How weathering affects Black people’s health

In December 2023, I had surgery to remove my fibroids. Fibroids are benign tumors that grow in the uterine wall. I’d had the growths for nearly a decade and, even though they were benign, they certainly added difficulty to my life.

Heavy periods had plagued me since I was a teenager, but they had gotten worse as I’d gotten older. They often lasted over a week, leaving me tired and anemic. Often my cramps were so bad they made me nauseated. I went through pads and tampons quickly, and often worried that sneezing or coughing or laughing at the wrong time would lead to an embarrassing leak and a day with a jacket tied around my waist.

Fibroids grow over time and new ones form. Over the years, my doctor found another sizable fibroid, and the one they first found had grown so large that it pressed on my stomach, leading to almost daily heartburn. Four months later, I got approved for a laparoscopic myomectomy, a surgery to have the fibroids removed. I woke up in the hospital groggy from anesthesia and sore from the five incisions the surgeon made, but excited for my new fibroid-free life. I later found out that I had more than two fibroids: they removed 10 in total, and the largest had grown to 15 centimeters — about the size of a mango.

It’s a familiar story, but despite the answers and clarity my myomectomy gave me, it’s also a mysterious one for a lot of people with uteruses. As many as 77 percent of women will have fibroids in their lifetimes, but we don’t know what causes them. This also means that we don’t know what’s behind fibroids’ racial disparities. Black women are more likely to experience symptoms because of their fibroids, and they are two to three times more likely to have them reoccur once they’re removed. We’re also more likely to be diagnosed at a younger age.

Doctors have theories about why that is. Some researchers think genetics are a factor; others think it could be chemicals we come in contact with. And some think it could be a phenomenon known as weathering.

Weathering is a term coined by researcher Arline Geronimus. It was not without controversy when it was first introduced, but more of the medical community points to it as a factor for a number of health disparities for Black Americans.

Dr. Uché Blackstock, the founder and CEO of Advancing Health Equity, explores this and other systemic failings of the health care system in her book Legacy: A Black Physician Reckons with Racism in Medicine.

“Essentially, it’s this idea that dealing with the chronic stress of everyday racism causes a wear and tear on our bodies that prematurely ages us,” she says. “That actually makes us as Black folks susceptible to developing chronic diseases like heart disease, like autoimmune diseases, and also like fibroids.”

In an episode of The Weeds, I sat down with Dr. Blackstock to discuss weathering, how racism has impacted medical care past and present, and what solutions could create more equity in health care.

Below is an excerpt of our conversation, edited for length and clarity. You can listen to The Weeds on Apple Podcasts, Spotify, Stitcher, or wherever you get podcasts.

What role does weathering play in the health of Black people?

Basically almost every health outcome, we do very poorly. And it’s not because there is anything inherently wrong with us, but there is something very wrong with the social systems that we live in.

This idea of weathering is so important for us to talk about because it may seem covert to some people, but there is a stress that we live with every day that actually wears down our bodies. And that’s something that we need to be aware of in how it factors into us developing other diseases.

What does stress do to the body? We all hear that adage “Black don’t crack.” Maybe people look younger, but our bodies are telling us a different story.

We know that Black birthing people have a higher cortisol level than their white peers — about 15 percent higher. Cortisol is a stress hormone. That’s the hormone that goes up when you are in a fight-or-flight response. The problem is that hormones should not be consistently high. It should go up and as needed come back down. But with Black folks, because we have to go through the stress of living in essentially a racist society, our cortisol levels are consistently high. That causes an increase in our heart rate, a stress on our heart, and an increase in blood pressure.

There’s also another idea called epigenetics, the study of gene expression and what happens when people are stressed. And there is also a correlation that because of the stress that we live with due to racism, that causes a change in how genes are expressed.

So while race is a social construct and it’s not biological, how we experience racism can turn on and off genes. And we think that has some implication into why Black folks are more likely to develop diabetes, autoimmune diseases, inflammatory diseases like heart disease or atherosclerosis, and infant mortality.

When you compare the ends of our DNA — those are called telomeres. When you look at our telomeres, Black people and other people of color, our telomeres are shorter. They actually look like they belong to people several decades older. So again, race is a social construct, [there’s] no biological basis for it. But the impact of racism in practices and policies and interpersonal interactions actually has an impact on our DNA.

I would love to dig into some more data around how these disparities work. There was this really interesting example you’ve talked about when it comes to Black immigrants.

When Black immigrants come to the United States, their health status is on par with white Americans. But what happens is after one to two generations, their health status actually declines to that of Black Americans. So what that tells you is that there is something very wrong with the forces that Black people are subjected to just living in this country, that our health status could decline after one or two generations from that of white Americans to Black Americans.

There’s nothing inherently wrong with Black people. There is something very, very wrong with the systems that we are forced to live under or within.

And that is what is accounting for this decline in life expectancy, we have some of the lowest life expectancy of any racial demographic group.

What’s on your policy wish list? What do you think would lead to better health care and better outcomes for Black patients?

I think a lot of the solutions have to happen at multiple levels. They have to happen within medical schools, how medical schools are educating our future physicians. Not just including the history, but understanding how what we call the social determinants of health, education, employment, free access to healthy foods, green space, all of that impacts health. So getting medical students more of a holistic education as to how people can stay healthy and how they get sick.

For hospitals, it’s really their obligation to keep track in real time of health equity metrics to see, are there differences in how our patients are being treated compared to white patients? Are there differences in prescribing habits?

I was working with one ER where Black patients were waiting 80 minutes longer to be admitted to the hospital than white patients. And we talked about actually developing standardized processes to keep track of that and then to make interventions if necessary.

And for policymakers, I want them to think about health in all policies. We know that because of the legacy of slavery, because of discriminatory housing policies, our communities have been deprived of wealth and resources and opportunities. So when we think about opportunities for home ownership, for building wealth, when we think about education and how we can provide our children with a free, quality public education, all of that is incredibly important to making our communities healthier.

Does the political will to get these things done exist?

We’ve got to put the pressure on our electeds to say this is a priority for us. In 2024, why is it less safe for a Black birthing person to give birth than it was 20 years ago? That does not make any sense, but it does show how deeply embedded racism is in our society. And it’s unacceptable, the fact that we have worse maternal outcomes than other high-income countries and even some middle-income countries and we spend even more on health care than they do.

For those of us, and in particular Black women who have to navigate the health care system as it exists today, what are some things we can do to make it as safe as possible for ourselves?

This is always a hard question for me because it’s the system. It shouldn’t be up to us, and it shouldn’t be up to Black women to have to feel like we’re going to war when we are at our most vulnerable and seeking care. But obviously, there are some things I always advise people to do. There was this viral TikTok video recently by a white health professional who said, why are all my Black patients on FaceTime with someone when I come into the room?

It’s because we don’t trust you.

I always recommend people either bring a trusted friend or a loved one to an appointment. It could be for moral support. It could be to help you ask questions.

Also document your symptoms. When did the pain start? When did the symptoms start? How long has it been? Make sure that you have everything written down because often during appointments you can get very nervous.

Ask your doctor or health professionals, what do you think is going on? What is your plan for me? What is the follow-up? What are red flags where I should come back or seek care or go to the ER?

But also just know that Black women, we are doing amazing things. Like there’s Health in Her Hue, which is a digital startup run by Ashlee Wisdom, and that is a directory of Black health professionals and culturally responsive health professionals who are trained to work with Black women patients.

There is the Irth app, also started by a Black woman, which is a directory of maternal health providers that specifically work with Black birthing people. So we’re the ones also that are creating the solutions to make the health care system more accessible and respectful to us.