The Hidden Health Toll of Race

In the fall of 1976, Arline Geronimus began living in two separate, unequal worlds. At Princeton University, the political theory major became a research assistant to Charles Westoff, a professor who studied teen pregnancy among the urban poor. Down the road at Planned Parenthood in Trenton, N.J., she spent time with real-life, impoverished pregnant teens.

A self-assured, middle-class Jewish girl from Brookline, Mass., Geronimus shuttled between the extremes of haves and have-nots, eventually spotting a chasm between the theories of Princeton researchers and the experiences of the women she taught.

Geronimus would sit in on the professors' meetings, listening to them discuss how young girls, ignorant of family planning, were ruining their lives with accidental pregnancies. Bearing children at an early age would rewrite these mothers' life scripts, with terrible consequences. The funders behind the academic studies — including those in charge of Planned Parenthood's own research arm — supported the consensus opinion that teen pregnancy was a crucial cause of ghetto poverty and ill health among America's urban blacks. The only question was how to get these girls to stop having babies before they'd come of age.

The girls Geronimus met at Planned Parenthood's alternative school for expectant teens, however, seemed to know exactly what they were doing. When she tried to teach them about contraception — something they supposedly knew nothing about — they laughed at her. The girls in the program told Geronimus they were overjoyed to have children. Far from blundering into motherhood, many were experienced with child rearing, having helped raise siblings or cousins. Some talked about how long they'd been trying to have a baby.

As the months wore on, the professors' belief — that poor childhood health and ghetto joblessness would disappear, if only these girls would stop getting themselves pregnant — started to seem absurd. "What I was hearing in the halls of Princeton was inaccurate," she remembers. "It just didn't fit in, in any way, with what I was seeing."

Though Geronimus didn't understand the discrepancy, she noticed that these girls, even at 15 or 16, had been worn down by tough lives. Compared with her classmates in Princeton's dorms — many of them hailing from America's WASP elite — the poor black girls at the clinic seemed to lack the energy and health of youth. Geronimus couldn't quite put her finger on it, except to say these girls seemed older — and not in a good way.

Somebody, Geronimus thought, had to put the facts together and change things for the better for these girls and others like them. In a fit of youthful arrogance, she took it upon herself to become that person. Now a professor at the University of Michigan, Geronimus has spent the last 30 years challenging the received wisdom of researchers about a pressing social question: Why are some racial minority groups less healthy than others?

A multitude of figures illustrate the stark health differences between African Americans and whites. Black residents of high-poverty areas, for instance, are as likely to die by the age of 45 as American whites are to die by 65. The disability rates of black 55-year-olds approach the rates of 75-year-old whites. Traditional theories, which blame the phenomenon on factors like genetics or income differences, fail to fully explain these huge disparities. Geronimus has devoted her career to finding the real reasons. Her own complex explanation for what's happening — the weathering framework — rests on two unexpected, controversial causes: racism and stress, in the broadest senses of both terms. American minorities face a bevy of chronic obstacles that whites and the socioeconomically advantaged cope with far less often: environmental pollution, high crime, poor health care, overt racism, concentrated poverty. Over the course of a person's life, the psychological and physiological response to this kind of stress leads to dire health problems, advanced aging and early death.