What comes to mind when you hear the word “weathering”?
Perhaps you think of erosion, depletion, and wearing down. Or maybe enduring, surviving, and withstanding. All of these associations accurately describe what happens to our bodies in response to chronic stress. This particular type of physiological stress affects the brain and other parts of the body.
Public health researcher Dr. Arline Geronimus coined a term for this process that she calls “weathering”. Racism, poverty, and discrimination “literally wears down your heart, your arteries, your neuroendocrine systems, all your body systems so that in effect, you become chronologically old at a young age,” she says. In fact, poverty and racism ‘weather’ the body so much that they accelerate aging and disease.
This is a very different type of stress than non-marginalized and affluent populations experience, one that you can’t take a break from. This particular type of social and systemic stress affects Black women’s maternal and infant health outcomes. It’s also critical in looking at chronic diseases as markers for growing health inequities among marginalized populations.
Slow violence, poverty, and oppression
Violence that happens over time and often silently is called structural violence. This type of slow violence and oppression are insidious, pervasive, and the fundamental cause of weathering. The traditional belief that health disparities are due to genetics, diet, and exercise don’t explain data that’s accumulated over the years. Instead, Geronimus makes the case that marginalized people suffer nearly constant stress from living with poverty and discrimination. This may cause damage to bodies at the cellular level and lead to serious health problems over time. For example, depression can, and often is, caused by structural violence. Traumatic experiences and chronic social stressors can enlarge the amygdala, the brain’s processing center for emotions. This can leave people more susceptible to anxiety, depression, and other mental health struggles.
Weathering is a greater predictor of health outcomes than genetics, diet, and exercise
We need to rethink and reframe the traditional narrative that individual behavior is the sole cause of, and solution to, our health problems. As a healthcare and public health community, we know the root causes of poor health lie deeper. Weathering provides a clear example of how health is impacted far by social conditions, far beyond genetics, diet and exercise.
The cumulative effects and constant stress of microaggressions may contribute over time to weathering, taking both a physical and emotional toll on the body. Microaggressions are the indirect, subtle, or unintentional discriminatory acts or slights against members of a marginalized group. Yet, they can have a macro impact on individuals and communities. A more appropriate name for them is subtle acts of exclusion.
One study illustrates this point. Researchers found that Black American college graduates who had attended Historically Black Colleges and Universities were 35% less likely to develop metabolic syndrome (a predictor for heart disease and stroke) by their early thirties than Black American college graduates of predominately white institutions. This suggests that students’ racial identity predicts physiological and psychological distress only in settings in which they are the minority due to weathering.
This may be true for other racial and ethnic groups as well. Research suggests that residents of distressed urban areas fare better when living in a close knit community. Social support, especially with shared identities, may enhance safety and foster group cohesion and connectedness that collectively protects against potential threats.
Disrupting weathering and promoting health equity
Addressing weathering can be informed by the Health Impact Pyramid. It shows that interventions with the greatest potential health impact address the social determinants of health (e.g., income, education, employment, social and physical environments, etc.). This involves making structural changes to create more supportive and equitable social environments. For example, replacing old pipes to reduce lead poisoning in drinking water falls under this tier. While the other tiers are important, they are limited in their effectiveness because they are focused on individual behavior. Improving the water we swim in and the air we breathe will have greater impacts than changing individual behavior.
The concept of weathering aligns with our understanding of Adverse Childhood and Community Experiences (ACEs). Trauma from negative experiences in childhood, as well as historical and generational trauma, impacts health throughout our lives. Weathering impacts allostatic load, the cumulative effects that chronic stress has on mental and physical health. Strategies that prevent or address ACEs, such as trauma-sensitive schools, can improve health outcomes later in life. From data collection and surveillance to public policy, reducing ACEs and their impacts are multifaceted and require a cross-sector approach.
Programs that support social ties in neighborhoods, schools, and workplaces are essential to reducing the effects of weathering. One successful example is Vital Brooklyn, a holistic, integrated community development program for underserved neighborhoods in Central Brooklyn. This initiative addresses both ACEs and all of the social determinants of health with upstream, community-centered strategies. Some examples are increasing safe and stable places to live by building affordable housing, supporting economic empowerment by creating new, livable wage jobs, and increasing access to primary and preventative health care services in the highest need areas.
What can be done to prevent or minimize the harms of weathering?
As Dr. Geronimous aptly says, “systemic problems call for systemic change.” So, how can we as public health and healthcare professionals advance health equity and racial justice given such a widespread, systemic issue?
- Include weathering considerations in racial equity impact assessments. Include explicit discussions of the extent to which proposed policies promote a culture of inclusion, respect, and belonging for marginalized groups.
- Employ equity strategic planning from the top and a process to embed equity principles into day to day practices.
- Ensure that organizations and professionals receive quality training and education in health equity, unconscious bias, and cultural humility.
- Address unconscious bias through training, policy, and practice change.
- We know that having healthcare providers who share your identity/ies can improve health outcomes.
- To increase representation in healthcare and improve patient health, it’s essential to improve pathways into public health and healthcare for diverse and marginalized populations.
- When using a Health in All Policies framework, take a whole systems approach that embeds the impacts of weathering and ACEs on communities into policies. A more holistic, equity-centered approach to policy development is more effective and sustainable than trying to make a healthy lifestyle more affordable and accessible.
- Challenge the widely accepted notion that things are “just the way they are.” Ask why certain groups face disproportionately higher rates of health conditions and mortality.