart is racing. I can tell my pulse has gone up. This is what microaggressions are doing for me, your colleague and your friend. That is how real it is. I can feel the physical effect of having to explain this to you, who should already know it because you are a professor at a college of predominantly people of color."

Natalie Burke: Wow.

Linda Villarosa: So you should know this. And then I’m like, [inaudible 00:27:20].

Carrie Fox: Yeah, Linda, thank you for sharing that. And to both of you, I know we’re coming to the end here, but I need to acknowledge that, that what you just said and what both of you have shared over the course of this very quick time together reinforces why we do this. Right? If we think about what we can do by first deepening people’s understanding often through story and real life experiences, we can drive and change actions. And that’s why Natalie and I do the work that we do that so much of this comes down to a lack of understanding and empathy for one another. We’ve lost so much of humanity, not just through COVID, but over time in our society. And I just appreciate the work of both of you so much for bringing that front and center.

Natalie Burke: I definitely, I would say, also Linda and I wanted to make sure I paid you the compliment in reading your article one of the things and language is important to me, it was beautiful. It was beautiful and it felt affirming. And we need more of that. So I just really appreciate that you were able to marry that with the facts, and the data and the information that tells a story in a way that is comprehensive and accessible, but relatable, because as I was reading your story about Chicago, I was thinking about Queens, New York, where I grew up in a multi-generational household, with Jamaican immigrants and what my street looked like and what my elementary school was locally looking like and how that community and neighborhood has changed over time. So I just wanted to make sure that I actually fan girl do a little bit, just to say, I really appreciated it because in reading it, it felt like echoes of my own past and my own history. And actually, I think it’s a great teaching tool in a sense of being able to have conversations about these things in other communities. So just thank you for that.

Linda Villarosa: Thank you. I appreciate it. And you can talk to people and [inaudible 00:29:20] good with numbers, and good with science, but in order to really have people truly understand, you have to make them feel something. So that’s what I try to do is marry the two sides, I guess, of everyone’s brain to say, "I want you to know something, but I also want you to feel something." So that’s what I try to do with my work, not just to say, "Here’s what I need you to know through science." It’s like, "Well, here’s what I need you to feel and to have empathy and to have compassion for other people." So thank you for recognizing that. I really appreciate it.

Natalie Burke: And it’s a big part of what we missed in this whole COVID journey, what you just said, that empathy and human connection, that willingness to care about your neighbor and your community, and to do the things necessary to support each other through this, I think was lost early on, unfortunately. And I think we paid a really, really high price for it. So my hope is that moving forward pieces like you wrote, conversations like we’re having here, create an opportunity for us to change that moving forward in ways that open doors to new conversations. So just thank you for that.

Carrie Fox: All right. Last question, before we wrap Linda, what can you preview with us about Under the Skin?

Linda Villarosa: Oh, boy. Well, Under the Skin is a little bit delayed because, I guess I started in 2018, it was supposed to be done a year ago, but when I worked on The 1619 Project, I realized I needed to go back further in time. I had planned to start in 1850 around some census data. And then I said, "No, I need to go back to 1619 and talk about the effect of 250 years of enslavement on today’s medical system and today’s health outcomes." Then COVID happened and I ended up getting pulled into writing about it a few times, and also this pandemic informed my own thinking and also supported and validated the thinking and reporting I had done. So it’s going to be a very broad and deep look at health inequality in our country. It’s told through narratives. Some of it is my own. Some of it is other people. Some of it is behind the scenes of some of the stories and what happened after they were published. So I’m very excited about this. I have a very tough editor at Doubleday and a really thoughtful attentive agents. So I have a little team of people, but it’s an intense book and I’m excited and happy that it’s almost done well.

Carrie Fox: We look forward to reading it and learning more from you in the process. Thanks, Linda so much for being with us today.

Linda Villarosa: Thank you. What an enriching and nourishing conversation.

Natalie Burke: Thank you, Linda.

Carrie Fox: Thanks for listening to this episode of Mission Forward and especially thanks to Linda and Natalie for joining us. If you like what you heard, please share this episode with a friend and check out other episodes and subscribe. And if you’re willing, please leave us a rating or review. They mean a lot to me and they can help our show grow. Mission Forward is produced with the support of [inaudible 00:32:38] and the Mission Partners team, engineering by Pete Wright. Music this week is Blue by [inaudible 00:32:46]. Thanks for your support and see you next time.

This season, we are taking you on a journey to meet ten people influencing and shaping how we communicate at scale for social change. From advertising executives to coalition directors, news editors, campaign managers, and authors, they're all people who are shaping and challenging the deep power of communication. If you’re working to become a more inclusive and thoughtful communicator, there’s nothing holding you back—except you.

Carrie Fox

Carrie Fox is the founder and CEO of Mission Partners, a woman-owned strategic communications firm and Certified B Corporation that guides high-potential nonprofits, foundations, and socially responsible corporations in realizing their greatest social impact. Since launching her first firm in 2004, she has guided hundreds of organizations around the world to lead with purpose, fueling organizations and their missions forward in new and more impactful ways.