How weathering affects the health of black people

In December 2023, I underwent surgery to remove the fibroid. Uterine fibroids are benign tumors that grow in the uterine wall. I had this tumor for almost 10 years, and even though it was benign, it definitely added difficulty to my life.

I have suffered from menstrual pain since I was a teenager, but it has gotten worse as I’ve gotten older. They often lasted a week or more and left me tired and anemic. The cramps were so bad that I often felt nauseous. I use pads and tampons too quickly and often worry that if I sneeze, cough, or laugh at the wrong time, it will lead to an embarrassing leak and I’ll end up spending the rest of the day with my jacket tied around my waist. was doing.

Uterine fibroids grow over time and new fibroids are formed. Over the years, my doctor discovered other, larger fibroids, but the first one I found grew so large it was pressing on my stomach and causing me heartburn almost every day. Four months later, I was approved for laparoscopic myomectomy (surgery to remove the fibroids). I woke up in the hospital, groggy from anesthesia and the pain of the five incisions my surgeon had made, but excited about my new life without fibroids. I later found out that I had more than one uterine fibroid. A total of 10 were removed, the largest having grown to 15 centimeters. This is about the size of a mango.

It’s a well-known story, but one that remains a mystery to many people with uteruses, despite the answers and clarity that myomectomy provides. As many as 77% of women will develop uterine fibroids at some point in their lives, but the cause is unknown. This also means we don’t know what’s behind the racial disparities in uterine fibroids. Black women are more likely to experience symptoms due to fibroids and are two to three times more likely to have them relapse once they are removed. They are also more likely to be diagnosed at a younger age.

Doctors have a theory as to why. Some researchers believe that genetics may be a factor. Some think it may be caused by chemicals we come into contact with. And some think it could be a phenomenon known as weathering.

Weathering is a term coined by researcher Arline Jeronimus. When it was first introduced, it was not without controversy, with many in the medical community pointing to it as a contributing factor to many health disparities for Black Americans.

Dr. Uché Blackstock, founder and CEO of Advancing Health Equity, explores this and other systemic flaws in our health care system in her book. Legacy: Black doctor reflects on racism in healthcare.

“Essentially, the idea is that dealing with the chronic stress of everyday racism wears down the body and causes it to age faster,” she says. “As a result, we as Black people are more likely to develop chronic diseases such as heart disease, autoimmune diseases, and uterine fibroids.”

in an episode of weedI sat down with Dr. Blackstock to discuss how weathering, racism, and racism impact healthcare past and present, and what solutions can increase equity in healthcare. Ta.

Below are excerpts from the conversation, edited for length and clarity.can hear weed Apple Podcasts, Spotify, Stitcher, or wherever you get your podcasts.

John Killin Hill

What role does weathering play in Black people’s health?

Uche Blackstock

Basically almost all health outcomes are very poor. Not because there is something inherently wrong with us, but because there is something very wrong with the social system in which we live.

This idea of ​​weathering is very important for us to talk about because it may seem secret to some, but we actually live with stress every day that wears down our bodies. And we need to be aware of how it affects the development of other diseases.

John Killin Hill

What effect does stress have on the body? We’ve all heard the saying, “Black people don’t crack.” People may look young, but our bodies tell a different story.

Uche Blackstock

Black people who give birth have been found to have higher cortisol levels than white people, about 15 percent higher. Cortisol is a stress hormone. This is a hormone that rises during the fight-or-flight response. The problem is that hormones shouldn’t be high all the time. It should rise and fall as needed. However, for black people, cortisol levels are always high because they have to experience the stress of living in an inherently racist society. This increases your heart rate, puts stress on your heart, and increases your blood pressure.

There is also another idea called epigenetics. This studies gene expression and what happens when stressed. There is also a correlation between living with stress due to racial discrimination, which causes changes in the way genes are expressed.

Race is therefore a social construct, not a biological one, but how we experience racism can turn genes on and off. And we think that has something to do with why Black people are more likely to develop diabetes, autoimmune diseases, inflammatory diseases like heart disease and atherosclerosis, and infant mortality.

If you compare the ends of our DNA, they are called telomeres. If you look at our telomeres, black people and other people of color, our telomeres are shorter. In fact, they look like they belong to people decades older. Again, race is a social construct. [there’s] There is no biological basis for it. But the effects of racism in practices, policies, and interpersonal relationships actually affect our DNA.

John Killin Hill

I’d like to dig deeper into the data on how these disparities work. There was a very interesting example that you talked about regarding black immigrants.

Uche Blackstock

When black immigrants come to the United States, their health status is comparable to that of white Americans. But after a generation or two, their health actually declines to that of black Americans. So what this tells us is that there is something very wrong with the power that black Americans receive just by living in this country, and that our health status is being transferred from white Americans to black Americans. This means that it may decline after a generation or two.

There is nothing inherently wrong with black people. There is something very wrong with the systems we are forced to live under and within.

And that’s what’s causing this decline in life expectancy, and we have one of the lowest life expectancies of any racial group.

John Killin Hill

What’s on your policy wish list? What do you think will lead to better health care and better outcomes for Black patients?

Uche Blackstock

I think many solutions need to be done at multiple levels. They have to happen within medical schools and how medical schools educate future doctors. It’s not just about including history, it’s about understanding how so-called social determinants influence health, such as health, education, employment, free access to healthy food, and green space. Therefore, medical students need a more comprehensive education about how people can stay healthy and how they get sick.

It’s a real imperative for hospitals to track health equity metrics in real time and see if there are any differences in how patients are treated compared to white patients. Are there any differences in prescribing habits?

In one ER where I worked, black patients waited 80 minutes longer to be admitted than white patients. And we talked about actually developing a standardized process to track that and intervene as needed.

And I want policymakers to think about health in all their policies. We know that our communities are deprived of wealth, resources, and opportunity because of the legacy of slavery and discriminatory housing policies. So when we think about homeownership opportunities and wealth building, when we think about education, and how we can provide free, high-quality public education for our children, all of those things make our communities healthier. very important to do.

John Killin Hill

Will the political will exist to accomplish these things?

Uche Blackstock

We have to put pressure on our elected officials to say this is a priority for us. Why will childbirth be less safe for Black people in 2024 than it was 20 years ago? It doesn’t make sense, but it shows how deeply ingrained racism is in our society. Masu. And the fact that we have worse maternal outcomes than other high-income countries and even some middle-income countries, and that we spend even more than them on health care, is unacceptable.

John Killin Hill

What can we do to make the health care system as safe as possible for us, especially Black women who have to navigate the health care system that exists today?

Uche black stock

This is always a difficult question for me because it’s a systems issue. It is not our fault, and it is not Black women’s fault, that we have to feel like we are going to war when we are most vulnerable and seeking care. But obviously there are some things that I always advise people to do. Recently, her TikTok video posted by a white medical professional went viral. “Why is it that when I walk into the room, all my black patients are on their FaceTime with someone?”

It’s because we don’t trust you.

I always recommend bringing a trusted friend or loved one to your appointment. It may be for emotional support. It may be helpful to ask questions.

Also record your symptoms. When did the pain start? When did the symptoms start? How long did it last? Write everything down, as appointments can often be very stressful.

Ask your doctor or medical professional, what do you think is going on? What are your plans for me? What is the follow-up? What are the red flags to come back, seek treatment, or go to the ER?

But also know, black women, that we are doing great things. Similarly, Ashlee Wisdom’s digital startup Health in Her Hue is a directory of Black health professionals and culturally sensitive health professionals trained to work with Black women patients.

There’s an Irth app that was also started by a black woman. This is a directory of maternal-fetal health care providers who specifically care for Black births. Therefore, we are also the ones creating solutions to make the healthcare system more accessible and respectful to us.