Although Ms. Geronimus’s claims gained little traction at the time, the concept she pioneered—“weathering”—eventually became a foundation for the social justice ideology that is now upending medicine and social policy. She has said in interviews and her writings that the term “weathering” was intended to evoke the idea of erosion and resilience.
The subject of hundreds of peer-reviewed studies and thousands of citations, the weathering hypothesis is now widely taught in public health schools and accepted as perhaps the most plausible scientific explanation of how American society grinds down black and brown bodies. And the weathering paradox—that “relatively young people can be biologically old”—is now influencing policy decisions at all levels of governance.
Some critics are beginning to push back against what they see as the heavy-handed, COVID-era politicization of health care. Ian Kingsbury, research director at Do No Harm, a nonprofit that seeks to keep identity politics out of medicine, said the uncritical acceptance of the weathering hypothesis as factual science has created an aura of invincibility.
“Unfortunately, judges and other policymakers look to academic journals to be authoritative and trustworthy voices on what is evidence and what is science,” Mr. Kingsbury said. “And so you sneak this stuff in there and, unfortunately, as far as a lot of people are concerned, you’ve created knowledge.”
More broadly, Boston University public health dean Sandro Galea warns in a new book, “Within Reason: A Liberal Public Health for an Illiberal Time,” that his profession has veered into overcorrection and revolutionary excess. Mr. Galea doesn’t name names in his book, but he rebukes public health advocates for favoring political narratives over empirical data, denying the reality of social progress, and fixating on a utopian quest “to create a world free of risk.”
Ms. Geronimus did not respond to emails requesting an interview for this article.
The rise and reach of Ms. Geronimus’s weathering hypothesis—a once obscure and idiosyncratic idea that is becoming conventional wisdom in medicine—provides a window into how activist rhetoric and social justice ideology pioneered by feminist, queer, and critical race theorists are recasting health care as a Machiavellian power struggle between the privileged and the oppressed.
In her 2023 book, “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society,” Ms. Geronimus swept across time and space, omnisciently diagnosing celebrities and public figures with weathering. She claimed that it explains why Martin Luther King Jr. had the damaged heart of a 60-year-old when he was assassinated at age 39 and why Fannie Lou Hamer died of breast cancer and complications of hypertension at age 59. She asserted that the trauma of being black in America is one reason why tennis greats Serena Williams and Arthur Ashe had, respectively, life-threatening blood clots at age 36 and a heart attack at age 36.
“Success comes at a spectacularly high health cost for those who have to fight the hardest to achieve it in the context of a society that doesn’t value them,” Ms. Geronimus said in her book. “Structural violence is insidious, pervasive, and fateful. It is the fundamental cause of weathering, and it is entirely ignored in the age-washing narrative.”
This one-dimensional way of analyzing social relations has the effect of privileging the stress of those presumed to be oppressed, according to Stanley Goldfarb, a professor emeritus at the University of Pennsylvania’s medical school and founder and chairman of the Do No Harm nonprofit.
“The problem with the theory is that these hormones and these stress responses don’t know what skin color you have,” Mr. Goldfarb said. “The point is: What’s unique about their stress? The point isn’t that stress is bad. The point is you decided that your stress is unique and different from everybody else’s stress.”
Still, weathering is an attractive explanation to researchers because the link between psychosocial stress and physical wear and tear is consistent with lower life expectancy for African Americans and lower-income people.
However, weathering studies do not actually measure stress or racism but only correlate biological metrics back to the weathering hypothesis. The scientific conundrum is that the same biological evidence that supports weathering could also be “consistent with a lot of other things,” Mr. Kaestner said in a phone interview, noting that “it’s always a measurement problem.”
“Weathering is a hypothesis, still in search of definitive evidence,” he said. “I’ve never seen one [study]—including my own—where it’s a definitive study that this really is a smoking gun that racism or prolonged psychosocial stress causes adverse health outcomes.”
Stress and racism are assumed as the causes of overeating, smoking, and other unhealthy habits, in large part because the public health field and medical research steer clear of explanations that are genetic, biological, behavioral, or cultural—which would violate the rule that prohibits blaming the victim.
“That the chronic cascade of stress hormones in the bloodstream may also physiologically propel us toward eating ‘comfort’ foods high in fats and sugars, or to turn to alcohol or other drugs for relief, only makes this problem all the worse,” Ms. Geronimus wrote in her book.
This leaves only one permissible option: structural oppression. A reader of these studies will be struck by the absence of alternative explanations.
“They’re writing a story about weathering. I’m going to leave it at that,” Mr. Kaestner said. “It’s a widely held view that this is, in fact, what’s happening. There’s tons of these correlation studies that really don’t get anywhere near documenting a causal relationship, but if you write enough of them, it becomes conventional wisdom in the public health community.”
“By the end of our conversation I feel trapped—hyperaware of all the ways my social identity as a member of a black minority exposes me to stressors,” The Guardian writer ruminated. “Am I trapped?”
Ms. Geronumus responded, “I think there are things you can do that will make a difference, but you are stuck being weathered. And it really will take other kinds of structural changes for weathering not to happen.”
She asserted that the totalizing nature of white society renders conventional prescriptions for good health—diet and exercise—as naive and possibly dangerous.
The conclusions are extrapolated from a sample of 727 black participants in a national health survey. The health benefits, she reported, are even more pronounced for black people who grow up in racially segregated neighborhoods—a finding that flies in the face of decades of research that links racial segregation to racial disparities across a wide swath of measures, from education to net worth.
The influence of the weathering hypothesis—especially the claim that racism has profound effects on biology and epigenetics—can even be seen in research that ostensibly challenges Ms. Geronimus’s hypothesis.
One could interpret colorism as undermining the racial power theories of the weathering hypothesis, but Mr. Monk interprets colorism as a form of white supremacy.
Ms. Geronimus’s more recent research concludes that people of color are not the only victims of weathering. She has expanded the hypothesis to include working-class Appalachian white people who experience poverty and social stigma and Ashkenazi Jews who were persecuted in Europe or stigmatized by anti-Semitism in this country. She cited her father as an example, describing how he donned his psychological armor every day to go to work among gentiles at his bench job in a bacteriology laboratory and died in his 60s of an inflammatory disease that affected multiple organs, including the lungs and heart.
The continued expansion of the weathering hypothesis is gaining traction. Ms. Geronimus wrote that in 2020 she was asked by immigration attorney Kari Hong to submit expert testimony on weathering in support of early release petitions for immigrant asylum seekers who were being held in detention. Ms. Hong argued to federal judges that these foreign-born detainees were “biologically older than their chronological age” and should be released “just as senior citizen detainees.”
A hypothesis first developed to correct what she saw as moral judgment and victim-blaming of the black underclass developed into an expansive theory of the United States as a soul-crushing, body-destroying totalitarian hellscape she has ominously called “the surround.”
In a 2015 paper, she and her co-authors described the “the surround” as a clandestine program of cultural brainwashing that operates by means of “phantasms” that implant a virtual social reality into the brains of unsuspecting victims through the imposition of culture and power.
The paper does, however, suggest that health equity for the oppressed is attainable through a total immersion in social activism: “counter narratives, oppositional gaze development (or critical consciousness raising), and protest.”
Ultimately, the subject of weathering is linked to a whole range of progressive moral concerns—from the gender binary to climate change. And the solutions that Ms. Geronimus proposes in her book include a return to “collectivism”—in the form of extended, multigenerational, cross-household, women-centered kinship networks.
“Contrary to popular opinion and accepted wisdom,” she wrote, “healthy aging is a measure not of how well we take care of ourselves but rather of how well society treats and takes care of us.”