It started with a prickling heat beneath my skin. Over the next few days, my cheeks tightened and islands of irritation formed in protest of my own body—itching and weary. When the butterfly rash developed across my face, I began to wonder: was this the sign that I, like many other Black women in my life, had an autoimmune condition? While they can be difficult to diagnose for a variety of reasons, one of which being medical racism, there are more than 80 known autoimmune conditions. Symptoms of these conditions are diverse, however there are more common signs such as chronic fatigue, joint pain, body aches, and rashes. Of those who have autoimmune conditions, women are nine times more likely than men to have the disease, and Black women are three times more likely among women to have autoimmune conditions. Much of this research does not account for the intersectional experiences of gender expansive people and the cumulative impacts of systems of racism, transphobia, and homophobia.
These disparities are not standalone. The disproportionate prevalence of autoimmune conditions among Black women, like many others, can be linked to the sustained forces of systemic and institutional racism and U.S. imperialism, by way of a process described as “weathering.”
In 1992, Arline Geronimus introduced the “weathering” hypothesis, suggesting that the prevalence of health disparities among “socially minoritized” groups could be explained by the experience of “cumulative socioeconomic disadvantage,” accelerating aging processes and deteriorating health. While the weathering hypothesis was groundbreaking, and in many ways paved the way for further explorations of embodied inequality, it had significant conceptual limitations. Most notably, at the time of its development, it failed to situate its claims within a deeper historical and political critique, leading to an over-biologization of what were fundamentally structural and institutional harms. The depoliticized language of “environmental stressors” and “socioeconomic disadvantage” within the hypothesis remove the agency of the state and do not foundationally capture the longstanding systemic violence and exploitation many communities have been subject to at the hands of the American empire.
This critique is also not unique to the field of Public Health, as it more broadly mirrors that of the language used in describing present day genocide. This is highlighted in Anila Daulatzai’s critique on the ways occupation and imperialism become naturalized into everyday life without sufficient interrogation of their systemic roots. She writes in Remaining Undone and Acknowledging Afghanistan, “when we are made to see things as discrete, separate, and unconnected…it becomes too easy not only to render them as individual pathologies with established etiologies, but more importantly to remove any necessity to interrogate the seriality of war.”
Even in contemporary times, as others in the field seek to empirically demonstrate how systemic disadvantage is biologically embodied, such work falls short of explicitly naming sociopolitical forces responsible for producing disadvantage. While not always intentional, framing embodiment without naming U.S. imperialism risks reproducing what Eugene Richardson calls the “ideological apparatus of imperialism,” which obscures the structural causes of health inequities under the guise of an allegedly neutral science.
The call for naming the systems and institutions culpable for injustice and health inequities is not new. In her work Body and Soul, Alondra Nelson details the many ways the Black Panther Party utilized health in their project of liberation. She details the ways the Party opposed the biologization of social issues that pathologized the Black community and instead sought to address systemic inequalities in a deeper historical context. In 1973, for example, the Party organized to dismantle the development of a research center at the University of California at Los Angeles (UCLA) focused on exploring the “biological causes” of violence. The Party explained that the prevalence of violence was not biological, but in fact a “symptom of societal disease” and the legitimate results of institutional oppression. The Party highlighted that while medicalization could serve as a means of underwriting movements, over-medicalization could divert attention from necessary sociopolitical changes. In the words of disability rights activist Irving Zola, medicalization can “locat[e] both the source and treatment of social problems in an individual,” restricting the point of intervention to the individual body.
Much like the Black Panther Party, we must be strategic in the ways in which we employ historical context and narrative in the pursuit of health equity, and turn to decolonized methodologies within epidemiology in pursuit of greater liberation.
In the subfield of embodiment literature, weathering has been operationalized through the measure of allostatic load, or the cumulative physiological wear and tear on the body in response to chronic stress. Under irregular stressful circumstances, the body adjusts to external stimuli to maintain stability, but when stress is persistent, this system becomes chronically activated and dysregulated. This dysregulation manifests as elevated levels of inflammatory cytokines, neurotransmitters, and glucocorticoids, each contributing to the dysregulation of other bodily systems. Allostatic load is often measured as a composite of several clinical indicators, such as systolic and diastolic blood pressure, creatinine levels, BMI and HbA1c, to quantify the effects of chronic stress; some of these clinical indicators are rooted in racist medical histories.
While there is acknowledgement of uncertainty in the utility of allostatic load algorithms, studies have proceeded with its use without deeper interrogation of the clinical and historical construction of its elements, reflecting a broader trend in Western science of assuming empirical objectivity while ignoring the origins of scientific categories. Western scientific methods are rooted in positivist epistemologies that assume there is a singular objective truth. It is a myth however that research is objective, as it is conducted from a particular perspective that is informed by individual backgrounds, assumptions, and biases, including those related to colonialist power structures. In Decolonizing Methodologies, Linda Tuhiwai Smith challenges the dominance of Western knowledge systems, calling for an interrogation of the impacts of colonialism on knowledge systems and research practices, aiming to reclaim control over Indigenous ways of knowing and being. While quantitative data can be valuable in some contexts, decolonizing epidemiological research requires methodologies that prioritize personal narratives and lived experiences.
Allostatic load can provide a useful framework linking social environments to health outcomes, however it is critical to remember it is not the body’s dysregulation that causes health disparities, it is the existence of systems of institutionalized racism, colonialism, and U.S. imperialism, propped up by racial capitalism, that treats Black and Brown bodies as disposable capital.
Thankfully, many are already doing the work of reframing and in doing so, have turned to Ecosocial Theory developed by Nancy Krieger. This theoretical model emphasizes the process of embodiment, but is explicit in naming the political and historical forces responsible for health inequities. In describing how biological processes are deeply intertwined with social, historical, and political contexts, resulting in inequities that manifest in bodies across the lifecourse. Another tenet of this framework is accountability, or an instruction to name the institutions and agencies accountable for the social and environmental factors that impact health. And, these institutions, including epidemiologists, have responsibilities for the health outcomes of populations. In this framework, health disparities are not random or purely biological but are expressions of systemic injustice.
When I brought my concerns to my doctor, describing the symptoms I was experiencing, they did not name racism as a possible cause. In pursuit of health, we must move toward decolonized and justice-centered methodologies. This includes naming systems of oppression explicitly in research questions and frameworks, co-producing knowledge with communities most impacted, and contextualizing clinical data within histories of structural violence. We must ask not only what we are measuring, but why, and in whose interest. In doing so, we move from simply documenting disparities to challenging the systems that create them. In public health and medicine, there are those who insist that science is apolitical. But science is produced, interpreted, and applied by people—and when the body-minds of Black and Brown communities have been relentlessly racialized and politicized, science cannot be neutral. It is political, and so Public Health must be, too.
Authored by Christine Board
Christine Board is a doctoral student and public health practitioner in pursuit of liberation and equity. In addition to working in the field of public health, she is a multidisciplinary creative and believes that narrative and storytelling is a way to elevate truth and center community.
