By Veronica Squires
Yesterday I led a retreat with my administrative team at the Good Sam clinic that took a deep dive into social determinants of health and community asset mapping. I found myself needing to articulate how and why the lifespan gaps that exist in our city (and many other major cities across the country) are problematic. It’s not as if we can prevent death altogether, and certainly all people in all walks of life experience incredible tragedy and trauma. I felt like I needed to answer the question, “What is the specific injustice in the presence of disparities in life expectancy?”
The injustice is not that people are dying. We will all leave this earth at some point. The injustice is the accelerated weathering of the body, mind, and spirit that is happening in low-income urban and rural neighborhoods which results in people having a poor quality of life while they are alive, and dying years before they should.
Last year I had the pleasure of hearing David R. Williams, PhD, MPH, Florence and Laura Norman Professor of Public Health at the Harvard T.H. Chan School of Public Health and Professor of African and African American Studies and Sociology at Harvard University, give a keynote address at the Healthcare Georgia Foundation’s Connections Conference. He referenced a fascinating 2015 study that looked at Race/Ethnicity, Poverty, Urban Stressors and Telomere Length. The study was led by Nobel laureate. Dr. Arline Geronimus, a visiting scholar at the Stanford Center for Advanced Study. He found that those living in stressful environments, or those experiencing on-going racism or oppression, presented with shorter telomeres earlier than they should. They were aging prematurely.
A blog from the University of Michigan summarizing the study explains the concept of biological weathering:
“The stress of living in extreme poverty causes early onset of age-related diseases and takes years off the lives of many of the urban poor—evidence at the cellular level now shows.”
Then later in the blog: “Currently, residents of Detroit are struggling—whether they are white, black or of Mexican descent—in ways that measurably impact their health negatively, including at the cellular level,” said Geronimus, “Our findings suggest that any group subject to extremely difficult life conditions and contexts will bare physiological scars.”
Shortly after the study was published, the Huffington Post ran an article summarizing the study this way:
“Evidence increasingly points to telomere length being highly predictive of healthy life expectancy. Put simply, the shorter your telomeres, the greater your chance of dying.”
And later in the Huffington Post article this summary from Geronimus himself:
“I think a lot of people just don’t understand how bad it is for some Americans. It’s disproportionately people of color given our history of residential segregation and racism, but it’s also anyone who gets caught.
Geronimus continues, “It’s like the dolphins who get caught in the fishing nets, it’s anyone who gets caught there. If anything, some of our evidence suggests that whether it’s the poor Mexican immigrant or the African-Americans who have been discriminated against and dealt with hardship for generation after generation, they’ve developed systems to cope somewhat that perhaps white Detroiters haven’t. So there’s great strength in these populations. But it’s not enough to solve these problems without the help of policymakers and more emphatic fellow citizens.”
As a white, middle class American I think Geronimus is right. Until I lived in a poor neighborhood in southwest Atlanta, I literally had no idea how difficult mere daily survival could be. My hope and prayer is that as a society we can learn from experiences like mine, we can trust the science which is increasingly proving that inequitable living conditions impact the body and lifespan, and we can start asking the question, “What will make my neighbors healthy” from a new place of empathy and commitment to action.
Biological weathering is real and we need to do something about it.