Summary: A study of the chronic stress marginalized persons experience and the health impacts resulting in the earlier onset of debilitating diseases and shortened life expectancy.

According to Arline T. Geronimus, many marginalized persons not only weather extraordinary and chronic stress. They are also weathered by them, at a bodily level, resulting in earlier onset of the debilitating diseases of aging and shortened lifespans. One of the things that caught her attention was the discovery of much higher death rates from COVID among people of color in the same age cohorts of majority culture persons. Some may be the kinds of jobs that put people at greater risk. Some is due to less access to timely health care. But a significant factor was that many in their thirties and forties had risk factors one would expect to find in persons two decades older.

This is one instance of what Geronimus calls “age-washing” that ignores the impact of stresses that weather the bodies of those who face the injustices that are a constant threat for people marginalized because of race, cultural, and economic status. She shows how stress affects every system in the body resulting in earlier onset of cardiovascular disease including high cholesterol and hypertension, diabetes, kidney disease, autoimmune diseases, and cancer. It is not unusual to enter one’s forties already suffering debilitating diseases that often lead to an early death. Both life expectancy and healthy life expectancy are shortened.

Her findings challenge our conceptions. We might attribute these problems to diet and lifestyle. Yet she finds similar issues with fit, educated, and successful people of color including athletes like Arthur Ashe and Serena Williams. The chronic stress of threats from a racialized society actually may affect the successful more because they must constantly negotiate these. “John Henry-” like heroic efforts really can kill.

She also challenges our conceptions about teenage moms. For one thing, most are in their late teens, 18 or 19. She raises the issues that if weathering means the earlier death of women, having children early has a kind of logic not only in terms of their own life expectancy but also that of mothers and grandmothers who help with childcare. And in fact pregnancies with complications are higher in incidence from the late twenties on and lowest among those in their late teens and early twenties. This is not to say that delaying childbirth might be done for good reasons but simply to point up the logic of having children while young for stressed populations.

This is further exacerbated by the experience of “giving birth while black” in which expressed concerns are often discounted and symptoms that would raise red flags are ignored with greater frequency. Geronimus argues for the importance of advocates, midwives, and birth doulas who will be attentive to these oversights and support women in getting necessary healthcare. Along with medical practices, she critiques social policies such as “welfare to work” policies and “no child left behind” education policies for increasing stress.

She proposes and unpacks five principles as a way forward, attending to health care, social policy and urban planning, the educational setting, and the family:

1. Think biopsychosocially: address the stealth inequities that surround us.
2. Think holistically and ecologically.
3. Do not erase oppressed stakeholders: do “nothing about us without us.”
4. Pay attention to the need of working- and reproductive-age adults.
5. Recognize all our fates are linked.

I’ve written in the past about the necessity of developing a consistent pro-life ethic, concerned not merely with the unborn but the born throughout every stage of life and from every part of society. Taking into account the stresses on the bodies of those who face racial injustice is yet another way to be consistently pro-life. With this path-breaking account by Arline T. Geronimus, we no longer can say, “we didn’t know” but rather “what must be done?” ( )