On Wednesday afternoon, doctors, medical students and other health care professionals packed into the Yale School of Medicine’s Fitkin Amphitheater. The over 100-person crowd gathered to listen to Linda Villarosa, contributing writer for the New York Times and The Root, speak on “Race, Inequality and Health of Black Mothers.”

In the talk, which was sponsored by the Poynter Fellowship in Journalism and the School of Medicine’s Department of Pediatrics, Villarosa — who is also the director of the journalism program at The City College of New York — discussed how systemic racism faced by black mothers leads to physiological stress. The stress then contributes to poorer health outcomes among black mothers and black babies, including lower birth weights and increased infant mortality, she said.

“This is clearly the problem of a broken system and part of our American legacy and shame,” Villarosa said. “We don’t have to go back to the ’30s and ’40s to talk about discrimination in health care.”

Villarosa began her talk by sharing hard-hitting facts: Among wealthy countries, the U.S. spends the most on health care but has the lowest life expectancy and highest infant mortality rate. Additionally, it is the only wealthy country where pregnant women death rates are on the rise.

In particular, African-Americans have poorer health outcomes than other ethnic groups — a theme that has been constant throughout history. For example, the health of black mothers in the U.S. is on par with some of the poorest nations. Black mothers are 3.3 times more likely to die from pregnancy- or childbirth-related reasons than their white counterparts, while black babies are 2.3 times more likely to die than white babies.

In fact, according to Villarosa, the infant mortality rate is higher now than in 1850, when black women were still enslaved. It is “simply wrong and shocking” that 4,000 additional black babies would be alive in 1850, she said.

Even when income, insurance status and socioeconomic status are controlled, black women suffer worse health outcomes. A black woman with an advanced degree is more likely to die or lose her baby than a white woman with an eighth-grade education or lower, Villarosa added.

According to Villarosa, long-standing societal racism, pervasive discrimination and dismissal of concerns in a health care setting are responsible for this phenomenon, impacting both physical and emotional health.

Villarosa specifically cited an example from Columbia professor Lynn Freedman. Just six months ago, when a patient in active back labor squatted in the operating room, a health care professional told her to “get up off the floor because you look like you’re in the jungle.”

“It’s not race; it’s racism,” Villarosa said.

Citing a 1997 study of 59,000 black women, she noted that women who reported the greatest experiences of racism had higher rates of preterm birth, obesity, diabetes and other conditions.

In addition, the accumulation of psychological stress from systemic racism leads to chronic physiological stress in the form of repeated incidence and prolonged elevation of stress hormones such as cortisol, which Villarosa said compromises essential body functions due to its toxic nature.

Villarosa also spoke about her own personal experiences. When she was pregnant in 1996, she had an intrauterine growth restriction that required her to induce the birth of her baby before her due date.

“The neonatologist asked me: When was the last time you did cocaine or crack cocaine?” Villarosa said, “I replied: What is crack cocaine? I’m the health editor of Essence!”

The shift toward racism as an explanation for those poorer health outcomes is also seen in research done on health outcomes of immigrants. A year after the largest U.S. immigration raid in Iowa in 2008, a greater number of Latino infants had low birth weights than in the year prior to the raid. In another study, researchers found that mothers of Mexican or Central-American ancestry had smaller babies after the 2016 election of President Trump, according to Villarosa.

“We can’t doctor our way out of problems … but I’m very cheered when talking to medical students,” she said on the topic of potential solutions.

For example, she noted, students from the University of Vermont’s medical school are pushing for more racism and bias training to update their curriculum.

In 2008, Villarosa’s first novel, “Passing for Black,” was nominated for a Lambda Literary Award.

Ann Hui Ching | annhui.ching@yale.edu