Extraordinarily stressed and vigilant? How racism makes people physically ill | Poverty

When Arline Geronimus arrived at Princeton University in the late 1970s to study politics, she entered a world of entitlement and privilege that she never knew existed. The college was “marinaded in testosterone, and upper-class generational Wasp wealth”, she says from her office at the University of Michigan, where she is a professor of health behaviour and education. At Princeton, she was a double minority, a woman and a Jew. Women had only just been allowed and there were complaints about a quota of Jews each year (something Princeton denied). That didn’t apply to Geronimus, she tells me with a laugh, because she wasn’t “the good kind” of Jew – the “good kind” being German or western European, not from eastern Europe or Russia like her.

Her profound sense of being othered at Princeton oriented her towards seeing something that others didn’t see – how people’s experiences of marginalisation affect their health. “I was born about 10 years after world war two,” she says. “The Holocaust was very much in Jewish people’s minds … my parents and grandparents had suffered incredible oppression in Russia and had to become political refugees. I heard horror stories from them about what they went through to establish a life.”

Her grandparents had moved to the US in the early 1900s, eventually settling in a Brooklyn tenement. Her grandmother worked in a sweatshop and her grandfather sold bananas. When he was no longer able to lift heavy objects, her uncle dropped out of school to help him. She grew up seeing first-hand the health effects of social exclusion on the basis of identity and the ways those effects reverberated through her family and community. Precariously housed and employed, she witnessed chronic disease and early death, and the sacrifices that everyone had to make to propel even one member into a different social class.

Now, 40 years since she walked into a Princeton where white men wore badges saying: “Bring back the old Princeton” in objection to the presence of students like her, and after decades of research into public health, Geronimus is an expert in what she calls “weathering”, a term she coined in the early 1990s. She defines it as “the physiological effects of living in communities that bear the brunt of racial, ethnic, religious and class discrimination”.

Weathering, she adds, “is critical to understanding and eliminating population health inequity” and involves not just the physical and environmental stressors of being marginalised, but the “psychosocial” ones as well – high stress, constant vigilance, a lack of trust that things will be OK. The process, she has observed in her research, leads to premature ageing, chronic conditions and early death.

In her new book, Weathering: The Extraordinary Stress on the Body of an Ordinary Life in an Unjust Society, the pandemic seems to vindicate her thesis. It wasn’t just a person’s age that made them vulnerable to the virus, it was also their weathering. It was already established that Covid killed people in racialised communities at a much higher rate than white ones, but that, according to Geronimus’s research, was because they had higher rates of heart diseases, diabetes and inflammation; all risk factors that made Covid more deadly. Even before the pandemic, people in these communities scored high on the “allostatic load score” – the presence of stress hormones such as cortisol along with inflammation, their belly fat distribution linked to stress, and high blood pressure – leading her to conclude that “if you have a weathered body, you’re more likely to die of infection at a younger age”. That, tragically, has turned out to be consistent with the patterns of death in the pandemic.

Weathering was a concept that suggested itself to Geronimus early in her career, when she began working with pregnant teens and teenage mothers from deprived communities in the predominantly black city of Trenton, New Jersey. “It was a gradual process,” Geronimus says, getting more animated with the memory of her “huzzah” moment.

A cast-iron assumption at the time in public health and political conventional wisdom was that teen pregnancy was a blight, a health risk to mothers and their babies, and the result of ignorance or predation. She found that “not only were [teen mothers] not at higher risk, they were at lower risk. No one believed me! It doesn’t seem like common sense to people.”

Except, it seems, for the young women she spoke to for her research. “I was supposed to help teach people who allegedly didn’t know anything about contraception,” she says, but what she found were teenage black mothers who had knowingly made a calculation that flew in the face of popular conceptions about them.These young mothers, her research suggested, had surmised that it was safer for them, and their children, to get pregnant early, because they expected, from the experiences of older black women around them, to develop chronic illness or have shorter lifespans.

Geronimus speaks carefully, constantly weighing her words; sometimes she restarts her sentences. It feels like the habit of someone who is trying to temper with academic neutrality the passion that underlies her research.

The human toll of weathering has been proved to her again and again, in shocking statistical divergences between the health outcomes of different groups where nothing explained the discrepancies other than the experience of marginalisation. Most shocking to her throughout her years of research was an episode in 2008 in Iowa, when 900 heavily armed Immigration and Customs Enforcement agents raided a slaughterhouse and meat processing plant in the rural town of Postville. Nearly 400 largely Latinx employees were arrested for allegedly working illegally and being undocumented. They were handcuffed and chained together and nearly 300 went on to be deported. It was one of the largest workplace raids in US history, and it decimated the small community.

According to Geronimus’s research, what followed across Iowa over the next nine months was a sharp rise in the rate of Latina mothers delivering low-birthweight babies. “You didn’t even need to be in the raid,” Geronimus says, to experience the stress and weathering effects. Just being a part of that vulnerable group was enough to make the raid impact on you almost as if you had been there. “What it made so clear was how much this erosion of health is due to what’s in the air, in terms of how you’re viewed, your social identity, the threats to your life, how that requires you to be very vigilant. You could eat all the right foods, get your exercise every day, but if you’re chronically vigilant, you will suffer weathering, either through the excesses of othering or the absence of due process.”

Her book is a chain of these tragedies, told on both a community and a personal level. Geronimus makes it clear that weathering happens to everybody, and draws on examples of celebrities such as Serena Williams not being believed when pregnant with a blood clot condition. She talks of peers, black men of high income and high status, succumbing early to chronic illness or death. She references her father, a man who made it into higher education and thus the ranks of the upwardly mobile, who did not want to be spoken to when he returned home from his job in a medical laboratory until he had “removed his armour” – the layer of vigilance he had to cultivate to survive as a lower-status Jew in a high-status job.

Geronimus has always faced fierce resistance. “That’s why I wrote the book,” she says. “Earlier in my career, people were very cold. There were headlines in books and newspapers like: ‘Research queen says: let them have babies’. This was the early 90s, the height of neoliberalism and underclass rhetoric. I had no constituency. It wasn’t just that I ran up against more rightwing or neoliberal people. In the popular press, I was a heretic. I got death threats. It was all ideological.”

It was also racial. It was, she says, mostly “white people who were so awful”. She recalls an article that said: “The slave masters must be dancing in their graves because they have Arline Gerominus keeping black teenagers barefoot and pregnant.”

“I was called the biggest threat to youth in this country,” she says. “Everybody had been led to believe that teenage motherhood was a sign of degeneracy. I didn’t really have any support.” This was despite the fact that her work on teen pregnancy was solid, credible, peer-reviewed and published in top journals – it just happened to be “saying something deeply unpopular”. At the same time, she says, she was celebrated among those communities she was supposedly sabotaging. Many black people assumed she was black.

She doesn’t receive nearly as much vitriol as she used to, but she still thinks that we’re not there yet. People are so brainwashed by the myths of the American dream, social mobility and self-improvement that they are led to believe that one way or another it’s minorities’ own fault for not thriving. In the US, Gerominus says, the belief is that “black Americans are not working hard enough” or are fatalistic and “stress-eating, lying on the couch”. The truth she has seen is that they are in fact constantly resourceful, pulling together as a community and “solving the unsolvable” in the face of daily, structural challenges.

To this day, only “part of the idea” of weathering has been incorporated into mainstream public-health consciousness. “There’s language to talk about it that we didn’t have 30 years ago, of structural racism or systemic racism, social determinants of health – everybody’s now conversant in these concepts.” This covers the part “where your body is eroded by the corrosive effects of being a part of an exploited, oppressed group”.

But the other part of weathering is still not widely grasped: the coping part, the part where the people being weathered “stand up, try to be resilient, and try to withstand all the structural barricades and the exposure or the exhaustion. Weathering means both things – it is both shelter and storm.” This second part is often ignored, reducing community or group-based dynamics and demands to identity politics positions in a culture war. “What we misread as selfish competitive identity politics is about social identities that have been imposed on groups. But many of the hardships and adversities they face are because they’ve been racialised.”

Once you see the concept of weathering, you can’t unsee it. By the end of our conversation I feel trapped – hyperaware of all the ways my social identity as a member of a black minority exposes me to stressors. Am I trapped? “I think there are things you can do that will make a difference,” she says, “but you are stuck being weathered. And it really will take other kinds of structural changes for weathering not to happen.” As a professional, my chances of combating weathering are higher, she says. But having access to regular health checkups is the biggest ameliorative factor.

If individual efforts are limited, does she see any improvements that give her hope that weathering is being taken seriously at that most impactful, system level? “I don’t know if there are any specific initiatives explicitly dealing with weathering,” she says. But she does see some cause for hope, for instance in the field of reproductive health. While there are still huge disparities in maternal mortality rates and health outcomes between white and black mothers, “many people are understanding that doulas matter, ob-gyns can make things worse … the importance of being reassured during delivery”.

Researchers are also understanding how we could do things differently in classrooms. She points to ostensibly small things, such as asking for demographic data at the end of tests rather than the beginning. “When you’re constantly reminded that you’re black taking a test in a world where people think blacks are not as intelligent as whites, your vigilance creeps up on you, there’s physiological things that happen in your brain – where your blood flow goes, and which neural circuits are engaged – that can affect your performance, and also add to weathering.”

Her biggest hope is that people start to think about things in terms of weathering and that it leads them in different directions, away from the same old failed policies. She hopes that solutions are offered for public-health crises outside the usual ones relating to urban development and lifestyle improvements.

“People think about high-poverty urban areas in the US as these places where there’s nothing of value. Nobody should have to live in horrible housing without access to grocery stores or well-lit areas to exercise, or [go to] schools that are full of mould, but it doesn’t mean you have to send the people out to the periphery and away from each other,” she says, referring to extreme cases where people are simply moved away from densely populated housing. In fact, drawing on that second definition of weathering as a condition of resilience and resource-sharing, “being with each other is a buffer”.

“We tend to think of social mobility as moving up to something better,” she says. “But whatever moves you to opportunity also moves you away from things that give your life purpose and meaning, and people who validate your view of the world and don’t just assume what your moral fibre is or your intellectual abilities are just because of what social identity has been imposed on you.” There are, she says, “real minuses to social mobility and even the pluses don’t get you out of weathering. If we really think that being socially mobile is a sign of good character then we need to make sure that persistence and tenaciousness and sacrifice doesn’t make you sick or disabled or die young. We shouldn’t stand for that.”

  • Weathering: The Extraordinary Stress of an Ordinary Life in an Unjust Society is published by Little, Brown (£25). To support the Guardian, buy your copy from bookshop.theguardian.com. Delivery charges may apply

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