What Does The Weathering Hypothesis Mean to Healthcare?

May 02, 2023 - It is nearly impossible for healthcare to address its equity problem without acknowledging the role of the weathering hypothesis, a concept stating that experiences with racism and discrimination can have adverse health consequences.

With more data coming out linking experiences of racism with disparities in certain health outcomes, most commonly disease states related to stress like heart disease and high blood pressure, it is clear that weathering has a place in the health equity conversation.

Below, PatientEngagementHIT outlines the concept of weathering, where there is evidence verifying the hypothesis, and what experts say must be done in the wake of weathering.

What Is the Weathering Hypothesis?

Generally, the weathering hypothesis states that the stress of experiencing everyday discrimination can result in adverse health outcomes, researchers from the Columbia University Mailman School of Public Health wrote in a 2019 literature review on the subject.

“Weathering is the result of chronic exposure to social and economic disadvantage that leads to the acceleration of normal aging and earlier onset of unfavorable physical health conditions among disadvantaged (vs. advantaged) persons of similar age,” the researchers wrote in Annals of Epidemiology.

Exploration of the weathering phenomenon began with AT Geronimus in 1992, when she looked at maternal health outcomes and disparities. Typically, maternal health and birth outcomes follow a curvilinear pattern: outcomes are worse for teenage moms and moms over age 30 than they are for moms in their mid-twenties.

That pattern certainly holds true for White populations, Geronimus found, but falls apart when looking just at Black moms. For Black moms, younger age is linked to better maternal and infant outcomes. Geronimus theorized that is because of the concept of weathering; Black women experience “earlier onset of unfavorable physical health conditions” because they are chronically exposed to racism and discrimination.

Years after Geronimus’ paper, the Columbia literature review looked at 41 studies on weathering that were of good methodological quality, but the extent to which they found the weathering hypothesis to be valid varied.

As healthcare has come to emphasize health equity, discussion of the weathering hypothesis has come front and center. Race is a key social determinant of health, and understanding the extent to which weathering actually impacts health outcomes is crucial for understanding how healthcare and social services can address it.

Health Outcomes, Disease States Impacted by Weathering

Since 2020, when the stark disparities in COVID outcomes shone a light on an historically unequal healthcare industry, healthcare researchers have worked to gather evidence outlining how those long-term disparities came about. Central to that has been data outlining the role that weathering has played in carving out health disparities.

It should be noted that studies investigating the impact of chronic exposure to anything, including racism and discrimination, take a long time to complete. The health impact of that chronic exposure could potentially be slow, so researchers need a long timeframe to gather meaningful evidence.

Many of those studies have been coming to conclusion in recent years and are looking at the impacts of discrimination on certain outcomes, or looking at discrimination in certain settings.

For example, one study published in the Journal of the American Heart Association outlined a link between workplace discrimination and high blood pressure. The researchers said this was one of the first studies looking at discrimination in an isolated setting.

Overall, people who reported moderate workplace discrimination were 22 percent more likely to develop high blood pressure eight years later; for those reporting high discrimination, the odds of developing high blood pressure were 54 percent higher.

A separate study from Boston University showed that experiences of interpersonal racism at work, in housing, and in interactions with the police led to a 26 percent greater risk of coronary heart disease in Black women.

The link between chronic exposure to racism and clinical outcomes like coronary heart disease and high blood pressure is clear. Coping with racism can be stressful, according to Shanshan Sheehy, a BU Chobanian & Avedisian School of Medicine assistant professor, who worked on the study.

“This is the first longitudinal evidence that perceived racism is associated with increased risk of coronary heart disease,” Sheehy explained. “Racism has a real impact on the heart health of Black women.”

Another article tied experiences with racism and discrimination to brain development changes, adding racism as a key adverse childhood experience (ACE). Researchers from McLean Hospital in Massachusetts found that experiences with discrimination can impact the brain in similar ways that post-traumatic stress disorder (PTSD) does.

Overall, the researchers found that Black kids typically face more stress, particularly related to racism, than White kids, and that plays out in their brain development.

“The dataset in our study included children younger than 10 years old—children who have no choice in where they are born, who their parents, are and how much adversity they are exposed to,” Nathaniel G. Harnett, director of the Neurobiology of Affective Traumatic Experiences Laboratory at McLean Hospital, which is part of Mass General Brigham, stated publicly. “These findings offer another chilling reminder of the public health impact of structural racism, and how crucial it is to address these disparities in a meaningful way.”

Addressing Weathering, Race as an SDOH

Currently, there are no great services or interventions that can target race as an SDOH, at least not one that is directly within providers’ control. Although healthcare experts are increasingly understanding how experiences of everyday racism can impact health outcomes, they are not necessarily equipped to stop those instances of racism.

However, providers can always focus on delivering empathetic, culturally aware healthcare that quells the impact of discrimination in the healthcare setting.

Still, most researchers are emphasizing societal changes that need to help to stem the tide of weathering. For example, the researchers from the workplace discrimination study said that overall better workplace policy and enforcement is the best tool for addressing this problem.

“There are several implications from these findings,” said Jian Li, MD, PhD, the study’s lead author and a professor of work and health in the Fielding School of Public Health and the School of Nursing at the University of California, Los Angeles. “First, we should increase public awareness that work is an important social determinant of health. Second, in addition to traditional risk factors, stressful experiences at work due to discrimination are an emerging risk factor for high blood pressure.”

The researchers from the BU study on discrimination and heart disease said something similar. Right now, the healthcare industry needs to work on building the evidence cementing the weathering hypothesis and prove that experiences with racism have health impacts. Ideally, that will push the rest of society to make changes,

“Structural racism is real—on the job, in educational circumstances, and in interactions with the criminal justice system,” coauthor Michelle A. Albert, American Heart Association president and a University of California at San Francisco professor of medicine, said in the press release. “Now, we have hard data linking it to cardiovascular outcomes, which means that we as a society need to work on the things that create the barriers that perpetuate structural racism.”

The work proving a link between weathering and health outcomes is still nascent, researchers have suggested. As more evidence confirms the impact racism and discrimination has on clinical quality outcomes, researchers hope to see more social policy change to ameliorate everyday discrimination.