--- title: The Physical Toll Systemic Injustice Takes On the Body description: Chronic stress from oppression can literally kill us—a condition known as 'weathering,' writes Arline T. Geronimus. canonical: https://time.com/6266329/systemic-injustice-health-toll-weathering/ author: TIME article:opinion: true article:content_tier: free article:published_time: 2023-03-28T11:00:52.000Z article:modified_time: 2026-08-04T08:06:32.626Z article:section: Ideas og:title: The Physical Toll Systemic Injustice Takes On the Body og:description: Chronic stress from oppression can literally kill us—a condition known as “weathering," writes Arline T. Geronimus. og:url: https://time.com/6266329/systemic-injustice-health-toll-weathering/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt580940fd4803b5b1/698a3b78d07533f4a4e6ddd0/Weathering-Stress-Depression.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 1632 og:image:height: 918 og:image:alt: Weathering-Stress-Depression og:type: article twitter:card: summary_large_image twitter:title: The Physical Toll Systemic Injustice Takes On the Body twitter:description: Chronic stress from oppression can literally kill us—a condition known as “weathering," writes Arline T. Geronimus. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt580940fd4803b5b1/698a3b78d07533f4a4e6ddd0/Weathering-Stress-Depression.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 --- # The Physical Toll Systemic Injustice Takes On the Body > Sponsored content. Supplied in partnership with TIME. 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It explains how TIME's journalism is made, from the first pitch through the editorial decisions behind a finished story or cover. #### How can I read about how TIME chooses its covers? Inside TIME is the newsletter where TIME's Editor-in-Chief explains cover selection and the editorial reasoning behind major stories. It is free at time.com/newsletters. #### Who is the editor of TIME? Sam Jacobs is TIME's Editor-in-Chief. He writes Inside TIME, a twice-weekly newsletter about the newsroom's reporting and editorial decisions. #### Is Inside TIME free? Yes. Inside TIME is a free newsletter, available at time.com/newsletters. A paid TIME subscription is separate and available at time.com/subscribe-agent. ## Video: The Health Costs of Gun Violence Trauma [Watch (HLS stream): The Health Costs of Gun Violence Trauma](https://cdn.jwplayer.com/manifests/sibCsZiD.m3u8) (3:44)  _Published 2022-05-31. For gun-wound survivors and their families, there’s a hefty price tag affixed to the healing process following a shooting incident, according to a Harvard Medical School study published in April that analyzed Medicare and commercial insurance claims between 2008 and 2018._ Mar 28, 2023 11:00 AM UTC  abstract portrait symbolizing depression and psychotherapy. Profile of a woman with a road and tears abstract portrait symbolizing depression and psychotherapy. Profile of a woman with a road and tears Getty Images by [Arline T. Geronimus](https://time.com/author/arline-t-geronimus/) ## Arline T. Geronimus Mar 28, 2023 11:00 AM UTC The pathologists who performed Dr. Martin Luther King Jr.’s autopsy noted he had the [heart of a 60 year old](https://www.pbs.org/wgbh/americanexperience/films/mlk/#transcript), although he was 39 when he died. His damaged heart was duly noted in the official record as a curiosity, but there was no question as to the cause of death: homicide; indeed, assassination. A racist hate crime. But if we were to try to understand the poor condition of his heart, we might be flummoxed. Our general repertoire for understanding the early onset of heart disease points us to demographic and behavioral risk factors like poverty, low education, family breakdown, unhealthy diet, and little exercise. King certainly looked physically fit, capable of leading miles-long civil rights marches. He was well-educated, not impoverished. He grew up in an “intact” household and had a strong father figure. His faith was unswerving, as was his sense of purpose. He had a loving wife and family. We might ask, did he partake of a particularly unhealthy diet? Did he have a genetic predisposition, a family history of heart disease? We can neither rule out nor rule in such possibilities for King. Yet, the more likely explanation, [according to data](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633295/) on the prevailing causes of heart conditions, is that chronic stress or exhaustion took a toll on his heart. But what does that really mean? Would his heart have been healthy if he had managed his stress with meditation? (We don’t know that he didn’t.) Or if he reduced his travel and public engagements to get more rest? Perhaps marginally. But those strategies alone would not have addressed the source of his most severe and chronic stressors—the fact that he lived continuously on alert to threats, maintaining his composure, nonetheless, and in survival mode. This chronic vigilance and adaptation takes a huge health toll on the human biological canvas—a condition known as “weathering.” --- ### More from TIME --- After almost 40 years of research in public health and a lifetime of wrestling with questions of racial and class injustice, I have concluded that a process I call [“weathering”](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470581/) is critical to understanding why someone like King, whom we’d consider young and healthy by all conventional measures, would have the damaged heart of someone in late middle age. Weathering afflicts human bodies—all the way down to the cellular level—as they grow, develop, and age in a systemically and historically racist, classist, stigmatizing, or xenophobic society. Weathering damages the cardiovascular, neuroendocrine, immune, and metabolic body systems in ways that leave people [vulnerable](https://scholarlycommons.law.wlu.edu/crsj/vol27/iss2/5/) to dying far too young, whether from infectious diseases like COVID-19, or the [early onset](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864527/) and pernicious progression of chronic diseases like hypertension. Because of the physiological impacts of unrelenting exposure to stressors in one’s physical and social environment, as well as the high physiological effort that coping with chronic stressors entails, weathering means that relatively young people in oppressed groups can be biologically old. Take Erica Garner. She became a tireless advocate for racial justice after her father, Eric Garner, was murdered by a New York City in 2014 police officer who placed him in an illegal chokehold for the crime of selling untaxed cigarettes. Her father’s dying words, “I can’t breathe,” became a rallying cry for the Black Lives Matter movement. Afterward, though she was initially apprehensive, Garner became a major force in the movement for police accountability. She died at age 27 in 2017, only three and a half years after the death of her father, and four months after the birth of her second child. Her own difficulty breathing, due to asthma, precipitated a major heart attack that killed her. According to [her doctors](https://www.womanlymag.com/matters-of-the-hearts/articles/the-heart-of-erica-garner), the pregnancy had stressed Garner’s already enlarged heart, so her death was classified as a maternal death. But why did she have an enlarged heart at her young age? In the weeks before her death, Garner described the stress, exhaustion, and frustration she suffered as a spokeswoman for the Black Lives Matter movement. “I’m struggling right now with the stress and everything,” [she said.](https://twitter.com/BenjaminPDixon/status/946436687588192257) “This thing, it beats you down. The system beats you down to where you can’t win.” Or as her sister, Emerald Snipes Garner, [described](https://www.msnbc.com/transcripts/politicsnation/2018%1e01%1e07%1emsna1058631) it a week after Garner’s death, “It was like a Jenga”; they were “taking out pieces, taking out pieces, ripping her apart.” **_Read more:_**[_Toxic Stress Load Is the Biggest Barrier to Living Longer. Here’s How to Reduce It_](https://time.com/6255795/toxic-stress-life-expectancy-how-to-reduce/) Weathering is a life-or-death game of Jenga. The Jenga tower appears strong and upright as the first pieces are removed, one by one. To all appearances, it continues to stand strong as pieces keep being taken away until the removal of one last fateful block exposes the many weaknesses of its interior, and the tower collapses. In spring 2020, COVID-19 turned out to be that last fateful block for [tens of thousands of people of color.](https://www.nytimes.com/2020/04/29/magazine/racial-disparities-covid-19.html) Every day, towers collapsed, as they continue to do, before our eyes. “The only thing I can say is that she was a warrior,” Garner’s mother, Esaw Snipes, said after she died. “She fought the good fight. This is just the first fight in 27 years she lost.” After she had spent 27 years of battling headwinds, fighting the same system that had killed her father for selling a few cigarettes, those headwinds took their toll and killed her too. She was weathered to death. I think the same could be said of [Fannie Lou Hamer](https://www.thenation.com/article/archive/fannie-lou-hamer-tired-being-sick-and-tired/), the 1960s voting rights activist who famously observed at age 46 that she was “sick and tired of being sick and tired.” She died 13 years later at age 59, of breast cancer and complications of hypertension. I think she intuitively understood the price she paid for her years of activism. After failing the literacy test in her first attempt to register to vote, she told the registrar of voters, “You’ll see me every 30 days till I pass.” In later years, as she [reflected](https://openroadmedia.com/ebook/the-crosswinds-of-freedom-1932-1988/9781453245200) on her persistence, her words suggest she knew she was being weathered: “I guess if I’d had any sense, I’d have been a little scared—but what was the point of being scared? The only thing they could do was kill me, and it kind of seemed like they’d been trying to do that a little bit at a time since I could remember.” “A little bit at a time,” piece by Jenga piece, the assaults on the body continue to accumulate as weathering. You don’t have to be a high profile political activist to experience weathering. Any marginalized person who persists daily to survive or overcome and to see to their family’s and community’s needs in the face of long odds and systemic barriers will weather, to greater or lesser extent. Through my decades of research, I have seen how cultural oppression and economic exploitation move from society to cells in the bodies of people of color, working-class people, political refugees, the deplored or stigmatized, and the impoverished who sustain ferocious hope as they work hard and play by the rules. However, as the Reverend William Barber, co-chair of the Poor People’s Campaign, asserted in June 2020, “Accepting death is not an option anymore.” He emphasized that the imperative extends far beyond the issue of police brutality. Echoing Fannie Lou Hamer, he said, “In everything racism and classism touch, they cause a form of death.” Barber’s words read as metaphor, but they are the literal truth. The country is waking up to what Black Americans have known for centuries and what public health statistics have shown us for decades: systemic injustice—not just in the form of racist cops, but in the form of everyday life—takes a physical, too often deadly toll on Black, brown, and working-class or impoverished communities. Contrary to popular opinion and accepted wisdom, healthy aging is a measure not of how well we take care of ourselves—but rather of how well society treats and takes care of us. When society treats our community badly, it doesn’t just “cause a form of death,” it causes damage that can literally age and kill us. _Adapted excerpt from the book_ [WEATHERING](https://www.hachettebookgroup.com/titles/dr-arline-t-geronimus/weathering/9780316258180/) _by Arline Geronimus. Copyright © 2023\. Available from Little, Brown Spark, an imprint of Hachette Book Group, Inc. All rights reserved._ ## Transcript When we hear about firearm injuries or mass shooting events, they tend to be characterized by the number of people who died. And when there are data shown about the worst, for example, mass shootings and U.S. history, those are also typically described by the number of people who died. But what's often forgotten, I think, in those cases is the number of people who also were hurt by firearms in those incidents, but managed to survive and what are the health and economic consequences of those non fatal injuries? So in this study design, we looked at one year prior to firearm injury through one year after firearm injury. And we found that non-fatal firearm injuries led to a roughly four fold increase in health care spending in the first year after the non-fatal firearm event. This four-fold increase in health care spending was explained by increases in every category of health care spending we looked at including hospitalizations, outpatient visits, prescription drugs, labs, imaging, tests, homecare, transportation, and others. We found that on average over the first year following a non fatal firearm injury, survivors experienced about a $30,000 increase in total health care spending across that year, when we multiplied $30,000 per survivor by the roughly 85,000 non-fatal firearm injury survivors each year in the U.S., that came out to be about $2.5 billion in total direct health care spending, attributable plausibly to non- fatal firearm injuries in the first year alone. Of that $2.5 billion in direct medical spending in the first year, about 96% of those dollars were paid by public payers like Medicare, private payers; like insurance plans, or employers who are effectively self-insured with about 4% paid by patients out of pocket. And so the vast majority of those dollars are paid by either taxpayers one way or another or through wages forgone from the workforce through employer health care spending. So the number of people who are injured in a non-fatal fashion through firearms is quite large. And I think intuitively as members of the public when they are not talked about as much in the coverage of these events, we tend to think that they were okay because they survived. Every innocent life lost in these mass shootings, is a tragedy, and remembering the lives lost helps us honor them and submit their legacies into our memory. At the same time, this study shows that the impact on the many other lives injured is profound, both clinically and economically. With ripple effects from survivors through family members and extending to employers and payers. ```json [{"@context":"https://schema.org","@type":"OpinionNewsArticle","@id":"https://time.com/6266329/systemic-injustice-health-toll-weathering/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6266329/systemic-injustice-health-toll-weathering/"},"headline":"The Physical Toll Systemic Injustice Takes On the Body","datePublished":"2023-03-28T11:00:52.000Z","dateModified":"2026-08-04T08:06:32.626Z","description":"Chronic stress from oppression can literally kill us—a condition known as “weathering.\"","url":"https://time.com/6266329/systemic-injustice-health-toll-weathering/","keywords":["Race","freelance"],"thumbnailUrl":"","author":[{"@type":"Person","name":"Arline T. 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