The case that being poor and black is bad for your health

It was the eighties, the height of a certain panic. Reaganism was rampant, but even the Democrats agreed to scapegoat America’s blacks as the source of the country’s problems. The Black family, that old chestnut, was as topical as ever, and of particular concern was the so-called scourge of teenage pregnancy. “Babies having babies,” as community leaders and politicians of various stripes put it, became emblematic of deferred dreams, evidence of the failure of a cultural, social, and political order. It was considered gospel that, for mothers and their babies alike, teenage pregnancy spelled disaster: for mothers, low grades in school; for their babies, low birth weight; no future for either of them, but cyclical poverty. Everyone knew.

Arline T. Geronimus, a young public health researcher, was skeptical. As a college student working at Princeton’s Office of Population Research in the late 1970s, she’d seen the stark poster child of teen motherhood turn from white to black, and the media in turn cotton to the idea that young, undereducated black mothers were responsible for the poverty and ill health in the ghetto. But at the women’s clinic in the nearby very black town of Trenton, New Jersey, Geronimus met young women who were well-versed in birth control methods and ecstatic about their pregnancies, who had the support of family networks—in short, who looked nothing. like the black teenage mother as she existed in the public imagination.

Geronimus graduated from the Harvard School of Public Health in the 1980s, where she studied the links between infant mortality and maternal age. (She later continued her research as a postdoctoral researcher at Harvard Medical School and then as a professor at the University of Michigan School of Public Health, where she still teaches.) What she found was that for white mothers, giving birth as a teen was indeed associated with higher health risks for their babies, but for black women the trend was reversed. A woman in her twenties who gave birth for the first time was at greater risk of her baby dying – and, as Geronimus later discovered, dying herself – than if she had given birth as a teenager. Something strange was going on with black women’s health, causing their health outcomes to decline over time. In a study published in 1992, Geronimus hypothesized that it had to do with the cumulative effects of racial and economic inequality, including inadequate medical access, dangerous living environments, and routine bigotry. She called this phenomenon “weathering.”

This theory made Geronimus unpopular among those concerned about the alleged plight of teenage black mothers. A representative of the Children’s Defense Fund called her work “perverted.” Rosann Wisman, then executive director of Planned Parenthood of Metropolitan Washington, D.C., wrote in the Washington After that Geronimus was “incredibly presumptuous . . . to assume that it is desirable and/or affordable that the ‘extensive family network’ provides for the maintenance of the teenage mother and her child.” People complained to the University of Michigan and sent death threats; colleagues advised students against taking Geronimus’ courses. Her work has been called racist. But in the decades since, the idea of ​​weathering has taken hold in a range of academic fields, including public health and literary studies, to help explain health differences that cannot be conclusively attributed to issues of lifestyle or genetics. The American ethos of personal responsibility continues to guide our medical system, as evidenced by the national response to the pandemic, in which community health initiatives were quickly jettisoned in favor of individualistic choices. (According to the MTA’s mask policy, revised last fall: “You do you.”) At the same time, recent years have forced a new awareness of the structural and systemic forces shaping American life. In 2021, Anthony Fauci refuted the view that the health problems associated with severe cases of COVID-19 (such as hypertension and diabetes, which African Americans are more likely to develop) were racially determined, instead emphasizing the “adverse circumstances some people of color are in from birth regarding the availability of an adequate diet , access to health care , and the undeniable effects of racism in our society.” What he described is very similar to weathering.

Geronimus recently released her first book, Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society, which draws insights from a nearly 40-year career of researching the adverse health effects of racism and poverty. She draws on a range of sources—academic studies and media coverage, stories from the lives of public figures, and from her own Jewish family history—to illustrate how members of marginalized groups are “vulnerable to dying or developing chronic illnesses and disabilities. suffer long before they become chronologically old.” She is particularly interested in comparative studies of urban poor African Americans and poor whites in Appalachia, two distinct populations who die and become disabled at much younger ages compared to the national average among whites. (Disability is one of Geronimus’ measures of assessing quality of life, which I’d argue with from a disability-justice perspective.) Both are “canaries in the coal mine,” she argues, but their shared class status isn’t the whole picture of weathering. For members of an oppressed class, economic mobility is often not enough to offset the effects of weathering. A group of studies conducted at the University of Georgia followed African American youth in rural Georgia and found that the students who showed higher levels of “planned self-control” and were more likely to attend college also had higher blood pressure, higher levels of cortisol, and were more likely to develop insulin resistance and metabolic syndrome before age 30 compared to peers who did not continue their education. Geronimus cites the work of a former University of Michigan colleague, epidemiologist Sherman James, who developed the concept of John Henryism, a physiologically taxing mode of coping named after the folk hero who captured a machine and then died.

When Geronimus invented weathering, she “thought metaphorically,” she writes. She was drawn to it as a contronym, communicating two opposing meanings: weathering as both “deterioration and erosion” and “strength and endurance.” The word expresses the exhaustion of people who have to endure. But advances in research into the human body’s response to stress enabled Geronimus to think physiologically as well. She found the work of Bruce McEwen, a neuroendocrinologist who studies the physiological effects of chronic exposure to crises. He and Eliot Stellar developed the concept of allostatic stress and overload, in which a prolonged protective stress response has measurable negative consequences for neuroendocrine, cardiovascular, metabolic, brain and immune health. Geronimus found in an article that black and white teens have similar allostatic load scores, while older black men and women have higher scores compared to their white peers. Such research lent empirical clarity to Geronimus’ early understanding that being black in America amounts to what some have broadly likened to a pre-existing condition.

Biologists have found more clues about the toll of stress, at the genetic level. The ends of our chromosomes are capped by telomeres, DNA sequences that ensure correct coding when cells divide. Telomeres shorten and degrade with each division. We call this aging – and dying. But stress can speed up the process. Studies have confirmed that people ravaged by chronic stressors tend to have shorter telomeres and that accelerated erosion can begin as early as childhood. A buildup of unstable cells is associated with numerous chronic problems and acute health events: diabetes, asthma, heart disease, hypertension, autoimmune diseases (such as rheumatoid arthritis), heart attacks, embolisms, cancers. Telomeres help explain, Geronimus writes, how “people who endure chronic stressors and other forms of structural violence may biologically age faster than their peers.” These biological processes are the unprecedented consequence of the well-known touchstones of inequality: toxic water, polluted air, substandard medical care, wage theft, state violence, corporate negligence. Geronimus wants us to understand that harmful health effects of racial and economic segregation are not just environmental or situational, but molecular and cellular.