How social injustice makes people ill

I was excited to receive a copy of Weathering: the extraordinary stress of ordinary life on the body in an unjust society. As a practitioner psychologist myself, who has an interest in working with the psychosocial impacts of racism, classism, discrimination, and othering, I have often spoken of the impact of injustice on marginalised groups. With a specific focus on the effects and toll of social injustice, on black, brown, working-class communities, this book illuminates the multiplicity of challenges that these groups face.

Divided in two parts, the first part outlines the conceptualisation of a process that the author, Dr Arline Geronimus calls 'weathering'. Weathering is formulated as a process that encompasses the physiological effects of living in marginalised communities that bear the brunt of racial, ethnic, religious and class discrimination. The second part of the book offers compelling ways forward for overcoming the challenges we currently face with weathering, systemic racism, and social injustice of diverse groups. 

I was moved by the examples of weathering in the first part of the book, as well as the impact of systemic racism, 'age-washing', described as a way of thinking that ignores the role of structural racism or classism and cultural oppression in the marginalised peoples' bodies by locating its causes elsewhere. What Geronimus offers is an eloquent critique which spans from the disproportionate exposure to the Covid-19 virus that people from ethnically diverse communities faced during the height of the pandemic, to the health damage caused by othering, racism, and injustice on Black, White, Latina communities in the USA.

Furthermore, the reader is challenged to consider the weathering impact on those living in high poverty areas, as well as on pregnant women from black and minority ethnic communities. In line with this, supporting yet shocking statistics illuminate how stress impacts and damages cardiovascular, neuroendocrine, and metabolic systems and how this consequently contributes to vulnerabilities that lead to people in these communities dying younger.

Although part of the complexities relayed in this book are prescribed to the weathering process, and systemic injustice, the book also offers other perspectives for the reader to consider. These relate to psychological problems such as depression and physiological responses which include the inner workings of stress responses. These include for example the chronic increase of stress hormones in the blood stream and the drive towards eating 'comfort foods' which are high in fats and sugars, or turning to drugs for release of tension. These responses ultimately contribute to adverse health problems including heart disease.

What this book offers is therefore an important and clear thesis of the impact of the physiological and psychological toll of resistance among people from ethnically diverse communities and other marginalised groups. Rather than end at highlighting these problems, it offers the reader some suggestion of ways to respond and positively move forward. These include mapping equitable policies, effective solutions which include incorporating the voices of those in the communities who will be affected by any policies enacted.

I also agree with the importance of taking seriously the voices of pregnant and birthing women; naming and challenging the systemic racism and racist, classist, ageist and age-washed ideas which influence the provision of care. Furthermore, it asserts the importance of addressing climate change challenges, especially as the impact of climate change is felt acutely by the least privileged as it exacerbates psychological weathering.

A minor critique however, is that the book focuses on examples and public health statistics mostly from the USA. Nonetheless, this does not take away from its potency as I was able to easily relate the concepts noted here to my own geographical location of the UK; the book instilled in me motivation to act and engage with challenges within my own context. I am left considering how to contribute personally and professionally in dealing with weathering, age-washing and the effects of social injustice in marginalised groups in terms of the toll taken on health.

I am left clear that as human beings when we experience racism, poverty, discrimination or othering, there is a bio-psychosocial cost to pay. Who in my context is impacted and pays this cost, who contributes to its perpetuation and what can we personally, professionally, and collectively do? If you care about contributing positively to social justice, public health, and wellbeing, then this book is a must read.

Reviewed by Professor Divine Charura, professor of counselling psychology at York St John University.