what is weathering hypothesis

The weathering hypothesis as an explanation for racial disparities in health: a systematic review

Affiliations.

• 1 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Electronic address: [email protected].
• 2 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
• 3 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
• 4 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
• PMID: 30987864
• PMCID: PMC10676285
• DOI: 10.1016/j.annepidem.2019.02.011

Purpose: The weathering hypothesis states that chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes and could partially explain racial disparities in a wide array of health conditions. This systematic review summarizes the literature empirically testing the weathering hypothesis and assesses the quality of the evidence regarding weathering as a determinant of racial disparities in health.

Methods: Databases (Web of Science, Ovid MEDLINE, PubMed, and Embase) were searched for studies published in English up to July 1, 2017. Studies that tested the weathering hypothesis for any physical health outcome and included at least one socially or economically disadvantaged group (e.g., Blacks) for whom the weathering hypothesis applies were assessed for eligibility. Threats to validity were assessed using the Quality in Prognostic Studies tool.

Results: The 41 included studies were rated as having overall good methodological quality. Most studies found evidence in support of the weathering hypothesis, although the magnitude of support varied by the health outcome and population studied.

Conclusions: Future evaluations of the weathering hypothesis should include an examination of additional health outcomes and interrogate mechanisms that could link weathering to poor health.

Keywords: Health disparities; Health inequalities; Race; Weathering.

Copyright © 2019 Elsevier Inc. All rights reserved.

Publication types

• Research Support, N.I.H., Extramural
• Systematic Review
• Health Status Disparities*
• Healthcare Disparities*
• Population Groups
• Social Determinants of Health*

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• F31 HL117613/HL/NHLBI NIH HHS/United States

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How ‘Weathering’ Contributes to Racial Health Disparities

When Dr. Arline Geronimus first introduced the theory in 1990, her ideas were derided and largely ignored. Now, people are starting to listen.

By Alisha Haridasani Gupta

For Arline Geronimus, avoiding the limelight had become a way of life.

Three decades ago, she put forward an idea that was unconventional for the time: that the constant stress of living within a racist society could lead to poor health for marginalized groups.

Dr. Geronimus, then a 32-year-old public health researcher at the University of Michigan, had spent three years gathering data on more than 300,000 pregnant women, in search of an explanation for the vast racial disparities in infant mortality rates. At the time, Black babies died more than twice as often  as white babies in their first year of life. It was widely assumed that high rates of teen pregnancy among Black women were to blame.

Dr. Geronimus’s research showed otherwise: The babies of Black teens were healthier than the babies of Black women in their 20s and older. These younger women, she posited, had endured fewer years of racism-induced stress, and therefore had given birth to more robust children.

She called this particular form of chronic stress “weathering,” evoking a rock being eroded by constant exposure to the elements. She first presented her findings and the outlines of her hypothesis at the annual conference of the American Association for the Advancement of Science in 1990.

The backlash was immediate, and ran the ideological gamut. The Children’s Defense Fund, a progressive organization that had knowledge about her talk ahead of time, set up a table outside to express outrage because they thought Dr. Geronimus’s conclusion was that teen pregnancy was not entirely bad. “The policy implications of her arguments are perverse,” a CDF representative told The New York Times a few weeks after her speech. A columnist at the Washington Times, a conservative paper, wrote “As Marie Antoinette might put it: Let them have babies.” Michigan alumni pressured the university’s president to fire her. She received death threats at home from anonymous callers.

“I was pretty traumatized,” said Dr. Geronimus, now 66, over coffee at the New York Public Library in March. “So I kind of retreated into my work.”

In the years that followed, Dr. Geronimus largely stopped going to conferences and rarely talked to reporters (she admitted that this interview was nerve-racking for her). But, with the University of Michigan’s continued support, she has published more than 130 papers, expanding and bolstering the evidence for weathering well beyond Black mothers. She has studied Latina mothers, Mexican immigrants and white people in Appalachian Kentucky, among other groups, repeatedly showing that people experiencing high levels of chronic stress as a result of their identities and circumstances have poorer health outcomes. Simultaneously, researchers across disciplines have linked the relentless strain of discrimination to premature aging and dysfunction of the immune , cardiovascular , metabolic and endocrine systems.

That body of evidence, which Dr. Geronimus describes in her new book, “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society,” has turned her into an “icon” and provided a framework for understanding health inequities that goes deeper than blaming poor health on lifestyle choices or flawed genetics, said Dr. Marcella Nunez-Smith, a professor at Yale School of Medicine who chaired the White House Covid-19 health equity task force.

“There’s a solid line from her work on weathering to what we now call social determinants of health,” Dr. Nunez-Smith said. Weathering was the foundation of many of the task force’s policy decisions during the height of the pandemic, which focused on reducing the excess stresses of the pandemic on people of color and low-income groups — like funding non-English speaking workers to help reach vulnerable populations for contact tracing , and switching from drive-through testing sites, which excluded those without cars, to walk-in options.

Covid is, in large part, why Dr. Geronimus, after years of turning down offers from agents, decided to re-enter the fray with her first book. In a grim affirmation of her work, the pandemic — with its disproportionately high numbers of deaths among people of color — has become one of the starkest examples yet of the effects of weathering.

The pandemic also presented an opportunity for structural change, she said, which would help address health disparities that have only gotten worse since she published her first paper back in 1986.

The Trap of Chronic Stress

When the body is exposed to stressors, it goes into fight-or-flight mode, said Elizabeth Brondolo, a psychology professor at St. John’s University who studies the psychophysiology of discrimination. Breathing, heart rate and blood pressure shoot up and the bloodstream is flooded with glucose and fatty acids to fuel the large muscles.

Over time, if the sympathetic nervous system reaction remains activated, it can erode internal systems, Dr. Brondolo said. Chronically elevated blood pressure can damage arteries and veins, which can lead to hypertension, for example. A constant stream of cortisol — known as the stress hormone — can create insulin resistance, leading to diabetes. Research has suggested that chronic stress can damage DNA and even alter brain structure .

Though many people feel stress on a day-to-day basis, surveys have repeatedly found that people of color and those with lower socioeconomic status report more severe and more frequent rates of stress. Research shows that these same groups often can’t escape their stressors because they face a higher likelihood of violence, job instability and discrimination while lacking social or material support.

There’s also a physically potent and persistent quality to race-based stress. In a series of studies between 1999 and 2009 and in clinical sessions, Dr. Brondolo and her colleagues examined the physiological impact of racist behavior, finding that the body and mind can’t easily shake off its effects. In one study , for instance, participants who reported being on the receiving end of racist behavior experienced elevated blood pressure for an extended period, even while they were asleep. “That’s really the key to what Dr. Geronimus is talking about — there was no recovery,” Dr. Brondolo said.

Dr. Geronimus’s research has found that upward mobility and wealth aren’t antidotes for weathering. In one 2006 study , she analyzed the health data — including blood pressure, cortisol levels, liver function and cholesterol — of over 1,500 survey respondents and found that high-income Black women had worse health outcomes than low-income white women.

In a related case, when researchers from Ohio State University examined Black students who attended historically Black colleges and universities, they determined that those years of being “sheltered, at least somewhat, from racial discrimination,” as they put it, put participants at a lower risk of health problems later on, compared with their peers who had attended predominantly white institutions.

One explanation for these findings is found in the stress a person experiences when they try to thrive in an environment where their identity or circumstances are in the minority — what psychologists call “high-effort coping.” “The actual physiological energy it takes to succeed against all kinds of structural headwinds and barriers itself is weathering,” Dr. Geronimus said. It is one of the reasons Black maternal mortality rates remain stubbornly high, she said, even among high-income families — and even as Black teenage pregnancies have plummeted in the decades since her first study.

The Challenges and Critiques

A caveat for much of public health research is that it’s observational; it can identify links and associations but cannot prove causation, said Robert Kaestner, a professor at the University of Chicago Harris School of Public Policy who worked with Dr. Geronimus on a  2009 study on Mexican immigrants. When it comes to weathering, he said, not only is it “a difficult empirical task” to measure discrimination, it is also difficult to rule out other environmental stressors.

Despite his skepticism regarding its ability to be measured, Dr. Kaestner described weathering as “intuitive,” “plausible” and “consistent with biological processes.”

The intersection of health and racism is also a fraught research area that raises challenging questions about privilege and bias. That Dr. Geronimus is a white woman might have afforded her some credibility in that context, said Dr. Camara Jones, an epidemiologist at Rollins School of Public Health at Emory University, who served as a medical officer at the Centers for Disease Control and Prevention from 2000 to 2014.

“White people, in general, are given more credit when they’re naming racism,” she said. “When people of color do that, we are seen as having a chip on our shoulder or being subjective.”

In 1992, Dr. Jones had also shown a link between racism and accelerated aging in a study on blood pressure disparities. But she didn’t pursue this line of research for very long, in part because one of her advisers told her that she didn’t want to be “known as ‘the racism lady,’” she said. “Even when I was writing grant proposals, people would call me and say ‘Camara, can you just change the word racism to discrimination?’”

But Dr. Geronimus’s race doesn’t negate the importance of her research, Dr. Jones said.

“I’m grateful for her work because now the knowledge is out there.”

Putting Weathering Research to Use

In March 2020, an immigration lawyer named Kari Hong contacted Dr. Geronimus with a question: Could her research help get detained immigrants out of confinement?

Ms. Hong was worried about her clients’ exposure to Covid-19 in the close quarters of detention centers in California and Arizona, where they were being held. “One judge had said people who are uniquely vulnerable to Covid-19 should be able to get out,” Ms. Hong said. “So then the question became, ‘Well, who’s uniquely vulnerable?’”

It was clear that older detainees and those with underlying health conditions would fall into that category. But for her middle-aged clients, the health risks were less clear.

Dr. Geronimus agreed to help. She wrote up legal declarations for seven different cases. “It is my expert opinion that detainees younger than 65 who are Black or have been subjected to trauma and other forms of stress-mediated wear and tear based on their social identity or circumstances are biologically older than their chronological ages,” she wrote, “and are more susceptible to experiencing Covid-19 infection in its most severe forms.”

All seven detainees were released.

“Without Dr. Geronimus I wouldn’t have had an argument at all,” Ms. Hong said.

In “Weathering,” Dr. Geronimus proposes other reforms that would decrease stress levels for people at risk, though she acknowledges some feel more realistic than others. These include deploying doulas to help reduce Black maternal mortality rates (a tactic that’s already shown success in a few local programs across the country) and reinstating the Biden administration’s expanded Child Tax Credits , which for many families reduced the hardship of making ends meet (Congress ended the program at the end of 2021).

The idea, Dr. Geronimus said, is to consider health equity even when developing policies “that do not, at first blush, appear health related.”

“It does sound intractable at first — I’ve certainly had my periods of hopelessness over what can be done,” she said. “But since these weathering stressors surround us, that means there are so many leverage points. You just have to be committed.”

A previous version of this article misstated Dr. Marcella Nunez-Smith’s title. She is a professor at Yale School of Medicine, not an associate professor.

How we handle corrections

Alisha Haridasani Gupta is a reporter on the Well desk, focused on women’s health, health inequities and trends in functional medicine and wellness. Previously, she wrote the In Her Words newsletter, covering politics, business, technology, health and culture through the gender lens. More about Alisha Haridasani Gupta

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Black Women Excluded from Critical Studies Due to ‘Weathering’

The impact of racial weathering on health.

Researchers hypothesize Black women who face continuous exposure to race-based stressors age faster as a result of this "weathering."

Weathered by a lifetime of racial discrimination, Black women age earlier and faster. Researchers theorize this accelerated health deterioration is caused by cumulative exposure to race-based stressors in a race-conscious society.

High levels of stress hormones can be toxic for Black women’s bodies, especially if the women are repeatedly pushed into a fight-or-flight state by prejudice, marginalization, institutional bias, and oppression. The ‘weathering’ hypothesis dates back to 1992 when Arline T. Geronimus, ScD, proposed it after learning that young Black women had better pregnancy outcomes in their late teens than in their mid-twenties. By contrast, she found White women faced the lowest risk of pregnancy complications in their mid-twenties and the highest risk in their teens.

“There was certainly a whole narrative that teen motherhood somehow caused perpetual poverty, lack of education, and poor birth outcomes,” Geronimus said in a 2018 interview with NPR. “[But] the data spoke for themselves — that the risks were higher in black young women the later they waited to have children, and that was not true for white [women].”

Due to this premature aging, Black women’s experiences have effectively been erased from many research narratives. In 1994, the Study of Women’s Health Across the Nation (SWAN) began analyzing the health of middle-age and older women over time, through participation of women who were likely to undergo menopause. But, in line with the hypothesis that Black women age earlier due to weathering, many were excluded from SWAN after experiencing menopause earlier.

In November, Alexis Reeves, PhD, authored a new study that enrolled the approximately 9,000 women who had been excluded under the guidelines of the previous SWAN study. This ‘enrollment’ involved matching up the women’s profiles to similar participants who had been included, in order to compare their health outcomes. She sought to break down how selection bias and racial disparities in these cohort studies painted falsely high estimates for age of onset of chronic diseases by not taking women of color into account.

Across the board, inclusion of these women in the study lowered the average age of developing many critical diseases. Compared to the estimates originally concluded by the SWAN study, Reeves found that heart diseases begin 5 years earlier in Black and Hispanic women, while insulin resistance begins 11 years earlier. The results show that interventions for hypertension and metabolic diseases in Black and Hispanic women should target these groups much earlier than originally estimated based on SWAN’s data.

This is further troubling because studies usually determine the age range for recruitment of participants based on the average age of onset — women of color would have been more likely to develop the health outcome by the recruitment age, and therefore be excluded from study.

“I wasn’t expecting to see how much the selection [of study participants] changed these estimates,” Reeves told Science . “We’re overestimating the timing of onset of these diseases for everyone in SWAN, regardless of race. It basically amounts to only telling part of the story.”

Geronimus equated the idea of weathering to the tabletop game, Jenga. As more pieces are pulled from the tower, the structure can no longer stand and collapses.

Allostatic load — the physiological burden of constant adaptation to stressors — is one way of measuring weathering. Higher allostatic load scores are connected to older age, heightened mortality, brain health decline, and low socioeconomic status. Measuring this load involves tracking biomarkers such as levels of cortisol and of epinephrine, alongside the outcomes of this stress on blood-pressure reactivity and cholesterol levels.

In addition to high allostatic load, weathering has been tied to telomere shortening. Telomeres — the structure at the ends of a chromosome — help protect chromosomal stability, and shorten with age. Critically short telomeres prevent a cell from dividing, which triggers a cell to either die or enter an inactive state. Shorter telomeres are overall a risk factor for development of cancers, cardiovascular diseases, diabetes, and other diseases. While telomeres naturally shorten after each round of cell division, chronic stress has been tied to higher telomere shortening rates. Weathering may also be measured in epigenetics, which refers to stable changes in the DNA sequence caused by environmental and behavioral factors. This DNA methylation can either prevent or promote the expression of particular genes in one’s DNA, countering the popular notion that health disparities between populations are related to inherent DNA differences. The reality is that epigenetics can rewrite this ‘destiny’ in response to influences such as chronic stress.

Geronimus found that by age 45, half of Black women had high allostatic load scores, while by age 64, more than 80% did. Socioeconomic status could not explain the racial disparities — poor and nonpoor Black women faced the highest probabilities of having high allostatic load scores.

If the goal of clinical research studies is to gather data on women’s health and inform the implementation of interventions against disease, we must address the exclusion of women of color. Knowing the reality of weathering, recruitment ages for studies like SWAN need to adjust. Racially-based stressors result in real disparities in morbidity and mortality rates, illustrating women are not one homogenous population.

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How poverty and racism 'weather' the body, accelerating aging and disease

Dave Davies

Public health professor Arline Geronimus says marginalized people suffer nearly constant stress, which leads to increasingly serious health problems over time. Jon Cherry/Getty Images hide caption

Public health professor Arline Geronimus says marginalized people suffer nearly constant stress, which leads to increasingly serious health problems over time.

In 2020, the overall life expectancy in the U.S. dropped by 1.5 years , largely due to the COVID-19 pandemic. But the reduction wasn't shared equally among the general population; Native American people lost an average of 4.5 years of life expectancy ; Black and Hispanic people lost, on average, 3 years, while white people lost only 1.2 years.

This figure tracks with other health trends: In general, Black and Hispanic people and those living in poverty in the U.S. have worse health outcomes — more high blood pressure , higher rates of diabetes and increased maternal and infant mortality — than the overall population.

Public health researcher Arline Geronimus from the University of Michigan says the traditional belief that the disparities are due to genetics, diet and exercise don't explain data that's accumulated over the years. Instead, she makes the case that marginalized people suffer nearly constant stress from living with poverty and discrimination, which damages their bodies at the cellular level and leads to increasingly serious health problems over time.

Geronimus coined a term for this chronic stress — she calls it "weathering," which, she says, "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 writes about the phenomenon in her new book, Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society.

Shots - Health News

'1619 project' journalist lays bare why black americans 'live sicker and die quicker'.

Geronimus' theories drew criticism when she first promoted them in the 1990s. But in recent years, her work has generated a wealth of support. She says weathering helps explain why Black women who give birth in their 20s have more complications than those who become mothers in their teens. The older women had endured the stress of their difficult living conditions longer, she says, and thus had suffered more damage to their health.

Code Switch

Making the case that discrimination is bad for your health.

"It's not that every Black person has more damage than every white person," she says. "It's really about how much stress versus social support you get in your everyday life. ... Because African Americans and low-income Americans are more likely to suffer more of these stressors, they are more likely to be weathered, weathered severely and weathered at younger ages."

Interview Highlights

On how the body's natural stress response can lead to weathering

Human bodies have evolved, and the reason we haven't gone extinct yet is because when we're faced with an acute, life-threatening challenge, our body automatically activates this release of hormones. And what those hormones do as they flood your body is they increase your heart rate. They increase your breathing rate. They propel oxygenated blood to your large muscles quickly. ... They galvanize fats and sugars from your storage areas of your body into the bloodstream to provide energy towards that ability to fight or flee. ...

That process, when you're fighting or running from the cheetah, is a wonderful adaptive process that is designed to last about three minutes. ...

The problem in the modern world is ... a lot of [stress] is simply everyday life: Coming home after night shift work and having to stay wide awake and vigilant so you don't forget to get off your bus for the next bus to go home. Trying to get your kids up for school at five in the morning so you can also get to work. ... This means that the stress hormones are chronically flooding your body. The fats and sugars that you catapulted into your bloodstream for energy are constantly flooding your body.

It means your heart rate is up, [and] like any other over-exercised muscle, you'll start to get an enlarged heart. You'll start to get hypertension from pushing so much blood through certain arteries and veins to get your heart rate going and your breathing going. If you were pregnant, you might lose your baby, because it's actually probably more adaptive if you're in fight or flight to not be carrying a baby. But even if you don't lose the baby, you'll shunt nutrients away from it because they can't be spent on the growing baby. And so your baby may be born low birth weight or growth retarded because it hasn't been well nourished in the womb.

On why middle- and upper-class "stress" isn't the same

[More affluent people] can take vacations. They can hire people to do their housework or even order their food to be delivered. It's not a relentless day in, day out. They still have many choices. They still have time to relax. They're not dealing with the stereotypical racism aspect that also can activate this process. So the problem is "stress" is this very diffuse term. And we think of it as something you can just meditate your way out of or take a vacation or a break. Many people in our country can't even take a break during working hours.

On improving maternal mortality rate

Maternal mortality still keeps going up. ... But I think more and more people are understanding that systematic racism in the medical care system is part of the problem. There are ways around it, whether those ways are having birth attendants who are doulas or midwives, rather than physicians; having your birth at home. Ways where you will be less stressed during and feel safer during the birth can make a difference. But at this point we don't have enough midwives or doulas or maternity-care providers at all. We have about one maternity-care provider per 15,000 births, and that's not spread evenly over the country. ... So we also have to do things that get more people trained, and trained not just as OB-GYNs but as midwives and doulas.

On studying why Latin American immigrants, such as those from Mexico, have worsening health the longer they're in the U.S.

You're a fish out of water. If you've been raised in an immigrant family from Mexico, and then you're moving into predominantly white, American, affluent and well-educated communities and institutions, ... where you don't share the same assumptions or background, where the people you're working with don't appreciate all you've been through, where you're having to always be on your guard and manage how you portray yourself or present yourself to try and not fulfill stereotypes that you think people you're working with or going to school with might have about you. ....

And that means you're at a certain level of vigilance and looking for cues everywhere of whether you belong, whether you're welcome, whether you're going to be subject to what many people call microaggressions. ... Those experiences themselves can cause weathering.

On how social mobility of minorities doesn't mean less stress

[Our health is] an indicator of ... the context that we live in, of a society that is racist, oppressive, class conscious. ... We won't solve health inequalities between Blacks and whites or Latinx and whites or other groups simply by getting people more education or higher incomes. This chronic stress arousal is more likely in those kinds of unsupportive environments than ... the more supportive environments, if you stick with your own group. Weathering is not against social mobility, it's not for segregation, it's for non-erasure. It's for seeing and recognizing what is really happening, and what it does to you biologically, and realizing if we want to eliminate health disparities or promote health equity, we have to attend to what's happening in these different settings.

Audio interview produced and edited by: Heidi Saman and Thea Chaloner. Audio interview adapted for NPR.org by: Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth.

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Biological Weathering and Its Deadly Effect on Black Mothers

By Patia Braithwaite

This story is part of SELF 's ongoing series exploring black maternal mortality. You can find the rest of the series here .

Imagine for a moment that you’re a very silly 22-year-old driving through Florida sometime around 2009. You’re speeding down a road called Alligator Alley at approximately 92 miles an hour, which is about 20 miles above the speed limit. It’s late. Maybe the windows are down. Maybe the music is blaring. Maybe you’re singing off-key. You’re basically living your best life until police lights appear behind you, and you remember you’re not in a coming-of-age film. You’re a black woman driving alone in the middle of the night. In the South.

This is how I die, you think, as a stoic police officer takes your license and registration from your shaking hand. The police killing of Michael Brown that thrust Black Lives Matter into the national spotlight hadn’t happened yet. But you grew up hearing about Sean Bell and Amadou Diallo , Brown’s forefathers on the list of black people killed by police, his companions in this traumatic, helpless club. You know how dangerous this can be.

The police officer walks away. After what feels like an eternity, he returns.

“For the love of God,” he hisses, handing you back your information. “You really need to slow down.”

You didn’t get a ticket. You really deserved a ticket.

The officer leaves, but your heart won’t stop racing, and your muscles don’t relax. You’re still shaking, and your breathing doesn’t slow. There’s nothing to do but sit there, wading through fear and the feeling that you got lucky, then keep driving.

I was that 22-year-old who thought she was going to die in the middle of the night on a Florida road. I know very well the visceral fear that comes from premature death being an acceptable hazard of the black American experience. I understand what it means for racism to be such a fact of everyday life that my first thought when I got pulled over wasn’t “I hope I don’t get a ticket” but “I hope I make it through this alive.”

The term “ weathering ” describes how the constant stress of racism may lead to premature biological aging and poor health outcomes for black people, like disproportionately high death rates from chronic conditions such as heart disease , stroke, diabetes , and most cancers .

Mental anguish and stress from “fighting against larger structures and systems can have an impact on your health,” Joia Crear-Perry , M.D., founder and president of the National Birth Equity Collaborative, tells SELF. This, in a nutshell, is weathering.

Weathering plays a significant and intriguing role in conversations about black maternal mortality , a public health crisis based around the fact that black women are three to four times more likely to die from pregnancy-related complications than white women in the United States, according to the Centers for Disease Control and Prevention (CDC). As part of our ongoing series on black maternal mortality , we’re unpacking how weathering works, why it matters even if you’re not pregnant, and what you can do with this information.

Any kind of long-term stress can affect your body. “We’ve learned a lot about what stress does to your body and your organs and how it accelerates the aging of your cells,” Arline Geronimus , doctor of science, professor at the University of Michigan School of Public Health and member of the National Academy of Medicine, tells SELF. “This has helped me understand how lived experiences become biology,” says Geronimus, who first coined the term “weathering” with her landmark 1992 Ethnicity & Disease hypothesis on the subject.

Stress is your body’s natural response to perceived danger. It’s actually meant to be helpful. When you experience stress, your brain’s hypothalamus prompts your adrenal glands to release hormones including adrenaline and cortisol, according to the Mayo Clinic . These hormones can impact a host of bodily functions, like increasing your blood pressure and quickening your heart rate. All of these physiological changes allow you to fight your potential stressor or flee from harm (hence the term “fight-or-flight response”).

To illustrate how this works, Dr. Crear-Perry uses an example far too many black people can relate to: a store employee following you for no reason besides the color of your skin. “Your heart starts racing, and you start breathing faster,” Dr. Crear-Perry says. “That's a natural physiological response to the stress of being a black person in America.”

Stress responses that happen infrequently and last for a few minutes or so are perfectly normal, but chronic stress can be really detrimental to your health. (“Tell me something I don’t know,” you say.) Chronic stress can make you more prone to mental illnesses like depression , according to the American Psychological Association (APA). It can lead to migraines, tension headaches, and backaches. Chronic stress can also impact your blood vessels, arteries, and heart, which over time can raise your cholesterol levels and even increase the risk of a heart attack. Then there’s how you deal with this stress. If it’s by drinking more than a moderate level of alcohol , smoking cigarettes, or other unhealthy behaviors, that can only compound your risk of health issues.

Chronic stress is unhealthy for the average person, but these symptoms can be even more worrisome for pregnant people . If symptoms of stress like trouble falling asleep, loss of appetite, and headaches get severe enough during your pregnancy, they can impact you and your growing fetus, according to the National Institute of Child Health and Human Development (NICHD). High blood pressure—which chronic stress can absolutely help induce—can directly increase the chances of having preterm labor as well as a baby with low birth weight, the NICHD explains. Those kinds of poor birth outcomes were the impetus for Geronimus’s weathering research.

Geronimus came up with the idea of weathering while examining why teen moms have overall higher rates of preterm birth, low birth weight, and infant death, with young black mothers having even higher rates than young white moms . She became interested in this area of study after working with several groups of black teen mothers as a young research assistant. Geronimus’s theory was that if she could take into account the different life experiences between black and white teens (like income levels), birth outcomes would improve the longer people waited to get pregnant, no matter their race. To find her answer, she dug into large pools of data like the CDC’s information on birth outcomes in 1983 among people aged 15 to 34 of various races.

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“When I actually studied it, I began to see I was wrong,” Geronimus says.

What Geronimus found was that birth outcomes worsened among black moms as they aged. “If you were black and a teen mom, you had better birth outcomes even when compared to your 20s, and certainly by the mid or late 20s,” Geronimus says. The same wasn’t true for the white moms she studied.

In response to this finding, Geronimus developed the theory that weathering was a form of premature aging due to exposure to social inequity, she explains. The term is meant to capture the positive connotation of weathering (making it through a difficult experience) along with the negative implication (being damaged in the process).

Oppressed groups are essentially put between a rock and a hard place, Geronimus says. “They [are] expected to do things even though they were set up for failure, and if they [succeed] at them, it [exacts] a physical price.”

Since first publishing her theory on weathering, Geronimus has conducted more research to see how it holds up. In 1996 she published a study in Social Science & Medicine that looked at 54,888 births in black and white Michigan residents between the ages of 15 and 34, finding that as the black moms aged, they were more likely to have low birth weight and very low-birth-weight babies. The effect was more severe for black women living in low-income areas, but it persisted no matter their income level.

One prime question in weathering research is how discrimination can lead to tangible negative health outcomes. In 2010, Geronimus and her fellow researchers published a study in Human Nature , examining how telomere lengths differed in 110 black and 105 white women from 49 to 55 years old. Telomeres are “stabilizing caps” located on the ends of chromosomes that protect DNA, sort of like the plastic ends on your shoelaces, Geronimus explains. They naturally shorten during cell division and throughout your aging process, but there’s also research to suggest that environmental factors can speed up that deterioration. A 2013 literature review published in the Journal of Internal Medicine notes that one of the most robust studies on telomere lengths suggested a 25% risk of early death among people with the shortest telomeres. Because of that, Geronimus and her team theorized that telomere lengths could be an indicator of weathering. They found that, based on telomere length, black women in the age range of 49 to 55 were on average 7.5 years “older” biologically than white women of the same age, though they note the various limitations to the study, like small sample size, and say more research is necessary before reaching a definitive conclusion here.

But the ability to measure how overexposure to stress hormones can cause biological damage, known as the allostatic load, may give Geronimus’s theory more scientific credence. Allostatic load is measured through a composite index of lab test results indicating stress-related wear and tear across the body, Geronimus explains. Various research points to racial disparities that can’t be fully attributed to things like differences in income level.

To further illustrate the idea that weathering is a biological process that can happen across socioeconomic status, in 2015 Geronimus published another study on telomere length, this one in the Journal of Health and Social Behavior . The study authors examined the telomere lengths of 239 black, white, and Mexican adults living in Detroit who spanned a range of low to moderate incomes. The researchers found that white residents who lived in poverty had shorter telomere lengths than their white moderate-income counterparts, black residents had equivalent telomere lengths regardless of income level, and Mexican residents living in poverty had longer telomere lengths than their Mexican moderate-income counterparts.

“This [outcome] is actually what my colleagues and I had predicted because [weathering] is not about poverty itself,” Geronimus says. Instead, it’s about how others in your environment treat you based on race, which financial security can’t always change. For instance, middle-income black residents who still had relatively short telomeres were spending time in environments where they were subjected to othering and social isolation, which “was affecting their telomere lengths from a kind of prolonged [physiological] stress,” she explains. This study was also limited by issues like small sample size, but it still adds to the collection of evidence that racism may affect health.

Geronimus’s research on Mexican residents in Detroit (many were born abroad) complements recent research on birth outcomes in African immigrants and U.S.-born black women. A 2017 Medicine study looking at 1,121 black women born in the United States and Africa found that participants who had recently immigrated had lower rates of preterm birth than the U.S.-born black Americans (though they’re certainly not immune from pregnancy and childbirth complications).

“There’s a toll of having to prove yourself all the time and interact with the people who disparage you and oppress you,” Geronimus says.

There isn’t yet a quantifiable amount of stress we can point to that indicates if someone will experience weathering, Geronimus says, or an exact age when its effects begin. But this wealth of research does help challenge the frustrating notion that oppressed people can simply “pull themselves up by their bootstraps” to eliminate disadvantages and disparities.

The concept of weathering explains, at least in part, why factors like education, income, access to health care, and pure willpower can’t fully insulate you from poor health outcomes. However, it’s key to see weathering as one of many frameworks seeking to understand how racialized stress impacts black people, Angela Aina , M.P.H., codirector and research lead of Black Mamas Matter Alliance, tells SELF. As an example, Aina cites the Sojourner Syndrome framework developed by anthropologist Leith Mullings , Ph.D. The Sojourner Syndrome framework is the idea that factors like race, class, and gender all work together to create very real barriers to good health. While a lot of weathering research aims to look at race on its own, the Sojourner Syndrome framework argues that none of these factors can be separated from the others. It was built on the research of Sherman A. James , Ph.D., who invented the term John Henryism, another framework that explores how black people pour a lot of effort into coping with stressors like discrimination, and how that effort can be damaging to their health.

A 2016 study published in Souls: A Critical Journal of Black Politics, Culture, and Society analyzed the way that “respectability behaviors” impact health. As strategies people employ to try to manage other people’s perceptions of them and avoid discrimination, respectability behaviors are an example of the coping efforts described in John Henryism. The study, which included survey data from 3,015 black people over the age of 18 living in Chicago, found that black people who engaged in “vigilance,” or the anticipation of discrimination or racism, had higher reports of chronic illnesses including hypertension and depressive symptoms. This study and its adjoining “vigilance” framework join a long and robust history of research on how navigating everyday life as a black person in America can quite literally be bad for your health.

This brings us to the crux of our exploration: weathering and black maternal mortality . In New York City, a college-educated black woman is three times more likely to experience severe maternal complications than a white woman without a high school education, according to a 2016 "New York City Department of Health and Mental Hygiene’s Severe Maternal Morbidity" report.

Weathering seems to be an inextricable part of black maternal mortality. Pregnancy offers a compelling opportunity to study weathering in a concrete way. It’s a relatively short-term medical condition with very measurable outcomes like birth weight or infant mortality, “whereas things like hypertension or diabetes take decades [to develop], and it’s harder to pinpoint the root cause,” she says.

That also means there tends to be more direct weathering research on infant outcomes, not other reproductive outcomes like maternal mortality. It’s not as though any researcher has been able to study exactly how much of a role weathering plays in the deaths of the black people we lose every year due to pregnancy or childbirth complications. But it’s only logical for a phenomenon that could so impact infant outcomes to have the awful power of harming their pregnant and postpartum parents too. A 2019 study in The Journal of Maternal-Fetal & Neonatal Medicine found that every 1 out of 270 births in California involved both preterm labor and severe maternal health complications. The two are often terribly and closely connected.

Reading all of this probably felt demoralizing. Reporting it definitely did. So what can you do with this information as a black person?

The obvious advice some would offer here for combatting weathering—whether or not you're pregnant—is to find ways to destress, but that’s only helpful to a certain extent. Without addressing the root cause of racism, Dr. Crear-Perry says, we will continue to see health disparities, and we will continue to experience weathering. “It’s a constant mode of worrying,” Dr. Crear-Perry says. “So maybe ‘they’ need to stop making us worry so much.” Until then, self-care on its own isn't going to cut it.

With that said, if you don’t have a therapist and seeing one is feasible for you, that can be another part of your tool kit in fighting weathering. Granted, that can come with its own set of issues (like the stress of finding an affordable therapist or dealing with one who doesn’t understand where you’re coming from), but sometimes it’s better than nothing.

If you're black and pregnant, educate yourself about the conditions and complications you're more likely to face. The onus should not be on black people to save ourselves from maternal mortality and other poor health outcomes, Dr. Crear-Perry notes, but advocating for yourself is necessary sometimes. Dr. Crear-Perry stresses the importance of trying to find a provider you feel comfortable with and of bringing a friend or partner with you to doctor’s visits to help you parse information if possible. Many pregnant black people have also sung the praises of having a doula or other birth advocate (especially one of color) committed to helping them have the best birth possible.

Finding solidarity and community can be helpful in the fight against weathering for pregnant and nonpregnant people alike. Aina notes that engaging with and relying on people who can speak to your cultural experience can help shore up your emotional stores, whether you’re talking about a microaggression you dealt with at work or navigating birthing options while black and pregnant. “You can also take that next [step]. You may be looking for, for example, pregnancy support groups [and] want to be with people who may be more culturally relevant to you in your experiences. That is where local organizations within our Alliance come into play,” she says.

Black people deserve support for the enormous stresses of everyday life in a racist society. We should be able to live and breathe and birth and love without the wear and tear of discrimination—and the fear of it—burrowing into our cells and bones and blood. For now, that’s just a fantasy. At the very least, know that I’m dreaming it right along with you.

• Too Many Black Women Are Dying from Pregnancy and Childbirth in the U.S. So What Are We Actually Doing About It?
• 11 Conditions You Should Know About If You’re Black and Pregnant
• Allyson Felix Wants to Save Black Mothers

SELF does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a substitute for medical advice, and you should not take any action before consulting with a healthcare professional.