Essays

March 30, 2023

‘Weathering’ Forces Us to Think Differently About Aging

Public health researcher Arline T. Geronimus wrote the book Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society years after she coined the term “weathering” to explain how constant, long-term stress brought on by discrimination prematurely ages and sickens people in marginalized groups. We spoke with her about her research, why “working hard and playing by the rules” can counterintuitively worsen your health, and what individuals can do to better the situation.

By Leslie Price

For people who aren’t familiar with the concept of weathering, how would you describe it and how it affects certain populations?

Weathering is a chronic, stress-related biological process that leaves marginalized or exploited Americans vulnerable to dying, or suffering from chronic disease and disability long before they are chronologically old. It afflicts human bodies all the way down to the cellular level as they grow, develop, and age in a racist, classist, xenophobic, homophobic society. It wears down body systems and body organs, so you have a kind of body-wide health vulnerability, your biological aging is accelerated, and you’re more prone to many different diseases, conditions, and to early death and disability if you’re a member of a marginalized group.

You came up with weathering as a hypothesis when you were an undergrad. At what point did you see the science around how this sort of stress impacts our body catch up with what you knew?

It’s only in the last decade. There have been bits and pieces of information that I’ve pulled from other disciplines [over the last two to three decades], and from lab science in particular, to put together plausible mechanisms for weathering, rather than the sort of metaphor it was when I first coined the term. But science is just catching up with the entire construct of weathering. If you read the book, you know I called it weathering because I was trying to illustrate two things: one being how bodies get eroded by what they’re subjected to when they’re marginalized. But also, the high-effort coping and the keeping-on in the face of systemic barriers related to racism and these other isms. It is both shelter and storm.

People get the idea that exposure to threat has a physiological effect on the body. I still think people do not entirely understand the second part, the active, effortful coping. It’s the people who, to use a cliche, work hard and play by the rules, but are batting their heads against structural barriers, or being exposed to toxins, or sleep deprivation. It’s those people who are most likely to weather. That seems to fly too much in the face of people’s beliefs, that it’s people who do all the wrong things, not the right things, who weather.

One of the things I thought about when I was reading the book is how in America, we really like to focus on individual solutions to what we see as individual problems, instead of sitting back and critiquing systems. When you talk about weathering, how does that challenge this individualistic thinking?

It fundamentally challenges it, because it suggests there are real limits on what an individual can do to make any difference in their health. It’s not that you can do nothing, but if you’re a member of a marginalized group and you’re treated in a certain way — whether that’s through chronic material hardship, environmental racism, daily indignities and microaggressions, unhealthy living situations, poverty, or just plain racism — an individual cannot change those things on their own. That’s systemic. They can’t just meditate themselves out of that, or go on a spa vacation, especially if they are in the working class and don’t even have any paid personal time or vacation time, and also earn so little they couldn’t afford a vacation. These are things that society as a whole needs to make a commitment to changing. 

You can eat all the healthy things you want, you can exercise every day, and you can still weather. You can be rich, as wealthy as the top 1%, and if you’re Black or transgender or any one of a number of groups that we treat badly as a society, you will still weather.

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The intersection of weathering and class can be kind of counterintuitive. You can be financially privileged and be more weathered, and you can be in poverty and have less weathering because you’re being less exposed to environments that are adding to your stress load. Can you talk a little bit about that?

A very important characteristic or cause of weathering that many people who study so-called “social determinants of health” have missed, or don’t talk about as much, is the way in which certain racial ideologies themselves can harm health. And also, how much having an alternative cultural framework to the dominant American one that marginalizes your group can reduce weathering. If you have health insurance, or if you have some status in your professional career, or the things that you gain when you’re able to get an advanced education and career, you are often in predominantly white or dominant institutions. You’re more often exposed to various indignities, microaggressions, finding out that you’re being paid less than everybody else, not being promoted. 

[In 2020], I was sitting with a colleague of color, and some of our other colleagues were talking about the inconveniences of Covid in terms of childcare or not being able to go to the movies or things of that level. She turned to us and said, “I’ve had nine family members die from Covid.”

I’m not saying childcare isn’t a problem, but Covid had eradicated most of her family. Being in environments that are not made for you historically, or where there are not many people like you, you’re exposed to a cultural framework that’s based on generational privilege, usually, and expectations of a long, healthy life expectancy. For you and your family members, that itself is weathering and that’s the kind of exposure that more higher-income people of color or other marginalized groups are exposed to, more than low-income people, or even the most impoverished.

That reminds me of the survey results that came out a year or two into the pandemic that said the majority of people who want to be back in the office were white men, and that women and people of color were more eager to embrace either work from home or hybrid because it lessened their stress. When you read the book, it seems obvious. But look at how hard our society has been pushing people to just “go back to normal” and go back into their office, even when a lot of people are having a healthier existence not doing that. 

You mentioned the expectation of a longer life. One of the terms in the book I had not heard before is “age washing.” Can you explain what “age washing” is?

There is a belief that — in an era where we have medical care, vaccinations, antibiotics, all kinds of treatments, so much knowledge, and we are generally a well-fed, well-resourced country — that people’s health and aging follows a [known] developmental trajectory. That when you get to your twenties through middle age, you’re in your prime of life, and then you start to age. [There’s an assumption] that that’s universally true among Americans, and that the only thing that changes it is either really bad luck or because you don’t take care of yourself — you don’t eat the right foods or exercise or whatever. 

This is infused with a lot of assumptions about what causes health to be good or not good. Your aging is very much affected by your literal environmental exposures, by your material hardship, and by your bio-psychosocial exposures. Because of that, it’s really a conceptual leap and a moral leap (based on certain expectations) that you and your children can have long, healthy lives if you do the right things. A lot of the reason you’ll have a long, healthy life has nothing to do with doing all the right things.

You have a lot of information in the book about people who are looking at their life and thinking about health problems that could come into the picture in their twenties, thirties, and forties, and seeing people in their families die in their forties and fifties.

I highlighted this line: “A common misconception is that the health differences between Black Americans and white Americans are due to essential genetic differences.” You say that speculation is false, and you go into great detail to disprove it. Do you think that this is known and understood in the medical community?

Not completely, no. I think more and more people in the public health field know this, but in the medical field, I don’t think so. It’s also institutionalized systematically. You get your blood tests back, your lab tests back, and if you’re Black, this is the range and if you’re white, this is the range. As if there’s an essential difference based on your skin color. A lot of people in the medical profession somehow think Black people don’t feel pain. I guess it was convenient when they used to experiment on Black people without anesthesia.

There are probably some people who’d explicitly say that race is a social construct who, in other ways, are going along with policies, procedures, and practices inherently based on the belief there are essential genetic differences. I write a little about this in the book, but as [medicine] moves to using algorithms to make decisions, a lot of those algorithms, if you knew what they were, you would realize are very racist or are based on assumptions that there are essential differences between Blacks and whites. That’s even worse. People think those things, because they’re mathematical or whatever, are objective, but often they’re anything but. 

In the book, you cover some of the changes that were signed into effect during the Clinton years. Can you talk about some of the damage that was done, and the repercussions?

The Clinton years are not totally divorced from Reagan in the sense that I think some people who considered themselves more liberal or democratic were coming up with a philosophy that they thought could be accepted, given the constraints the Reagan years had put on sort of the full range of what’s okay to discuss in the policy world. I think this is what many people call neoliberal, which is what Clinton was as a president.

Welfare reform, and its specific assumptions, its explicit attempt to reduce teen childbearing, and its very punitive and miserly program (term limits, not getting more welfare if you have a second child, et cetera), were based on what I think were completely wrong assumptions about why certain populations, especially very low-income populations and those in segregated, predominantly minority and disinvested communities, would both not have the prerequisites for being able to postpone childbearing and become healthier, but would actually, because of weathering, see their chances of healthy childbearing deteriorate over their twenties. The more general idea that many policies worked under during the Clinton years was that you need to deconcentrate poverty, that the problem of the inner city is you have all these poor people there.

This is a narrative. The middle class has left and no one has role models and people are having babies as children, so they’re not very good parents. As I covered in the book, they tore down public housing and came up with experiments like “the move to opportunity.” A big part of the rationale was deconcentrating poverty. Well, that was denigrating and destructive, certainly from a weathering point of view. Disinvested areas do need attention, but it’s not because of the [character of] the people who live there. It’s because of the decades and decades of disinvestment in those communities.

All of these policies were actually undermining autonomous protections and making life more stressful.

If you don’t keep municipal infrastructure going in a high-poverty, segregated area, if you move all the jobs away from those areas, and you don’t have good public transportation, if you put highways through peoples’ neighborhoods so that the suburban people can get to work in their cars — all those things are going to cause weathering.

Who do you hope reads the book?

Anyone who cares deeply about some of the major, existential political issues of the day. I made it accessible to a very broad audience. Obviously policymakers, people in health policy. But also social policy.

I want to be clear: Every human being is capable of weathering if they’re put under the lousy conditions that we’ve subjected members of certain groups to, in some cases for centuries.

At the end of the book, you offer some suggestions for action. What do you feel is most promising, especially given our current political climate? And do you have any recommendations for people on an individual level? Because I can see people reading this book and being very moved by the unfairness of this, the unfairness of, I can do everything right in this world, and I will potentially have worse health and a shorter lifespan.

But that’s stressful itself. I’ve gotten a lot of emails from young Black women who are afraid to have babies because they’ve seen how much maternal mortality has risen. It’s very good in a way that those problems have come to light; nothing would get solved if they didn’t. But at the same time, it freaks people out, understandably. And that itself is a source of weathering stress. 

What I’m hoping people get from the book is two things: One is that we just looked at everything all wrong, but, but now we have an alternative. We have a new way to think about things through a weathering lens, and what I want people to do is consider [problems] through that lens instead of this individualistic, makers-and-takers way of looking at things. 

If you use weathering as your framework for discussions with the people around your dinner table, the people around your conference table, your clients — if you have that common framework as your starting place — then together you can come up with better solutions than we have so far. 

The other thing I wanted to communicate was: It’s just not your fault. Many people of color have multiple health problems in this so-called prime of life. I hope people get relieved of any guilt or [feeling of] responsibility they have [about that].

And the last thing is, because weathering is everywhere (I call it the extraordinary stress of everyday life, because it’s pervasive), everybody can do something about it in their corner of the world. How can we change things? 

I think voting rights are essential. I have a lot of ideas about how to try and reduce the maternal mortality rate. I was trying to give people a sense that this is everywhere, but there’s something you can do in your own area of expertise, your own area of concern, with the problems in your own community or family.

 

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