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How COVID exposed racial disparities in all aspects of the health care system


Life expectancy in the U.S. has always been different for white people and Black people. And since the start of the pandemic, that difference has widened. Linda Villarosa is familiar with these disparities. She's a journalist who covers race and health, and she's also had her own experiences dealing with racism in health care. When she visited her father in the hospital while he was sick with colon cancer, Villarosa says she was shocked at what she found.

LINDA VILLAROSA: He was shackled basically to the bed. He had restraints. And I said, mom, what is going on? And she said, your father is really sick. And they're treating him like - and she said the N-word.

SHAPIRO: NPR's Karen Grigsby Bates from our Code Switch podcast talked to Villarosa about how COVID exposed racial disparities in all aspects of the health care system.

KAREN GRIGSBY BATES, BYLINE: I heard half a dozen stories of people who died because they went to the ER and they said, I can't breathe. I'm not feeling well. I - you know, I'm wondering if I have it. And they were sent back home, basically, and then they ended up dead. Is that still happening?

VILLAROSA: Yes. I think it's still happening. I think because we brought some awareness, it's better. But the basic underlying problem hasn't been solved. I am brought to the case of Dr. Susan Moore, who was a physician in Indiana. She went to the hospital with COVID. She is a doctor. So the very system that she was educated in, that she worked in didn't help her and, in fact, may have harmed her. So she said, I have COVID. And she said, I'm in a lot of pain. And she was treated as though she was drug seeking when she asked for pain relief.


SUSAN MOORE: I was crushed. He made me feel like I was a drug addict. And he knew I was a physician.

VILLAROSA: And what really struck me is throughout that recording, her refrain was, this is how Black people get killed.


MOORE: This is how Black people get killed.

VILLAROSA: So she left the hospital, and she died.

GRIGSBY BATES: We've been told that before vaccines, COVID recovery was determined largely by a number of factors that are described as co-morbidities. In the beginning, doctors were saying, well, why aren't you taking better care of yourself? I'm wondering if there's been some nuance now applied to thinking about that.

VILLAROSA: I think that right now there is more of a textured understanding, but I think still the basic problem is, to me, threefold. One is the problem of the health care system itself. Even though there's plenty of resources, there's not enough empathy, and there's discrimination baked into it. The second thing is we live in segregated communities. We live in places that were harmed a century ago, partly through redlining, partly through contract buying in Chicago, where my mother was from, and nobody could really own a home. So these communities are ones that aren't that healthful. In other words, the air might be dirty because they are near a polluting facility.

The other thing is the idea of weathering. So weathering is the idea that fighting against discrimination day in, day out ages you prematurely. Each time an incident happens, it fires up the systems of your body, including your blood pressure, your cortisol, your stress hormones and even your pulse rate. So if that happens over and over and over, as it does in the case of people who are Black in this country, it weathers the body the way a storm might weather a home - knocks the shutters off, chips the paint. If we are weathered, which is a kind of premature aging, then it's not a shock why we would have worse COVID outcomes at younger ages.

GRIGSBY BATES: Another place we see racial disparities is in maternal and infant mortality rates. You actually followed a Black woman, Simone Landrum, into the delivery room in New Orleans. And you describe, beyond the numbers, an issue with how she was treated. Can you tell us about that?

VILLAROSA: One of the things that struck both the doula, Latona Giwa, and I at the beginning was they interviewed her multiple times, and they said, how many children do you have? And she said, I have two children, and then I lost a baby last year. And then they said, oh, how? When was the demise? And they kept calling the baby she lost the demise. And that baby was a little girl who she named Harmony. And when she died, Simone herself almost died. And the labor wasn't going great. Her - the current baby was at risk.

If you know that someone has been traumatized the year before and things aren't going great right now, you should not be calling the baby the demise. She was treated badly, so badly in front of me, and in front of the doula. The three of us were the only Black people in the room in New Orleans. And I saw them, you know, not listening to her, arguing with her, but also treating her very unkindly, given that their job is to care for her.

GRIGSBY BATES: Wow. Are there big studies that pop into your mind immediately when I ask about studies that indicate that bias is a problem?

VILLAROSA: So they looked at amputations for diabetes. Even when everything was equal, Black people were still more likely to get a foot amputated. And so I don't think individual doctors go in being racist. However, somebody made a decision to often cut off the foot of a Black person. And that was the one that really hit me. I just kept picturing that. I'm picturing someone made that decision.

GRIGSBY BATES: COVID shone a pretty glaring spotlight on the just radical inequities along racial lines that exist still in this country. Is there any hope that that illumination has maybe been the starting point for starting to correct some of those inequities?

VILLAROSA: I think there has been movement. I did a lot of interviewing of medical students, and many of them in this generation were politicized by Black Lives Matter when they were in undergraduate college. So then they went to medical school, and they brought that same kind of activism and that spirit with them. And it's very exciting to see groups of medical students pushing back against parts of their education that they say, well, this is old. I don't want to be a doctor like this. I want to confront my biases and not enter the field with them. So, you know, there are bits of hope, but I think we have to just keep this issue on the forefront and not shy away from it.

SHAPIRO: That was Linda Villarosa, author of "Under The Skin: The Hidden Toll Of Racism In American Lives And On The Health Of Our Nation." She spoke with NPR's Karen Grigsby Bates. A longer version of the conversation can be heard on the Code Switch podcast.

(SOUNDBITE OF PHOENIX SONG, "COUNTDOWN") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Karen Grigsby Bates is the Senior Correspondent for Code Switch, a podcast that reports on race and ethnicity. A veteran NPR reporter, Bates covered race for the network for several years before becoming a founding member of the Code Switch team. She is especially interested in stories about the hidden history of race in America—and in the intersection of race and culture. She oversees much of Code Switch's coverage of books by and about people of color, as well as issues of race in the publishing industry. Bates is the co-author of a best-selling etiquette book (Basic Black: Home Training for Modern Times) and two mystery novels; she is also a contributor to several anthologies of essays. She lives in Los Angeles and reports from NPR West.
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