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LETTER |
Correspondence: Requests for reprints should be sent to Nigel Mark Thomas, MPH, 300 W 145th St, 2J, New York, NY 10039 (e-mail: nt170{at}columbia.edu).
Geronimus and colleagues’ finding1 is a curious one. The authors considered "whether US Blacks experience early health deterioration, as measured across biological indicators of repeated exposure and adaptation to stressors"1(p826) and found evidence of the "weathering hypothesis" among Blacks. Blacks had higher cumulative risk measurements than did Whites. These racial differences were not explained by poverty. Poor Black women had the highest allostatic load scores, followed by Black women who were not poor. This finding suggests that within the racial and gender stratification of the United States, Black women are more likely than other groups to engage in "John Henryism"—persistent high-effort coping with the pernicious effects of discrimination.2
What is missing from this discussion, though, is a synthesis of life expectancy tables with the weathering hypothesis and allostatic load scores. The weathering hypothesis suggests that health may decline in early adulthood as a physical consequence of cascading socioeconomic stressors.1 Allostatic load captures the wear and tear the body experiences as it strives to achieve stability in disruptive environments.3 Life expectancy—the statistical projection of the length of an individual’s life span, based on probabilities and assumptions of living conditions and other affecting factors—has been described as the best indicator of population health.4
This is the paradox: Black women live longer than White men.5 The disparity in average life expectancy is even starker when Black women are compared with Black men; Black men experience disproportionately higher death rates in all the leading causes of death.5 And Geronimus has documented elsewhere that although one third of 15-year-old Black girls will not reach their 65th birthday, the figure is two thirds for Black boys of the same age.6 This is a paradox that demands better explication if we are to truly advance our understanding of how stress-related chronic diseases contribute to excess mortality in marginalized populations in the United States and elsewhere.
References
1. Geronimus AT, Hicken M, Keene D, Bound J. "Weathering" and age patterns of allostatic load scores among Blacks and Whites in the United States. Am J Public Health. 2006;96:826–833. Published online December 27, 2005. doi:10.2105/AJPH. 2004.060749.
2. James S, Schultz A, van Olphen J. Social capital, poverty and community health: an exploration of linkages. In: Saegert S, Thompson JP, Warren M, eds. Social Capital and Poor Communities. New York, NY: Russell Sage Foundation Press; 2002:165–188.
3. McEwen B. Stress, adaptation, and disease: allostasis and allostatic load. Ann N Y Acad Sci. 1998;840: 33–44.
4. Pan American Health Organization (PAHO). Health in the Americas. Washington, DC: Pan American Health Organization; 2002.
5. Centers for Disease Control and Prevention (CDC). Health disparities experienced by Black or African Americans—United States. MMWR Morb Mortal Wkly Rep. 2005;54(1):1–3.[Medline]
6. Geronimus A, Thompson JP. To denigrate, ignore, or disrupt: racial inequality in health and the impact of a policy-induced breakdown of African American communities. Du Bois Rev. 2004;1(2):247–279.
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