How ‘Weathering' Contributes to Racial Health Disparities

Arline Geronimus had made avoiding the spotlight a way of living.

She proposed a radical idea three decades ago: that living in a racist society could cause poor health for marginalized populations.

Dr. Geronimus was a 32-year old public health researcher at Michigan. He had spent three decades collecting data on over 300,000 pregnancies to find the cause of the large disparities in infant deaths. In their first year of life, Black babies were more likely to die than white babies. Many believed that the high rate of teenage pregnancy in Black women was to blame.

Dr. Geronimus's research proved the contrary: Black teenagers were more healthy than Black women in their 20s or older. She argued that these younger women had been exposed to less racism-induced stress and had therefore given birth to stronger children.

This particular type of chronic stress she called 'weathering', referring to a rock that is constantly exposed to the elements. In 1990, she presented her findings and the outline of her hypothesis at the American Association for the Advancement of Science annual conference.

The reaction was swift and varied in ideology. Children's Defense Fund was a progressive organization and set up a table outside because Dr. Geronimus's conclusion that teenage pregnancy wasn't entirely bad was something they knew about. A representative of the CDF told The New York Times that her arguments had 'perverse policy implications' just weeks after Geronimus's speech. The Washington Times columnist, a conservative newspaper, said that Marie Antoinette would have it this way: Let them have children. Michigan alumni pressured the president of the university to fire her. Anonymous callers made death threats to her home.

Over coffee at the New York Public Library, Dr. Geronimus said, "I was quite traumatized," in March. "So I kinda retreated into the work.

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Over the years, Dr. Geronimus stopped attending conferences and spoke to reporters very rarely. She admitted that it was nerve-racking for her to be interviewed. With the University of Michigan's support, she published over 130 papers. This expanded and strengthened the evidence that Black mothers can weather the storm. Her research has shown that those who experience high levels of stress due to their identity and circumstances, such as Latina mothers and Mexican immigrants, have poorer health outcomes. Researchers from different disciplines have found that discrimination can cause premature aging, dysfunction of the immune and metabolic systems, as well as dysfunction of the endocrine and cardiovascular systems.

This body of evidence, which Dr. Geronimus describes as 'Weathering' in her new book, "Weathering" has made her an 'icon". It also provides a framework for understanding health inequalities that goes beyond blaming lifestyle choices or genetic defects, according to Dr. Marcella Nunez Smith, associate professor at Yale School of Medicine, who chairs the White House Covid-19 equity task force on health equity.

Dr. Nunez Smith stated that there is a clear line between her weathering work and what we now refer to as social determinants. Weathering was the basis of many of the task forces' policy decisions at the height of the pandemic. They focused on reducing excess stress on low-income and people of color, such as funding non-English-speaking workers to reach vulnerable populations to aid in contact tracing and switching from drive through testing sites to allow those without cars to test.

Covid is a large reason why Dr. Geronimus decided, after years of refusing agents' offers, to re-enter this fray with her first book. The pandemic, which saw disproportionately many deaths among people of colour, is a stark affirmation of her efforts.

She also said that the pandemic presented an opportunity to make structural changes, which would help reduce health disparities, which have only gotten worse ever since her 1986 paper.

Chronic Stress: The trap

Elizabeth Brondolo is a psychologist professor at St. John's University, who studies the psychophysiology and discrimination of the body when it is subject to stressors. The bloodstream becomes flooded with glucose to fuel large muscles, and heart rate and blood pressure rise.

Dr. Brondolo stated that if the sympathetic nervous systems reaction is not activated over time, it can lead to internal system erosion. Hypertension can be caused by chronically high blood pressure. Diabetes can be caused by a constant flow of cortisol, also known as the stress hormone. Research suggests that chronic stress can cause DNA damage and alter brain structure.

Although many people experience stress every day, research has repeatedly shown that those of color and those in lower socioeconomic standing report higher stress levels and are more likely to feel it on a daily basis. These same groups are more likely to be subject to violence, job instability, discrimination, and lack of social or material support.

Race-based stress can also have a persistent and physically powerful effect. Dr. Brondolo, along with her colleagues, examined the physiological effects of racism in a series studies that were conducted between 1999 and 2009. They also performed clinical sessions to examine the effects on the mind and body. For example, one study found that participants who were the victims of racist behavior had elevated blood pressure over a prolonged period of time, even when they were asleep. Dr. Brondolo stated that this is the real key to Dr. Geronimus's message -- there was no recovery.

Dr. Geronimus's research shows that wealth and upward mobility are not antidotes to weathering. She analyzed over 1,500 respondents' health data, including blood pressure, cortisol levels and cholesterol, and found that Black women with higher incomes had poorer health outcomes than white women with lower incomes.

Researchers from Ohio State University looked at Black students who were educated at historically Black colleges and universities. They found that they had been'sheltered at least partially from racial discrimination' for years, which put them at a lower risk of developing health problems later in life than their peers who were predominantly white.

These findings can be explained by the stress that people experience when trying to thrive in environments where they are not recognized or their circumstances are different. This is what psychologists refer to as 'high-effortcoping'. Dr. Geronimus stated that weathering is the physiological energy needed to overcome all types of structural headwinds or barriers. She said it is why Black maternal mortality rates are still stubbornly high even in high-income families, and even though Black teenage pregnancies declined over the past decade.

Critiques and Challenges

Public health research has a caveat. It's observational. It can detect links and associations, but it cannot prove causation. Robert Kaestner, a professor at University of Chicago Harris School of Public Policy, worked with Dr. Geronimus in 2009 on Mexican immigrants. He said that weathering is a difficult empirical task. It is difficult to determine if there are other environmental stressors.

Dr. Kaestner, despite his doubts about its measurement, described weathering as 'intuitive', 'plausible, and consistent with biological processes.

The intersection of racism and health is a complex area that requires careful research. It raises difficult questions about privilege and bias. Dr. Camara Jones, an epidemiologist at Emory University's Rollins School of Public Health, stated that Dr. Geronimus might have been able to claim some credibility because she is a white woman. She was a medical officer at Centers for Disease Control and Prevention between 2000 and 2014.

She stated that white people are generally given more credit for naming racism. "When people of color do this, it is seen that they have a chip on their shoulders or are subjective.

Dr. Jones also showed a link between racism, accelerated aging and blood pressure disparities in 1992. She didn't pursue this research line for long because she was told by one of her advisors that she didn’t want to be known as "the racism lady". "Even as I was writing grant proposals people would call me and ask me if I could change the word racism to discrimination.

Dr. Jones stated that Dr. Geronimus's race does not negate the importance and value of her research.

"I am grateful for her efforts because now there is knowledge."

Weathering Research: How to Use It

Kari Hong, an immigration lawyer, contacted Dr. Geronimus in March 2020 with the following question: Could her research help detained immigrants get out of confinement?

Ms. Hong was concerned about the exposure of her clients to Covid-19 while they were held in California and Arizona detention centers. Ms. Hong stated that a judge had told people who are particularly vulnerable to Covid-19 to be allowed to escape. "So, the question was, "Well, who's uniquely susceptible?"

It was obvious that detainees with underlying medical conditions and older people would be included in this category. Her middle-aged clients were not as at risk.

Dr. Geronimus was willing to assist. She drafted seven legal declarations. She wrote seven different legal declarations.

All seven detainees were freed.

"Without Dr. Geronimus, I wouldn't even have an argument," Ms. Hong stated.

Dr. Geronimus suggests other reforms to reduce stress for those at risk. However, she admits that some are more realistic than others. These include the deployment of doulas to reduce Black maternal mortality rates, a strategy that has been successful in a few programs across the country, and the reinstitution of the Biden administration's expanded Child Tax Credits. This program was a great help for many families who struggled to make ends meet. The program was ended by Congress at the end of 2002.

Dr. Geronimus stated that the idea is to think about health equity when designing policies that 'don't, at first glance, seem health-related.'

She said, "It sounds difficult at first. I've definitely had my moments of hopelessness over the possibilities." "But, since these weathering stressesors surround us it means that there are so many lever points. It is all about being committed.