Why Do Black Women Have Worse Long-Term Health Outcomes?

Back in the 1990s, a researcher named Arline Geronimus became a pariah in academic circles for suggesting that the constant stress from dealing with hardship and structural racism was a major reason black people --- and black women and infants in particular --- have such dramatically worse health outcomes than whites. But her ideas are starting to gain some traction.

Geronimus is now a professor at the University of Michigan, and her idea, called "weathering," is that the cumulative effect of fighting disadvantages left black women in worse shape as they got older.

Those incidences of high health costs --- for example, the disability rates of black 55-year-olds approach those of 75-year-old whites, and black infants are more than 200 times more likely to die before their first birthdays than white infants --- don't disappear even for black people who have more education and higher incomes. (Geronimus thinks that that's because of pressure for high-achieving blacks to be model minorities.)

"African-Americans at age 35 have the rates of disability of white Americans who are 55, and we haven't seen much traction over 20 to 30 years of trying to reduce and eliminate these disparities," she said.

Geronimus has recommended a broader policy approach to dealing with these problems. "We're not understanding what a broader social problem it is and how much social policies, housing policies, economic policies, urban planning policies all impact health through these various roots and mechanisms," she said.

A neonatal doctor quoted by NPR agrees. "I think if we had data to show that, yeah, if we build more sidewalks, if we build more soccer fields, if we put more money into physical education at school, we'll improve those outcomes later on," he said. "We'd be able to go to the legislators and have a lot more power to say, let's put money upfront."

But there's little political appetite for those kinds of policy solutions. People don't like talking about structural racism; when Geronimus first suggested that health outcomes were linked to navigating the circumstances of poverty, she was met with ridicule and even death threats. But there are also fiscal barriers. At a time when states are cutting social services to get their budgetary ducks in a row, pushing for more focus on alleviating the myriad consequences of poverty is a hard sell.