Physicians and public health experts have pointed to one culprit time and again when asked why Americans live shorter lives than peers in nations with similar resources, especially people felled by chronic diseases in the prime of life: stress.
A cardiologist, endocrinologist, obesity specialist, health economist and social epidemiologists all said versions of the same thing: Striving to get ahead in an unequal society contributes to people in the United States aging quicker, becoming sicker and dying younger.
Recent polls show adults are stressed by factors beyond their control, including inflation, violence, politics and race relations. A spring Washington Post-Ipsos poll found 50 percent of Americans said not having enough income was a source of financial stress; 55 percent said not having enough savings was also a source of stress.
“We should take a step back and look at the society we’re living in and how that is actually determining our stress levels, our fatigue levels, our despair levels,” said Elizabeth H. Bradley, president of Vassar College and co-author of the book “The American Health Care Paradox.” “That’s for everybody. Health is influenced very much by these factors, so that’s why we were talking about a reconceptualization of health.”
The Washington Post’s efforts to gain a deeper understanding of how stress can cause illness, disability and shorter lives led to a once derided body of research that has become part of the mainstream discussion about improving America’s health: the Weathering Hypothesis.
Stress is a physiological reaction that is part of the body’s innate programming to protect against external threats.
When danger appears, an alarm goes off in the brain, activating the body’s sympathetic nervous system — the fight-or-flight system. The hypothalamic-pituitary-adrenal axis is activated. Hormones, such as epinephrine and cortisol, flood the bloodstream from the adrenal glands.
The heart beats faster. Breathing quickens. Blood vessels dilate. More oxygen reaches large muscles. Blood pressure and glucose levels rise. The immune system’s inflammatory response activates, promoting quick healing.
Once the threat passes, hormone levels return to normal, blood glucose recedes, and heart rate and blood pressure return to baseline. That’s how the human body should work.
Life brings an accumulation of unremitting stress, especially for those subjected to inequity — and not just from immediate and chronic threats. Even the anticipation of those menaces causes persistent damage.
The body produces too much cortisol and other stress hormones, straining to bring itself back to normal. Eventually, the body’s machinery malfunctions.
Like tree rings, the body remembers.
The constant strain — the chronic sources of stress — resets what is “normal,” and the body begins to change.
It is the repeated triggering of this process year after year — the persistence of striving to overcome barriers — that leads to poor health.
Blood pressure remains high. Inflammation turns chronic. In the arteries, plaque forms, causing the linings of blood vessels to thicken and stiffen. That forces the heart to work harder. It doesn’t stop there. Other organs begin to fail.
Struggling and striving
It’s part of the weathering process, a theory first suggested by Arline T. Geronimus, a professor and population health equity researcher at the University of Michigan.
Geronimus, whose book “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society” published in March, started out studying the health of women and babies as a graduate student in the 1980s, having been influenced by two distinctly different jobs she had as an undergraduate: one as an on-campus research assistant, the other as a peer companion at an off-campus school for teen mothers.
At the time, she said, conventional wisdom held that the Black community had higher rates of infant mortality because teen mothers were physically and psychosocially too immature to have healthy babies. But her research showed younger Black women had better pregnancy and birth outcomes than Black mothers in their mid- to late 20s and 30s.
For this, she was criticized as someone arguing in favor of teen pregnancy, even though she was not. Shaken but undeterred, she continued trying to understand the phenomenon, which meant better understanding the overall health of the community these teens depended on for help. As she studied those networks, she recognized “people’s life expectancies were shorter, and they were getting all these chronic diseases at young ages,” she said.
But she hadn’t come up with a name yet for what she was witnessing. That happened in the early 1990s while sitting in her office: “‘Weathering’ struck me as the perfect word.”
She said she was trying to capture two things. First, that people’s varied life experiences affect their health by wearing down their bodies. And second, she said: “People are not just passive victims of these horrible exposures. They withstand them. They struggle against them. These are people who weather storms.”
People seem to instinctively understand the first, but she said they often overlook the second. It isn’t just living in an unequal society that makes people sick. It’s the day-in, day-out effort of trying to be equal that wears bodies down.
Weathering, she said, helps explain the double-edged sword of “high-effort coping.”
Over the years, Geronimus widened the aperture of her research to include immigrants, Latinos, the LGBTQIA community, poor White people from Appalachia. She found that while weathering is a universal human physiological process, it happens more often in marginalized populations.
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Regulation of cortisol — what we think of as the body’s main stress hormone — is disrupted. Optimally, it should work like a wave with a steep morning rise followed by a rapid decline, which slows until reaching baseline at bedtime.
But existing research suggests that is blunted by repeated exposure to psychosocial and environmental stressors, such as perceived racial discrimination, which flatten this rhythm.
Stress-induced high cortisol levels stimulate appetite by triggering the release of ghrelin, a peptide that stimulates hunger.
The interplay between elevated cortisol and glucose is especially complex and insidious, eventually leading to obesity, fatigue, cardiovascular disease, poor immune and inflammatory functions, higher breast cancer mortality rates and other metabolic disorders. Dysregulated cortisol also increases depression and anxiety and interferes with sleep.
Weathering doesn’t start in middle age.
It begins in the womb. Cortisol released into a pregnant person’s bloodstream crosses the placenta, which helps explain why a disproportionate number of babies born to parents who live in impoverished communities or who experience the constant scorn of discrimination are preterm and too small.
During the coronavirus pandemic, pregnant women experiencing stress endured changes in the structure and texture of their placentas, according to a study published this year in Scientific Reports.
The toxic stream can persist into childhood fueled by exposure to abuse, neglect, poverty, hunger. Too much exposure to cortisol can reset the neurological system’s fight-or-flight response, essentially causing the brain’s stress switch to go haywire.
Too much stress in children and adolescents can trigger academic, behavioral and health problems, including depression and obesity.
Stress can change the body at a cellular level.
The effects of relentless stress can be seen at the chromosomal level, in telomeres, which are repeated sequences of DNA found in just about every cell.
Telomeres are the active tips of chromosomes, and they protect the cell’s genetic stability by “capping” the ends of the chromosomes to prevent degeneration. (Think of the plastic tips of shoelaces.)
Researchers have discovered that in people with chronically high levels of cortisol, telomeres become shortened at a faster rate, a sign of premature aging.
The shorter the telomeres, the older the cell’s biological age.
Shortened telomeres cause a disconnect between biological and chronological age.
‘A societal project’
“I don’t think most people understand weathering stress. Stress is such a vague term,” Geronimus said. “But it still gives us a leverage point to get in there and see a more complex and more frightening picture of what it does to people’s bodies and whose bodies it does it to.”
Changes in seven biomarkers in cardiac patients during a 30-year period showed Black patients weathering about six years faster than White people, a 2019 study published in SSM-Population Health found.
Research also found that Black people experience hypertension, diabetes and strokes 10 years earlier than White people, according to a study published in the Journal of Urban Health.
The impact of repeatedly activating the body’s stress response is called allostatic load.
Research has shown that Mexican immigrants living in the United States for more than 10 years have elevated allostatic load scores compared with those who have lived here for less than a decade, and a study of Ohio breast cancer patients published in May in JAMA Network Open found that women with higher allostatic loads — who tended to be older, Black, single and publicly insured — were more likely to experience postoperative complications than those with lower allostatic loads.
“The argument weathering is trying to make is these are things we can change, but we have to understand them in their complexity,” Geronimus said. “This has to be a societal project, not the new app on your phone that will remind you to take deep breaths when you’re feeling stress.”
So, in short, social inequality causes stress, leading to shortened telomeres and, in turn, premature aging, disease and early death.
About this story
Reporting by Akilah Johnson. Illustration by Charlotte Gomez.
Design and development by Stephanie Hays, Agnes Lee and Carson TerBush. Design editing by Christian Font.
Editing by Kainaz Amaria, Stephen Smith and Wendy Galietta. Additional editing by Martha Murdock, Frances Moody and Phil Lueck.
Additional support by Matt Clough, Kyley Schultz, Brandon Carter and Jordan Melendrez.