Constantly experiencing discrimination, racism and stress can lead to premature aging of the body, called weathering. The Center for Community Solutions has discussed how weathering affects the physical health of BIPOC (Black, indigenous, and other people of color) individuals. Dr. Arline Geronimus, who coined the term, wrote a booked called Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society, where she described weathering in more detail while applying an equitable lens to address it. She listed five strategies to disrupt weathering which will be discussed here.
1. Think biopsychosocially: address the stealth inequities that surround us.
This model examines the relationship between biological, psychological, and social factors, and how they interact to influence health and illness. To think biopsychosocially, there is a public health approach that individuals can practice in any institutional setting. Called the Jedi public health (JPH) approach, Dr. Geronimus referenced the Jedi from Star Wars because they use their minds “as a force for good.” JPH acknowledges that health inequities happen from core cultural beliefs that help the privileged or dominant group while devaluing and marginalizing other groups.
Due to the prevalent beliefs of the dominant culture, their incorporation of policies, practices, and attitudes in institutions (i.e., schools, government, legal, economic systems, health systems, etc.) will not benefit vulnerable groups. Hence, the goal of JPH is to eliminate cues that are connected to social identities. For instance, in schools, teachers must stop practicing a fixed mindset (i.e., stereotyping based on social identities), but use a growth mindset (everyone, regardless of their identities, can achieve things) instead.
The stereotype that BIPOC individuals are not intelligent makes the student express self-doubt and anger at the teacher which can cause them to struggle in class.
An example of how a teacher uses a fixed mindset is telling a BIPOC student that if they have difficulty with their course work early on, then they will not do well and should think about dropping out. The stereotype that BIPOC individuals are not intelligent makes the student express self-doubt and anger at the teacher which can cause them to struggle in class.
Instead, if a teacher uses a growth mindset approach, like telling all their students that they can get an A in the class, and to seek help if they do not understand the material, then they—including BIPOC students— are able to pass the class.
2. Think holistically and ecologically.
Dr. Geronimus explained that stakeholders in public health are using a Health in All Policies (HiAP) approach to policy making. However, the flaw of HiAP is solving one social determinant (SDOH) at a time instead of simultaneously addressing more than one. By handling one SDOH at a time, professionals expect that marginalized and vulnerable communities will become solely responsible for changing their lifestyles (i.e., personal-responsibility narrative). Expecting less privileged people to be fully responsible for changing their lifestyle does not get to the root of the problem.
An example of this is a nonprofit or for-profit organization building a park in a resource-stricken community that lacks green space so that residents can access them. While these professionals think they found a solution, how can the residents maintain the park over time? Policy and sustainability must be considered.
Policy and sustainability must be considered.
In March 2021, the UK Commission on Race and Ethnic Disparities report recommended that all marginalized communities and individuals should be encouraged to “create agency”, which means taking control of their own health and taking full responsibility for their lifestyle changes. This shows that the ethnic population in the UK who have not taken full responsibility to change their health are to blame for their persistent inequality.
To combat the issues of HiAP, Dr. Geronimus explained that a person should practice a “high road” development approach where shared prosperity, environmental sustainability, and efficient democracy complement each other. They should not be seen as tradeoffs.
3. Do not erase oppressed stakeholders: do “nothing about us without us.”
For this strategy, Dr. Geronimus explained that individuals in the dominant culture should acknowledge that marginalized communities are experts in their own lives. So professionals should avoid incorporating their own privileges in solving issues. Rather, they should listen to vulnerable populations. An example of this is when medical professionals ignore the health complaints and concerns of Black birthing parents in maternity wards.
Ignoring Black birthing parents’ health concerns during labor and delivery leads to increased risk of maternity mortality and morbidity. Dr. Geronimus recommended that clinicians should override their own beliefs and stereotypes about Black birthing parents (e.g., that they can withstand pain) and implement patient safety bundles. Patient safety bundles are evidenced-based practices which handle health conditions in pregnant and postpartum individuals.
Dr. Geronimus explained that clinicians should have to follow the protocols instead of using their own judgments. So, for example, when clinicians implement the obstetric hemorrhage bundle during labor and delivery, they must measure the quantity of blood loss.
4. Pay attention to the needs of working- and reproductive-age adults
Public health initiatives greatly cater to infants, young kids, and older adults but often overlook the ages between 25-65 years old. Dr. Geronimus described adults within this age group as working- and reproductive-age adults more susceptible to weathering. Throughout this chapter, she explained how monopsony capitalism affected not only salaried and high paying workers, but especially workers from less affluent communities. Monopsony capitalism, a concept that describes there is only one buyer who is able to set the demand and the price.
According to Dr. Geronimus, monopsony capitalism leads to stressful working conditions such as salaried and high paying workers working longer hours into evenings or weekends, which could change their work-life balance. Those who are more affluent can hire domestic workers—from the working class— to take care of their homes (e.g., cooking, watching children, cleaning).
Domestic workers are not only stressed and exhausted from work, but catering the same needs to their own families, which leads to weathering. She suggested that there should be regulation to limit the authority of monopsony capitalism and offer family supports. Policies such as family leave, subsidized childcare, and universal pre-K can also help working- and reproductive-age adults.
5. Recognize all our fates are linked.
Dr. Geronimus explained everyone’s fates are linked and we cannot think of the consequences of weathering as binary (e.g., winners versus losers, deserving versus underserving, etc.). For instance, climate change affects everyone as the United States is a leader in emitting greenhouse gas emissions and she explained urban sprawl is one of the causes of it. Urban sprawl is tied to the creation of communities outside of urban areas due to redlining and the disinvestment of those urban areas. As people move to the suburbs, more roads are created for individuals to drive from these neighborhoods to the cities for work, which contributes to an increase in greenhouse gas emissions.
One city that tried to resolve climate change is Portland, Oregon. There were investments for public transit friendly initiatives, but only in white affluent neighborhoods and not in low income and racially diverse communities. Also, when housing prices in walkable communities increased, it caused low-income residents to move to East Portland (outside of the city) where it is necessary to have a car. The increase in greenhouse gas emissions has gotten bad to the point of staff and students from Harriet Tubman Middle School, located near a freeway; to limit outside time and they invested in a multi-million-dollar air filtering system.
To combat climate change, BIPOC communities created a ballot initiative to mandate companies who have at least $500,000 sales in Portland to contribute one percent of their annual gross income to the Portland Clean Energy Fund. Advocacy from BIPOC communities led the initiative to be being through the ballot. Currently, the Portland Clean Energy Fund can distribute about $40 million to $60 million per year to support home upgrades and retrofits, renewable energy projects, living wage training for residents, and urban gardens and green space in poor and BIPOC communities in the greater Portland area.
Ohio is ranked 44 out of 50 states and Washington D.C. in terms of health value (a combination of healthcare spending and population health metrics).
Ohioans should consider solutions to weathering
Weathering is a concept that affects all levels of society from the individual to communities and institutions. Ohioans also suffer from weathering as seen in our staggering health statistics. The Health Policy Institute of Ohio (HPIO) stated in its 2024 Health Value Dashboard that Ohioans are living less healthy lives and spend more money on health care than individuals in other states.
Ohio is ranked 44 out of 50 states and Washington D.C. in terms of health value (a combination of healthcare spending and population health metrics). Health disparities persist among BIPOC and less affluent individuals. HPIO explained in their report if disparities were eliminated, “60,004 fewer years of life would be lost by Black Ohioans” and “40,126 fewer children from families with low incomes would live with a person who smokes.” Dr. Geronimus presented some insightful solutions to address weathering. If we want our state to be healthier, we must consider incorporating those strategies into our daily lives.
