‘Weathering’ Widens the Gap in Racial Health Disparities
Studies have long shown that Black and Hispanic Americans as well as low-income populations have worse health outcomes than the population at large. But theories as to why that is the case have shifted in recent years away from the notion that differences in diet, genetics, and exercise are a central cause. University of Michigan public health researcher Arline Geronimus has long argued that marginalized people suffer nearly constant stress from living with poverty and discrimination, which damages their bodies at the cellular level, a process she calls “weathering.” Geronimus spoke with Spotlight recently about her new book, Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society. The transcript has been lightly edited for length and clarity.
Congratulations on your book. This sounds like a topic that you’ve been working on for some time, so why don’t you give me a little bit of the background and then just talk about the main points of the book.
In many ways, I’ve been working on this for 40 years—not the book itself, but the research that undergirds it. Since I was a graduate student, I’ve been very concerned with inequities in health among racialized, ethnic, immigrant, or other stigmatized populations and across socio-economic classes, including working class and poor White Americans. And early on in this three- to four-decade period, I came to believe that it was a lot more complicated than the usual explanations, which emphasized that individuals in the groups with worse health weren’t eating right or exercising right, or they were having their babies too young, or were too violent and drug addicted. The denigrating term “underclass” was used a lot in those days to describe Black Americans living in historically segregated, disinvested, and high-poverty urban neighborhoods, setting them apart as deviants. And for racialized groups, there was also this idea that maybe it was some genetic predisposition linked to race that undercut their health and longevity.
But my own work suggested that depending on which of those stories you told, you were at best being very incomplete and sometimes dangerously misguided in your attempt to understand the causes or remedies for health inequities. And instead, I started to develop the theory I call weathering—that there are adverse physiological impacts of everyday life on members of communities that have borne the brunt of racial, ethnic, religious and class discrimination or cultural oppression and stigma. As these impacts accumulate over years or decades they corrode or major body systems—including the cardiovascular, immune, metabolic and neuroendocrine systems—and damage tissues and organs down to the cellular level. The consequence of chronic activation of these physiological stress processes is increased vulnerability to infectious disease, early onset of chronic diseases of aging like hypertension or diabetes and the disabilities they induce, and early death. In effect, weathering can make chronologically young adults in marginalized, oppressed, or exploited groups be biologically old. Weathering is a bio/psycho/social process that is activated by toxins and hazards in your residential and work environments, influenced by the personal, cultural, and economic resources you have, by whether you can expect to be treated fairly in everyday circumstances, and can also be fueled by the tenacity you mobilize in the face of all the stressors and barriers you encounter.
And this would largely be under the umbrella of stress?
It would be, but that umbrella is very wide and somewhat vague. A distinction I highlight in the book is between the general colloquial notions of stress many of us have that are manageable compared to the pervasive objective and subjective stressors members of denigrated groups encounter throughout their daily round. Weathering stressors are byproducts of experiencing chronic material hardship, uncertain survival, objective environmental risk, and they trigger biopsychosocial reactions that automatically activate a specific set of physiological stress processes. Without opportunities for recovery all these fists in the face erode, weaken, and dysregulate your body down to the cellular level and literally accelerate your aging and your health vulnerability.
So, stress with very distinct physiological impact.
Exactly.
And presumably, the occupations that many in these groups would be engaged in would also be a part of that and would add physical stress in some cases.
Yes. Depending on what group we’re talking about, there’ll be a whole panoply of stressors, and some of them will come through long, dangerous hours of physical labor or living in communities that are subject to environmental toxins and whose housing is decaying. So, some of the stressors are physical and objective—if it’s pollution, it’s literally in the air—but other stressors are about being constantly vigilant to potential dangers that can accompany being with people or in settings where you have reason to be uncertain about your physical or social identity safety. It’s this unrelenting combination of stressors that together lead to weathering.
So, you and I occasionally feel stressed, but this is a completely different thing.
Right. Any human being is capable of having this physiological stress response and we all do from time to time when we are faced with acute real or perceived danger. In small and infrequent doses, this automatic reaction to danger is protective. But it’s the fact that this physiological arousal is continuously activated and from so many different sources, in a context where you have insufficient resources, cannot take vacation time or maternity leave, or even just a break or a personal day from work and other competing obligations, or ensure a good night’s sleep, that brings on this level of destruction to human bodies.
And it’s also cumulative in many cases for people who have been living in those conditions since birth.
Absolutely. Weathering is completely cumulative and that’s part of why it leads to accelerated aging. You’re exposed to more and more stressors with time, literally wearing down your blood vessels and other tissues and organs in your body. A cruel irony is that those members of disadvantaged and denigrated groups who face these demands with grit and resilience do not escape weathering completely. Tenacious high-effort coping in the face of structural barriers and barricades is a source of weathering, too. As you get older, your health vulnerability is exacerbated by the accumulation of living in these circumstances.
I would guess that extreme weather plays a role as well—the increasing number of weather-related disasters that have a disproportionate impact on these sorts of communities. The town of Rolling Fork in the Mississippi Delta for example.
Exactly. And so, it’s a combination of these chronic, everyday stressors and extreme stressors, and as you say, the extreme stressors, especially ones related to climate, are happening more and more, and they do disproportionately affect the very same people who have been weathered by more everyday stressors for years or decades of their lives.
What’s been the reaction from the field to your work?
The reaction of the field was cautious at the beginning, but as time has gone on and more scientific evidence is available —not just from my research team, but also from transdisciplinary scientists filling in more and more of the psychological and biological mechanisms and historical and social behavioral puzzle pieces—weathering has come to be widely and well accepted now. We also understand much more about the detailed workings of the physiological stress process and their health impacts than when I first introduced weathering theory. I was talking about it metaphorically but now I can talk about it down to the cellular level, about whether and how actual automatic harmful biological processes are activated by how you’re treated or positioned by society.
Are there potential solutions you offer in the book?
Yes. The book’s in two parts—the first part’s longer than the second part, but the second part is entirely focused on what we can do. Because on the one hand, weathering is a daunting problem. And you do have this sense of, well, what could we do about it short of a major revolution or something on a grand scale that’s not going to happen anytime soon? Where I have hope, and I talk about this through that second part of the book, is that in some ways, the very fact that these weathering stressors are pervasive in people’s lives means in almost any part of their lives, there are things society could do differently. And it doesn’t have to be society writ large. There are, for instance, experimental studies in the classroom that have shown that if you have to answer demographic questions where you check off what your gender or your ethnicity or race or socioeconomic status is before you take a test, you’ll do worse on the test than if you put them at the end. So, there’s some really simple things to be done in specific settings that can make some difference.
Another example is, when society has attempted to address the problems of living in disinvested urban and rural areas that are very high poverty, we’ve tended to institute policies to do what was called in the ’90 as “deconcentrating” poverty, as if there was nothing of value that people in those communities had to offer to each other, or to the world. That was the wrong direction to go in. First of all, it’s based on a lot of denigrating, unproven assumptions, and in addition, one of the ways that communities mitigate weathering is by establishing networks that work collectively by pooling risks and providing social support across the group –today we will pool money to avoid your family’s eviction or foreclosure; tomorrow you will take in my sick child when I cannot take time off from work. And so, dispersing and fragmenting populations across far-flung neighborhoods and breaking up communities and extended networks actually undermines their ability to withstand weathering assaults. I’m not suggesting that we leave the poor and minoritized in hazardous housing or without adequate municipal infrastructure. To recognize, not erase, their value, and to invest in people and places, not tear them down.
And I guess this idea of weathering also underlines the importance of existing programs, whether that’s WIC or SNAP or Medicaid expansion—healthcare in general becomes even more hugely important when you think of it in this context.
Yes. And in fact, some of the differences I’ve seen between high poverty populations and their ethnic counterparts in more affluent populations is that access to high-quality and structurally competent healthcare can make all the difference in the length of their lives. It doesn’t necessarily avoid weathering or reduce the prevalence of diseases of weathering, but being able to diagnose those conditions early and then manage them can keep them from becoming pernicious and can save or lengthen lives.
It’s also important for clinicians to think more about how they approach some of these problems. Clinicians are members of society too and they have a lot of the same images and stereotypes in their minds that can result in a lower quality of care for some groups, even when they have access to care. I write in the book about the critical importance of viewing social problems and health inequities through a weathering lens, rather than default to the stereotyped understandings many highly educated clinicians were trained with or have picked up from the culture.