It was the nineteen-eighties, the height of a certain panic. Reaganism reigned, but even Democrats agreed upon scapegoating America’s Blacks as the source of the country’s ills. The Black family, that old chestnut, was as topical as ever, and of special prurient interest was the so-called blight of teen pregnancy. “Babies having babies,” as community leaders and politicians of various stripes put it, became emblematic of dreams deferred, a testament to the failings of a cultural, social, and political order. It was taken for gospel that, for mothers and their babies alike, teen pregnancy spelled doom: for mothers, low grades in school; for their babies, low birth weights; for both, no future but cyclical poverty. Everybody knew it.
Arline T. Geronimus, a young public-health researcher, had doubts. As an undergraduate working in Princeton’s Office of Population Research, in the late seventies, she’d watched the grim-faced poster child of teen motherhood morph from white to Black, and the media in turn cotton to the notion that young, undereducated Black moms were to blame for poverty and for bad health in the ghetto. But at the women’s clinic situated in the nearby, very Black city of Trenton, New Jersey, Geronimus met young women who were well versed in contraceptive methods and ecstatic about their pregnancies, who had the support of family networks—in short, who looked nothing like the Black teen mother as she existed in the public imagination.
Geronimus went on to graduate school at the Harvard School of Public Health, in the eighties, where she studied the associations between infant mortality and maternal age. (She later continued her research as a postdoctoral fellow 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 to their infants, but for Black women the trend was reversed. A twentysomething giving birth for the first time incurred a higher risk of her baby dying—and, as Geronimus later found, of dying herself—than if she had given birth as a teen. Something peculiar was wearing on the health of Black women, dragging down their health outcomes over time. In a study published in 1992, Geronimus hypothesized that it had to do with the cumulative consequences of racial and economic inequality, among them inadequate medical access, hazardous living environments, and routine bigotry. She called this phenomenon “weathering.”
This theory made Geronimus unpopular among those concerned with the supposed plight of Black teen mothers. A representative from the Children’s Defense Fund called her work “perverse.” Rosann Wisman, at the time the executive director of Planned Parenthood of Metropolitan Washington, D.C., wrote in the Washington Post that Geronimus was “incredibly presumptuous . . . to assume that it is desirable and or affordable for the ‘extended family network’ to provide for the teen mother and her child.” People complained to the University of Michigan and sent death threats; colleagues dissuaded students from taking Geronimus’s courses. Her work was called racist. But, in the decades since, the idea of weathering has caught on within a range of academic fields, including public health and literary studies, to help explain health disparities that can not be convincingly attributed to matters of life style or genetics. The American ethos of personal responsibility still guides our medical system, as illustrated by the national response to the pandemic, in which community health initiatives were soon jettisoned in favor of individualist choice. (Per the M.T.A.’s mask policy, revised this past fall: “You do you.”) At the same time, these past few 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 conditions associated with severe cases of COVID-19 (such as hypertension and diabetes, which African Americans are more likely to develop) were racially determined, emphasizing instead the “disadvantageous conditions that some people of color find themselves 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 was describing sounds a lot like weathering.
Geronimus has recently released her first book, “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society,” assembling insights from a nearly forty-year career researching the adverse health effects of racism and poverty. She recruits a range of sources—academic studies and media reporting, 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 suffering chronic disease and disability long before they are chronologically old.” She is especially interested in comparative studies of poor African Americans in cities and poor whites in Appalachia, two distinct demographics who die and become disabled at much younger ages compared with the national average among whites. (Disability is one of Geronimus’s metrics for assessing quality of life, which I would quibble with from a disability-justice perspective.) Both are “canaries in the coal mine,” she argues, but their shared class status is not the whole picture of weathering. For members of an oppressed class, economic mobility is often not enough to negate the effects of weathering. One group of studies conducted at the University of Georgia followed African American youth in rural Georgia and found that the students who exhibited higher levels of “planful 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 the age of thirty compared with peers who did not continue their education. Geronimus invokes the work of a former University of Michigan colleague, the epidemiologist Sherman James, who developed the concept of John Henryism, a physiologically taxing mode of coping, named for the folk hero who conquered a machine and then died.
When Geronimus conceived of weathering, she was “thinking metaphorically,” she writes. She was drawn to it as a contronym, communicating two opposite meanings: weathering as both “deterioration and erosion” and “strength and endurance.” The word conveys the wearing down of people who must endure. But advances in research on the human body’s response to stress enabled Geronimus to think physiologically as well. She found the work of Bruce McEwen, a neuroendocrinologist studying the physiological effects of chronic exposure to crises. He and Eliot Stellar developed the concept of allostatic load and overload, in which a prolonged protective stress response has measurably negative consequences on neuroendocrine, cardiovascular, metabolic, brain, and immune health. Geronimus found in one paper that Black and white teens have comparable allostatic load scores whereas older Black men and women have elevated scores compared to their white peers. Such research lent empirical clarity to Geronimus’s early insight that being Black in America amounts to what some have crudely likened to a preëxisting condition.
Biologists have found further clues concerning stress’s toll, on the genetic level. The ends of our chromosomes are capped by telomeres, DNA sequences that help insure proper coding when cells divide. Telomeres shorten and degrade with each division. We call this aging—and dying. But stress can accelerate the process. Studies have confirmed that people beset by chronic stressors tend to have shorter telomeres, and that expedited erosion can begin as early as infancy. An accumulated abundance of unstable cells is associated with numerous chronic issues 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 can biologically age faster than their peers.” These biological processes are the unseen corollary to the familiar touchstones of inequality: toxic water, polluted air, substandard medical care, wage theft, state violence, corporate negligence. Geronimus wants us to see that deleterious health effects of racial and economic segregation are not simply environmental or situational but molecular and cellular.
Like many researchers working in the social sciences, Geronimus illustrates her argument with narrated case studies. There is Jason Hargrove, a bus driver in Detroit who blogged about the physical and emotional toll of his job in March of 2020, less than two weeks before dying with COVID. She shares the story of a colleague who grew up Black, Native, and poor in North Carolina and worked his way to a tenured faculty position at Duke University, yet, despite lifetime sobriety and healthful habits, “suffered a series of chronic and acute health events one would typically associate with someone decades older.” Geronimus also looks to her immigrant grandparents, Ukrainian Jews who fled Russian pogroms and then endured antisemitism in the U.S. along with a string of debilitating health problems. These stories give a human face to the book’s recited statistics, but they also leave much of Geronimus’s argument in the speculative realm. Weathering “could have” caused Erica Garner-Snipes, who died three and half years after New York City police killed her father, to have an enlarged heart—or, as Geronimus writes elsewhere, “her case could be idiosyncratic.” Shalon Irving, a member of the Epidemic Intelligence Service at the C.D.C., who, like Garner-Snipes, died of complications shortly after giving birth, “may have” been weathered. Of Geronimus’s working-class, Yiddish-speaking father, who died early and “probably” lived in a prolonged state of stress, “one could certainly speculate” that weathering was the cause. The promise of Geronimus’s book is to clarify and concretize the burdens of disadvantage with empirical evidence that cannot be dismissed as easily as personal testimony. But there is a missing middle in her book between the structural and the anecdotal that is, at heart, a conceptual problem. The structural forces of oppression exert an intuitive yet ill-defined pressure on a person’s immediate circumstances. They are everywhere, and yet they remain hard to pin down.
The book has another rhetorical problem, one endemic to recent populist explainers of social issues. There is a preponderance of what I think of as trade-book baby talk: frequent second-person addresses, facile similes (stereotypes are “like microbes”), breathless exclamations (“Imagine the burden these disability rates place on families!”), and too many transitional questions (“What’s wrong with this picture?”). The real detriment of such hand-holding is revealed in the final third of the book, which is dedicated to policy solutions. The proposals Geronimus offers are as friendly and unchallenging as her prose: affirmative posters in classrooms, green infrastructure, electoral politics, and the usual sloganizing (“take black women’s health seriously”). Meanwhile, the word “Medicare” appears only once—and not followed by “for all”—and a section on health-care spending spans all of a single paragraph. In short, “Weathering” delineates what amounts to an urgent health crisis, only to retreat to a language of incremental, vague, and borderline apolitical change. Geronimus endorses that which would prove “less costly”: “Three months of paid maternity leave—compared to zero, which is the prevailing model!—may seem like a lot to ask,” she writes. She, and all of us, would do well to remember that, as Dr. Vicente Navarro, a professor emeritus of health and public policy at Johns Hopkins University, has written, “It is not inequalities that kill people. It is those who are responsible for these inequalities that kill people.”
The power of Geronimus’s project remains the attempt to provide a conceptual framework for patterns that medical institutions, in their convenient recourse to individual failings, have yet to fully recognize. I think about luminaries of Black Hollywood and hip-hop who are routinely felled by their own hearts well before their time and how the pandemic has coincided with ongoing police and carceral violence. I think about the elevated lead levels that were recently found in eighteen hundred Illinois public schools, or the noxious fumes released on residents of East Palestine, Ohio, when a Norfolk Southern train derailed in February. It is an observed truth that illness and death follow some kinds of people more than others. The mountain of evidence accretes still. ♦
