Weathering hypothesis

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The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic, and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. [1] This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion, and racial discrimination. [2] The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. [3] In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. [4] This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. [5] Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging. [6] [7] [8] [9]

Contents

Origins

The weathering hypothesis was initially formulated by Dr. Arline T. Geronimus to explain the poor maternal health and birth outcomes of African American women that she observed in correspondence with increased age. While working part-time at a school for pregnant teenagers in Trenton, New Jersey, Geronimus first noticed that the teens who came to the school tended to have far more health problems than her classmates at Princeton University. She thus began to wonder whether the health conditions of the teens at that clinic may have been caused by their environment. [10] Subsequent research on the disparity in maternal health between African American and white women led Geronimus to propose the weathering hypothesis. She proposed that the accumulation of cultural, social and economic disadvantages may lead to earlier deterioration of health among African American women compared to their non-Hispanic, white counterparts. [11] Geronimus specifically chose the term weathering as a metaphor for the effects she perceived that exposure to stress was having on the health of marginalized people. [10] While the weathering hypothesis was initially proposed based on observations of patterns in maternal health, academics have expanded its application as a framework to examine other health disparities as well. [2]

Geronimus' research

While conducting research in the Department of Public Health Policy and Administration as a graduate student at the University of Michigan in 1992, Geronimus noticed a trend in disparities between the fertility of African American women versus their white counterparts. [12] She noted that while the average white woman experiences her point of highest fertility and lowest risk of pregnancy complications or neonatal mortality in her 20's and 30's, this generalization did not apply to African American women. Instead, among African American women, teen mothers are most likely to have healthy pregnancies and offspring. The data indicated a widening disparity in black-white infant mortality as maternal ages increase. Subsequently, Geronimus proposed the "weathering hypothesis," which she initially conceived as a potential explanation for the patterns of racial variation in infant mortality with increasing maternal age. [11]

Health disparities

In the context of the weathering hypothesis, individual health is dynamic and shaped over time by social, economic, and environmental influences. These social determinants dictate what different demographics are exposed to as they develop and age. [3] Racism and discrimination are two specific social determinants that lay the foundation for systemic inequality in access and upward mobility. This entrenchment of social inequities disproportionately impacts minorities and communities of color, who remain in environments of poverty that have significantly more stressors than those of wealthier, predominantly white communities. [3] These stressors—and the associated burden of coping with them—manifest as physiological responses that have detrimental effects on individual health, often leading to a disproportionately high occurrence of chronic illness and shorter life expectancy in minority communities. [13] Multiethnic studies have yielded significant data demonstrating that weathering—accumulated health risk due to social, economic and environmental stressors—is a manifestation of social stratification that systemically influences disparities in health and mortality between dominant and minority communities. [14]

Maternal health

Maternal mortality is three to four times higher for Black mothers than white mothers in the United States. [15] Infant mortality is also twice as high for infants born to non-Hispanic Black mothers compared to infants born to non-Hispanic white mothers. [16] Additionally, there are racial disparities for negative birth outcomes like low birth weight, which has been found to influence risk of infant mortality and developmental outcomes after birth, and preterm birth. [15] [17] Across all women, older maternal age is associated with higher rates of these negative outcomes during pregnancy, but studies have consistently found that rates rise more rapidly for Black women than white women. [17] [18] The weathering hypothesis proposes that the accumulation of racial stress over Black women's lives contributes to this observed pattern of racial disparities in maternal health and birth outcomes that increase with maternal age. [18] Research has consistently identified an association between preterm birth and low birth weight in Black women and maternal stress caused by experiences of racism, systemic bias, socioeconomic disadvantage, segregated neighborhoods, and high rates of violent crime. [16] There is biological evidence of weathering, including the finding that Black women have shorter telomeres, a biological indicator of age, when compared with white women of the same chronological age. [16] Though increased socioeconomic status serves as a protective factor against negative birth outcomes for non-Hispanic white mothers, disproportionate rates of preterm birth and low birth weight for non-Hispanic Black mothers have been found at every education and income level. [16] The weathering hypothesis has also been used to explain this trend because upward socioeconomic mobility is associated with increased exposure to discrimination for women of color. [16]

There is modest evidence supporting the effects of weathering on mothers from other minority groups, including for high birth weight outcomes among American Indian/Alaska Native women. [19] Research has started to explore whether the weathering hypothesis could also explain racial disparities in the outcomes of assisted reproductive technologies, but so far the findings are inconsistent. [20]

Mental health

Research shows that mental health disparities among marginalized communities exist. Daily discrimination faced by marginalized groups have been found to be associated with increased depressive symptoms and feelings of loneliness. [21] Low-income communities are more likely to have severe mental illnesses, which is frequently heightened by the inaccessibility to quality healthcare. [22] Researchers found that persisting epigenetic changes lead to increased risk of postpartum depression as a result of adverse life events and cumulative life stress among Black, Latinx, and low-income women. [23] In a study assessing African American men, experiences of racism were linked to a poorer mental health state. [24]

Cognition

Black Americans often show mean level differences in cognition across multiple cognitive domains compared to non-Hispanic Whites. [25] [26] [27] These cognitive disparities often are reduced or eliminated when factoring various social determinants of health such as stress, education quality, economic stability, or quality of healthcare. [25] [26] [27] Black Americans also have higher rates of Alzheimer's disease and related dementias than non-Hispanic Whites. [28] These higher rates of Alzheimer's disease might be due to the impact of more negative and pronounced social determinants of health, [29] [30] including racial discrimination, [31] [32] that might accelerate brain aging disproportionately in Black Americans. [9]

Intersectionality of systems of oppression

Intersectionality is a term coined by Kimberlé Crenshaw to describe the interconnected nature of different systems of oppression, the layered effects of which can be seen in the healthcare system. Research indicates that lower class status and increased depressive symptoms are associated with higher levels of biological weathering among Black individuals in comparison to white individuals. [33] In a study exploring disparities in mental health, researchers found that Black sexual minority women reported higher frequencies of discrimination and decreased levels of social and psychological well-being than their white sexual minority women counterparts. [34] Black sexual minority women had decreased levels of social well-being and increased levels of depressive symptoms in comparison to Black sexual minority men. [34] African American women are also more likely to contract COVID-19 than African American men and white women. [35] The prevalence of medical racism and sexism (lack of quality healthcare, harmful experimentation, etc.) has led to negative relationships with healthcare systems and increased risk of negative sexual and reproductive health outcomes among African American women. [36] Existing research show how systems of oppression work together to oppress marginalized groups within the healthcare system and, as a result, these groups disproportionately experience negative health effects. [35] Aging adults experience further intersections with health, health care, and structural inequalities that exacerbates health in marginalized groups. [37]

Arline Geronimus faced significant pushback for the weathering hypothesis from the medical community, economists, and sociologists, whose research had attributed racial differences in health outcomes to differing genetics, cultures, and life choices. [10] Additionally, there was criticism regarding the quality of her data. [38] Others pushed back against the weathering hypothesis because its application to racial disparities in maternal health seemed to contradict what advocacy groups had been saying about the negative consequences of teen pregnancy on young mothers. [10] A further criticism of this theory believes that Geronimus and others have not sufficiently demonstrated a link between weathering and racial and gender disparities in life expectancy. [39]

The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the allostatic load model, which proposes that an individual's exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers. [16] Research has tended to discuss allostasis and allostatic load as the molecular mechanism behind the weathering hypothesis, and Geronimus herself went on to study racial differences in allostatic load. [40] Another related theory is the life course approach, which emphasizes focus on cumulative life experiences rather than maternal risk factors as an explanation for birth outcome disparities. [41] Researchers have also been interested in studying the possibility of children inheriting the epigenetic changes which result from their mother's cumulative life stress, which could relate the weathering hypothesis with transgenerational trauma. [41] [42]

See also

Related Research Articles

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

<span class="mw-page-title-main">Allostatic load</span> Wear and tear on the body due to stress

Allostatic load is "the wear and tear on the body" which accumulates as an individual is exposed to repeated or chronic stress. The term was coined by Bruce McEwen and Eliot Stellar in 1993. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response which results from repeated or prolonged chronic stress.

<span class="mw-page-title-main">John Henryism</span> Strategy for coping with prolonged exposure to stress

John Henryism (JH) is a strategy for coping with prolonged exposure to stresses such as social discrimination by expending high levels of effort which results in accumulating physiological costs.

Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.

Minority stress describes high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses that accrue over time, eventually leading to poor mental and physical health. Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

Arline T. Geronimus is an American public health researcher and a professor of Health Behavior & Health Education at the University of Michigan, as well as a research professor at the University of Michigan's Population Studies Center. Geronimus is known for proposing the weathering hypothesis in 1992, which posits that cumulative racism experienced by black women cause them to experience inferior birth outcomes as their maternal age increases. She has also studied other issues regarding pregnancy, including the effect of teenage childbearing on the mother's economic status and the effect of immigration enforcement raids on low birth weight. Since originating the weathering hypothesis, Geronimus has extended it to implications for health across the life course for men and women in a variety of culturally oppressed, marginalized, or economically exploited social identity groups in the United States. Dr. Geronimus' book, "WEATHERING: The Extraordinary Stress of Ordinary Life in an Unjust Society" is being published by Little Brown in March 2023.

Mia A. Smith-Bynum a clinical psychologist who specializes in family science and is known for her research on mental health, parenting, family interactions, communication, and racial-ethnic socialization in ethnic minority families. Smith-Bynum is associate professor of Family Science in the School of Public Health at the University of Maryland-College Park, where she is also affiliated with the Maryland Population Research Center. She is Chair of the Black Caucus of the Society for Research in Child Development.

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The COVID-19 pandemic has had an unequal impact on different racial and ethnic groups in the United States, resulting in new disparities of health outcomes as well as exacerbating existing health and economic disparities.

White Americans, as the largest racial group in the United States, have historically had better health outcomes than other oppressed racial groups in America. However, in recent years, the scholarly discourse has switched from recognition of the immense positive health outcomes of white Americans towards understanding the growing persistence of negative outcomes unique to this racial group. Scholars have discussed the effects of racial prejudice and its negative effect on health outcomes to not only those being oppressed but also those being given privileges. In addition to the effects of living in a racialized society, white Americans have the highest rate of suicide and lifetime psychiatric disorders of any other ethnicity or racial category. In conjunction with these psychiatric issues, the population presents higher rates of alcohol usage alongside lower levels of psychological flourishing. Given this information, the health status of white Americans has gained increasing importance due to the differences in health outcomes between white Americans and white people from other parts of the world.

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The psychological impact of discrimination on health refers to the cognitive pathways through which discrimination impacts mental and physical health in members of marginalized, subordinate, and low-status groups. Research on the relation between discrimination and health became a topic of interest in the 1990s, when researchers proposed that persisting racial/ethnic disparities in health outcomes could potentially be explained by racial/ethnic differences in experiences with discrimination. Although the bulk of the research tend to focus on the interactions between interpersonal discrimination and health, researchers studying discrimination and health in the United States have proposed that institutional discrimination and cultural racism also give rise to conditions that contribute to persisting racial and economic health disparities.

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