The weathering hypothesis has gained traction over the last few years. It seeks to explain the poor health outcomes in the form of chronic disease and poor birth outcomes in the African American population by hypothesizing that their socioeconomic backgrounds and dynamics have, in effect, reprogrammed their DNA and left them susceptible to certain diseases. As COVID-19 ravishes the US, increasing concerns are being raised regarding the disproportionate incidence and the seriousness of the cases in the African American community. In this context, weathering has been raised as a possible reason for the horrific numbers.
The Weathering Hypothesis Overview
- In the current context, weathering means “the way that marginalized people and their communities cope with the drumbeat of big and small stressors that mark their lives.”
- Weathering is formed on the foundation that “the stressors that impact people of color are chronic and repeated over their whole life course,” and these stressors predispose the affected population group to certain health outcomes.
- The Weathering Hypothesis states “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.”
- The burden of poor social and economic factors falls disproportionately on the shoulders of the African American population. The ongoing and chronic nature of the stress of these factors effectively creates a situation whereby African Americans are more likely to suffer poor health outcomes and a higher incidence of chronic disease than white Americans.
The Foundation of the Hypothesis
- In 1992, when Arline Geronimus first theorized about weathering, she faced challenges on several fronts including medical professionals, who subscribed to the view health disparities were as a result of a genetic predisposition toward certain chronic conditions, economists arguing behavioral causation, and sociologists who had their money on a pathological culture leading to bad behaviors and weak families.
- The foundations of weathering are born in childhood, and represent the cumulative stress associated with poverty, low socioeconomic status, poor education, low incomes and other contributors. When stress is applied to these factors or stressors, a chemical change occurs in DNA gene expression, which predisposes African Americans to poorer health outcomes.
Development of the Theory
- Colleagues and professionals in both Geronimus; own and other fields that had researched the high death rates among African Americans were dismissive of her work maintaining their own positions.
- Geronimus’ results from further research were consistent with weathering. However, two laboratory scientists were researching the physiological impact of stress and won the rating wars. Geronimus is, in many ways, dismissive of their research, implying the 1990s equivalent of white-male privilege.
- As her research continued, Geronimus had data that was consistent with weathering as a permanent and irreversible chronic condition. Its risk factors permanently predisposing African Americans to other chronic conditions. Geronimus hypothesized access to health care was vital because, although weathering was causative in hypertension, for example, and the weathering process can not be reversed, access healthcare meant it was diagnosed and treated earlier, advice on diet and exercise provided, and treatments prescribed to stop its progression.
- Studies compared African Americans in high poverty neighborhoods with African Americans in the middle-income neighborhood. She found that the African Americans in higher-income communities, and found that the life expectancy rates were higher for those in Higher-income neighborhoods. However, although that group lived longer, but in many instances, they spend those extra years plagued with chronic illness, and in some instances, disabled.
- This illustrated that weathering must be addressed on a population, rather than individual, level, and that to make true health gains the issues needed to be addressed at ground level, with structurally rooted changes.
- A 2006 study illustrates just some results of further research, finding “racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.” Further, the racial differences start becoming more pronounced from age 35. The role of stress became clearer.
- The studies also found that “stress inherent in living in a race-conscious society that stigmatizes and disadvantages Blacks may cause disproportionate physiological deterioration, such that a Black individual may show the morbidity and mortality typical of a White individual who is significantly older.” In addition, the cumulative effect of stress causes further deterioration.
- For many years, leading academics have argued personal health choices and DNA are responsible for health disparities. Research offered an alternative explanation. It is not the DNA that a person is born that matters, rather chronic social and economic stressors are responsible for DNA methylation, which sees methyl molecules attach to a gene and change the way it is expressed, predisposing certain individuals to certain diseases.
- In 2008, there was still strong opposition to the theory, An article in the Annals of Public Health suggesting a paradox, given African American women live longer than both white and African Americans. The article said of the paradox it “demands better explication if we are to truly advance our understanding of how stress-related chronic diseases contribute to excess mortality in marginalized populations in the United States and elsewhere.”
- By 2010, weathering was generating interest from other academics, and other researchers were exploring the concept.
- Today weathering is not universally accepted, and it is unlikely it ever will be, but there are a number of studies that are either underway or have been completed that have supported the concept, which when coupled with the increasing number of studies suggests that the theory is now one of the mainstream views that seek to explain the disparities.
Leading Proponents and Commentary
- There are a number of academics and groups who subscribe to the theory today. Among them the following have been some of the more vocal supporters.
- Arline Geronimus first posed the theory in 1992, and since then has exclusively researched this concept over the lifetime of her career.
- Joia Crear-Perry, M.D., founder and president of the National Birth Equity Collaborative is a firm believer of weathering, arguing that other factors such as racism and discrimination, and the stress of addressing them on a daily basis over a lifetime are also stressors for African Americans.
- The National Birth Equity Collaborative is a collection of individuals looking to account for poor mortality rates associated with births to African American women. A cornerstone of their ongoing dialogue is the role that weathering plays in the eventual outcome.
- The CDC has said that weathering has a role to play in the ongoing discussion relating to the fact, African American women are 3-4 times more likely to die from birth related consequences than white Americans.
The Case in Support
- A lot of the research in this area has focused on the poor outcomes for African American women giving birth.
- The below chart is a perfect illustration of the concept of weathering. Despite relatively even percentages at the age of 20, disability escalates rapidly for an African American over the next 4-8 years, with none of the other population groups coming close. When the backgrounds of the participants are examined the effects of poverty and its associated effects are a point of distinction suggesting a causative influence.
- This chart looks at the infant mortality rates of three population groups. The white American and Hispanic population groups experiencing comparable rates of infant mortality. The African American women soaring over both, with extraordinary infant mortality rates. Again, weathering provides an explanation for these discrepancies. With the cumulative effects of stressors over the course of their lifetime starting to have a cumulative effect of the health outcomes of African American women.
- The following table provides an illustration of the effects weathering on aging and life expectancy, and compares it on a racial basis. The results illustrate the disproportionate outcomes.
African Americans and COVID-19
- The Weathering Theory has been proposed as an explanation for the disproportionately high number of African American deaths as a result of COVID-19. It is proposed that the stressors identified, have in a sense primed the African American population, to the point it is susceptible to COVID-19. There is a disproportionate number of African Americans dying from COVID-19, especially in cities and states that are home to a large population of African Americans.
The Case For
- In Chicago, African Americans account for one third of the city’s population, yet they account for over 50% of the positive COVID-19 cases in the city. State wide they account for 38% of deaths and 24% of confirmed cases. The numbers are disproportionate to the African American population in the state. Despite the high number, African Americans make up just 13% of the testing in the state.
- 26% of the population of Milwaukee County, Wisconsin are African American, yet African Americans account for 70% of the deaths from COVID-19. 6% of the state of Wisconsin is African American, yet African Americans account for over 50% of the deaths from COVID-19 in Wisconsin.
- In Louisiana, African Americans make up 33% of the population, yet African Americans make-up 70% of the states’s COVID_19 deaths.
- In Richmond, Virginia, every death bar one is an African American.
- Cities like Detroit, Chicago and Milwaukee have high African American populations. They also have a disproportionate number of African Americans dying from COVID-19
- Sherita Golden MD MHS, Head of Endocrinology does not support this theory citing overcrowding, high employment in essential industries, access to healthcare, high prevalence of chronic disease, stress, and immunity as equally possible scenarios that explain the high burden COVID-19 has placed on the African American community.
- The numbers are horrific the African American population is dying at disproportionate rates but does that equate to further evidence of weathering. The difficulty in the current scenario is that there are several other equally worthy contenders in the rhetoric discussing a reason for this these anomalies.
- There is unlikely to ever be a definitive answer in relation to weathering and COVID-19. Given this it is difficult to see weathering influencing future planning. However, the health disparities do need to be addressed, as regardless of the theory they are common features of most theories.