Arline Geronimus is a professor at the University of Michigan’s School of Public Health and a research professor at the Institute for Social Research at the University of Michigan. She is an elected member of the Institute of Medicine of the National Academies of Science and her scientific articles have been published in major journals like The New England Journal of Medicine, among others.
Below, Arline shares 5 key insights from her new book, Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society. Listen to the audio version—read by Arline herself—in the Next Big Idea App.
1. Weathering needs to be part of the public health conversation.
Weathering is a chronic stress-related biological process that leaves marginalized or exploited Americans vulnerable to dying or suffering infectious, chronic diseases and disabilities long before they are chronologically old. Weathering afflicts human bodies—all the way down to the cellular level—as they grow, develop, and age, in a racist, classist, xenophobic, or otherwise stigmatizing and marginalizing society.
Weathering is not measured in the number of steps walked, cigarettes smoked, opioids used, alcohol drunk, or calories eaten. It’s not primarily measured by your years of education, the size of your paycheck, or your bank balance. Nor do its fundamental causes include fatalism, sloth, or family breakdown. It’s not essentially about emotional despair, either. Weathering is internal damage done to hopeful, hardworking, responsible, skilled, and resilient people. They are aging and dying from the physical toll of constant stress on their bodies, paying with their health for their good efforts in the face of a rigged, degrading, and exploitative system.
The inner workings of our bodies are always active and adapting, physiologically responding as necessary to changes in our environment. Our bodies physiologically work to maintain a temperature of 98.6 degrees Fahrenheit by sweating in hot environments and shivering in cold ones. We don’t decide to sweat or shiver; our hypothalamus, which we can think of as the hormone control panel of the brain, automatically activates the processes that heat and cool the body. That our bodies have this automatic capacity to calibrate our biological processes to respond to challenges in our environment is a wondrous fact.
Human bodies have similarly evolved to react to acute life-threatening stressors. You see a hungry lion heading your way, and your body immediately activates a release of hormones that increase your heart rate, blood pressure, and breathing rate to propel oxygenated blood to your large muscles quickly, increasing your capacity to fight the lion or flee from it. Meanwhile, body systems or organs that are not important to your immediate survival are deprived of well-oxygenated blood and nutrients for the short duration of the threat. If you successfully escape the lion your body systems return to their usual functions in a matter of a few minutes: the stress hormones recede, the sugar and fat they catapulted into your bloodstream for energy return to their storage sites. The body quickly returns to its pre-arousal functioning. Take a deep breath. Life is good.
Key to weathering, the threat that activates these physiological processes does not have to take the form of a raging beast. Physiological stress processes are set in motion when any kind of threat is experienced. This is adaptive: if you’re under frequent threat, it’s better to react to a false alarm than to miss a real one.
Stressors endemic to material hardship, structural racism, or exposures to environmental toxins in your home, community, or at work are multiple, some chronic, some oft-repeated. They can be acute and traumatic, like a militarized drug raid of your apartment while your kids and frail grandmother hide in the corners of the room, praying the police will realize they have the wrong address before shooting. They can be mundane, yet constant, like when you face exhaustion from a night shift or double shift work and long commutes on decayed, unreliable public transportation systems. They can be prolonged when you stay cognitively and emotionally engaged imploring your recalcitrant landlord to fix your heater in winter. They can be psychosocial—encompassing recurring fears and anxieties, that perpetuate your vigilance and physiological arousal. They can be emotionally triggering, such as when you are exposed to the footage of your peers being killed by the police, in looping news clips shown across the city. They can be relived or ruminated upon, without a clear endpoint.
“Weathering is internal damage done to hopeful, hardworking, responsible, skilled, and resilient people.”
In these circumstances, physiological stress processes become chronic in your daily life. Your blood vessels remain flooded with fat and sugar, your heart rate stays high, even while you sleep, while other body organs—or your fetus, if you are pregnant—are denied the full complement of oxygen and nutrients they need to remain healthy.
This sustained physiological stress process activation takes a pernicious toll across all the major systems of the body: neuroendocrine, cardiovascular, metabolic, and immune. In turn, this wear and tear lead to hypertension, plaque buildup, pulmonary embolism, heart attack, heart failure, or stroke, insulin resistance, and diabetes, among many other chronic conditions. Wear and tear on the immune system weakens or dysregulates it, increasing your susceptibility to both infectious and autoimmune diseases.
2. We have been age-washed.
What keeps us from seeing how this straightforward physiological explanation contributes to health inequity? We have been what I call “age-washed.” We’ve been led to believe that there is a universally uniform growth and aging process, and that barring premature death from an acute virulent infection, a genetically linked disease, or an accident, everyone can lead a long healthy life—provided we make disciplined, doctor-sanctioned, health-promoting choices regarding diet, exercise, and lifestyle. This developmental and individual behavioral view of growth and aging assumes that if we take personal responsibility and play by the rules of good health and good citizenship, our chronological age will be an accurate predictor of our likelihood of disease and death.
Seeing members of marginalized groups that are more likely to suffer diseases during their prime years, we infer they must be engaging in unhealthy, even nefarious behavior. We can convince ourselves that something essential in their DNA programs them for poor health, or something in their culture leads them astray from the straight and narrow health behavioral path.
We might also believe that population differences in health and longevity will disappear if we each become educated and affluent enough to sustain a healthy lifestyle. While less accusatory, this interpretation relies on being age-washed, too. We fail to eliminate health inequities when we don’t acknowledge the structural forces at play. Because of these forces in an unjust society, more so than individual health behavior, the health associated with being 20 does not equal 20, and 30 is even less likely to equal 30 across more and less advantaged groups. Members of marginalized groups experience accelerated biological aging.
3. Taking personal responsibility can be a double-edged sword.
Weathering results from repeated or sustained activation of the physiological stress response over years and eventually, decades. This means that a person’s health and life expectancy depend more on their experiences, their interactions with others, and the physical environment they are surrounded by than on their DNA signature or lifestyle.
“Some specific triggers of physiological stress arousal are more likely to be activated in oppressed people when they find themselves in relatively advantaged settings.”
For the more affluent members of marginalized groups, the housing, education, healthy food, and healthcare their money can buy might reduce the harmful impacts of weathering, but they cannot eliminate them. Indeed, some specific triggers of physiological stress arousal are more likely to be activated in oppressed people when they find themselves in relatively advantaged settings, often historically designed to exclude their group members, and never designed with their needs in mind.
In an even more cruel irony, those in working-class populations who face their challenges with tenacity and engage the bureaucracies, make the long commutes to work, experience the sleep deprivation of night shifts or double shifts, fulfill competing obligations at home—those who are chronically “on”—become exhausted. Too often they are reminded how little power they have to avoid stressors, how unlikely they are to prevail in disagreements with those more powerful, and how underappreciated and under-compensated they are for the essential work they do. They are weathered in both senses of the word—damaged by the physiological responses their challenging environments require of them, and also by withstanding the ceaseless barrage of weathering stressors in the face of structural barriers. Their resilience is critical to facilitating their family’s and community’s ability to mitigate hardship. Yet, in the face of strong structural headwinds, their hopeful, tenacious, high-effort coping is both shelter and storm.
4. When we ignore structural forces and focus only on personal responsibility, even well-meaning policies can make matters worse.
Because age-washed narratives of personal responsibility take into account neither the structural impediments some groups face nor the weathering implications of the cumulatively toxic stressors they face every hour of every day, they can result in policies that exacerbate rather than reduce health inequity. These policies may (or may not) be well-intentioned, but at their best, they do little to disrupt weathering—at their worst, they are deadly.
In fact, erasure or misrecognition of the actual lived experiences of the oppressed and exploited, have left us only with policy approaches that ignore or caricature the actual needs and experiences of marginalized groups. This makes them harmful in their impact, if not in their intent. Weathering research consistently shows that the weathering of oppressed populations worsened, and that overall health inequities stagnated or increased, in the wake of such social policies of the last 40 years.
“Erasure or misrecognition of the actual lived experiences of the oppressed and exploited, have left us only with policy approaches that ignore or caricature the actual needs and experiences of marginalized groups.”
Some of these policies were punitive; some approaches were simply irrelevant to real needs. Others, in efforts to encourage personal responsibility, actively disrupted the collective protections that community members develop to pool their economic risks and see to the multigenerational caretaking needs that weathering imposes on their extended families. These collective protections are essential because of the scarcity of material resources in any single household. They are also needed because of the stinginess and political fragility of family support policies, such as paid parental leave or childcare assistance. An organic sense of collectivism and solidarity also offers members of oppressed communities affirming counter-narratives to the dominant culture’s image of them as morally marred or culturally deficient. These psychosocial resources may be especially important in resisting stress-related weathering diseases. In addition to material resources and opportunities, health also comes from affirmation of the cultural values, practices, affective ties, and beliefs that give life purpose and meaning.
5. There is a way forward.
Weathering can seem like an incredibly daunting and intractable problem to solve, but there are immediate changes we can make today that will have a significant impact. We must understand that the relationship between age and health is mutable, at least from the womb through middle age, and that it is subject to the efforts and commitments we make as a society. Doing so opens up opportunities for social changes—both small and large—that can disrupt and ultimately eliminate weathering inequities.
Systemic problems call for systemic change, but structural, even revolutionary, changes can happen short of a revolution in the classic sense; in fact, they have to. The revolution that is required is in how we identify what our gravest social problems are, how we widen the frame of possible explanations and responses, and who we see as having the authority and claim to participate in addressing these problems.
Learning about weathering, prior and current policy misdeeds, and well-meaning mistakes need not leave any of us in a state of paralysis or defaulting to the age-washed personal responsibility narrative to guide action.
Any measure that takes meaningful steps to improve the everyday quality of life for the exploited and oppressed will disrupt their weathering. Any measure that makes society more equitable merits will also disrupt weathering. Disrupting weathering is itself a critical step toward making society equitable. There can be no real equity where some populations face substantially shorter healthy life expectancies than others, especially when those same populations are not included in the policy conversation because they are viewed as stereotypes with contempt, fear, or resentment.
To listen to the audio version read by author Arline Geronimus, download the Next Big Idea App today: