By Theresa Frasca
ANN ARBOR—For Arline Geronimus, attending Princeton in the 1970s was her first anthropological study. Like many similar institutions, the university was going through great change as it sought to diversify, allowing women to attend for the first time, increasing the admittance numbers of minorities and accepting more public school graduates. Some alumni actively contested the changes and formed a protest group, “Concerned Alumni of Princeton.” As a coed and a graduate of public schools, Geronimus was at the forefront of Princeton’s evolving student body.
Her outsider status was clear to her from the start. Geronimus’s freshman roommate confided that she wouldn’t dream of allowing her parents to spend more than $1,000 on a debutante ball gown. Geronimus didn’t know what a debutante gown was, but she was stunned her roommate felt she was being socially conscious and frugal by limiting the amount to a mere $1,000 — a huge sum in the 1970s and equivalent to roughly $5,000 today. “I very quickly saw college as an anthropological experience,” says Geronimus. “That perspective, combined with my political theory classes, allowed me to look at my time there analytically. It’s been an ongoing project over the decades since to understand what was going on and the broader implications for society.”
While an undergrad, Geronimus held two distinctly different jobs. On campus, she served as a research assistant to Charlie Westoff, then director of the Office of Population Research (OPR). Off campus, she taught at a school for pregnant teens in Trenton, N.J. Back then, the concept of teenage pregnancy as a social problem was a relatively new phenomenon, and the idea of teenage motherhood as a preventable condition was just starting to ramp up at OPR, which was generating all sorts of studies, campaigns and statistics on the topic.
Geronimus’s worlds collided when she brought 20 teen moms on campus to a show performed by her musical theater group, the Princeton Triangle Club. “These young women shared so much of their lives with me, and I wanted to share my life with them,” says Geronimus. “So I bought them the best seats in the house, front and center.”
Somewhat fatefully, the show took place during a reunion weekend, and the audience consisted almost exclusively of alumni. “If alums were worried about coeds and diversifying Princeton with the valedictorians from suburban public high schools, you can imagine their reaction to 20 pregnant Black and Latino girls sitting in the front row,” says Geronimus. “It caused a real stir. I only realize now how subversive this was.”
To Geronimus, the young women she taught and befriended were not the grim statistics she was learning about on campus. These were young women who were excited to become mothers and who faced all kinds of real health and economic problems completely separate from their pregnancies. Additionally, the alleged opportunities these pregnant teens were giving up to have their children – education, careers and other possibilities – simply didn’t exist in the first place. “I realized that taking the OPR perspective, I just didn’t get it, “ says Geronimus. “Whether or not having a baby in your teen years is a problem, there were other unrelated and unaddressed issues that no one would debate are real problems. Why not tackle those with the same fervor? At the time, I knew that somehow I have to figure this out and give voice to this population.”
Geronimus decided to study the relationship of maternal age to pregnancy outcomes for her dissertation. “We all believed that in terms of health outcomes, teenage pregnancy was bad because reproductive health works as a developmental process,” she says. “Teens were considered too biologically and psychosocially immature for healthy childbearing, and, in fact, descriptively, teen moms had worse pregnancy outcomes than moms in their 20s. But U.S. teen moms also came from the most disadvantaged groups.” Geronimus hypothesized that if she could statistically account for the prior disadvantages, then teen moms and moms in their 20s would have equally good birth outcomes.
But she was wrong. “I found that postponing childbirth beyond the teens led to higher risks for those in high poverty communities,” says Geronimus. As she began to think about the women she knew in Trenton and the stressors and health problems they encountered, especially compared to her classmates at Princeton of the same age, she could see that women aged differently and faster in marginalized populations than privileged populations. And having kids younger was responsive to those risks. That’s how the concept of “weathering” began.
The “weathering hypothesis,” which Geronimus coined, is a common thread throughout her body of research. Weathering is the idea that the accumulation of chronic stressors of life in a marginalized or oppressed population, and the high effort of coping with them, can accelerate aging. Weathering advances the perspective that population health disparities arise from the different life experiences associated with an unequal society.
Geronimus chose the metaphor because it conveys two seemingly contradictory meanings. “To weather means to be worn down, but it also means to withstand, such as weathering a storm,” she says. Both meanings apply to the experiences and actions of marginalized populations. Throughout her career, Geronimus has researched the sociological causes and physiological processes of weathering and the actions individuals, families and communities can take to “mitigate, resist, and undo” its adverse impacts.
In her most recent work, Geronimus develops an approach for reducing health disparities, one that targets the unequal social, economic and environmental contexts that damage population health and cause some populations to age faster. Geronimus calls this “Jedi Public Health,” in reference to a scene in a “Star Wars” movie, where the Jedi protagonists escape the confines of their social identity by using simple “mind tricks.” These tricks convince adversaries at a blockade to let them move along to complete their mission. Geronimus says that the real world social environment is filled with cues that signal inferiority to, or even threaten, marginalized groups. These cues contribute to weathering and make it difficult for members of such groups to move forward in the directions they need or wish to go.
While larger policy changes are needed, Geronimus says small changes can have a big impact on health outcomes. One example is placing demographic questions (e.g. gender, race, ethnicity and income) at the end rather than the beginning of high-stakes tests. That way, members of stigmatized groups are less likely to take the tests hampered by a stereotype threat, a condition that undermines test performance and also activates the physiological stress process. The accumulation of many small changes like this could have real health benefits for marginalized populations.
This spring, the commitment Geronimus made to answering questions about equity was recognized with the Harold R. Johnson Diversity Service Award. The award is given to University of Michigan (U-M) faculty members who have exhibited outstanding leadership in the area of cultural diversity. Since those Princeton days, Geronimus’s life has revolved around diversity, equity and inclusion. She says receiving this award not only validates the work she’s done, but that it’s also brought her inspiration.
The other six recipients include distinguished faculty from the Medical School, College of Engineering, School of Education, and the College of Literature, Science, and the Arts. “It was encouraging to hear about the work of the other awardees, who are promoting not only diversity, but also equity and inclusion, which are harder to achieve in my view,” says Geronimus. “The commitment to creating equity and inclusion, as well as numerical diversity, has to come from within the school. It was great to learn about a whole range of people across campus who are working to make U-M more equitable.”
Geronimus knows a thing or two about improving equality on campus. The number of minority doctoral students in the Department of Health Behavior and Health Education at the School of Public Health grew dramatically during her time as chair of the program. Sherman James, who served as the department chair at the time, praises Geronimus for her transformative leadership. “Dr. Geronimus’s strong, international reputation, combined with her commitment to mentoring racial and ethnic minority students, were essential early on to the success of the School of Public Health’s Center for Research on Ethnicity, Culture and Health,” says James.
Under Geronimus, the doctoral program increased from eight students enrolled at any stage and no minorities to 42 students enrolled in the program, nearly half of whom were from underrepresented groups. One of the students Geronimus advised as both a graduate student and postdoctoral trainee, Jay Pearson – now an assistant professor of Public Policy at Duke – says Geronimus’s impact goes beyond the university. “The results can be seen in the diversification of the public health scientific workforce, where many of my diverse doctoral cohorts work in tenure-track positions or in professional capacities at the National Institutes of Health or the Centers for Disease Control and Prevention,” says Pearson. “Arline recognizes, appreciates and supports the tenuous social realities that are more likely to characterize the lived social experiences of a broader, more diverse student population. She often argued for the creation and maintenance of emergency funding for students in difficult financial situations. She’s worked tirelessly to promote diversity among doctoral students and increase the likelihood that these diverse voices might be meaningfully heard.”
Javier Rodriguez, a former postdoctoral trainee under Geronimus who is now a health researcher at Mathematica Policy Research, says Geronimus continues to serve as an adviser. “Even now, years after I finished my postdoc at the Population Studies Center, Arline continues to mentor me on the demanding task of effectively supporting researchers in positions of disadvantage,” says Rodriguez. “She provides me with a unique set of tools that allows me to give back – with the same enthusiasm – to the disadvantaged communities I come from. Arline welcomes scholars whose probability of success would otherwise be quite low, and that is true mentoring.”
Over the course of her career, Geronimus has published more than 65 academic papers in peer-reviewed journals, including the New England Journal of Medicine, International Journal of Epidemiology, Health Affairs and Demography, as well in other fields, including anthropology, economics and political science. She has served on 40 dissertation committees, 15 of which she was chair, and served as a primary advisor to more than 50 Master in Public Health students. She also was the founding director of the Public Health Demography Training Program at the Population Studies Center (PSC). In 2013, she was elected to the National Academy of Medicine of the National Academies of Science and received the U-M School of Public Health’s Excellence in Research Award.
“Arline has been a pioneer and continual leader in the field of population health,” says Jeffrey Morenoff, director of PSC. “She’s repeatedly demonstrated intellectual excellence and a commitment to cultural diversity in all aspects of her work – service, teaching, mentoring and scholarship. Arline has helped increase diversity within her academic units and the university, has solidified a commitment to diversity as part of the university’s educational mission, and has relentlessly strived to bring about equity in society.”
Geronimus calls herself a child of the ’60s, growing up in a town outside of Boston in the midst of extraordinary social and political movements, all of which affected her deeply. The middle child of three girls, she saw firsthand the difference public education could make. Both her mother and father held college degrees thanks to New York City’s impressive public college system. “I think my parents’ journey from large, immigrant families to first-generation college graduates informed my sense of why it’s so important to include everyone, to hear everyone’s voices, to turn to people who know from their lived experience what matters to them and what would make a difference,” says Geronimus. “It was all very formative, and it’s almost no surprise that I ended up doing what I’m doing.”
Geronimus says she’s at her happiest when she spends time with her husband and young adult children. And while her three children have chosen very different career paths – two are aspiring hip hop artists and one is in rabbinical school – Geronimus says she still sees pieces of herself and her values in the lives they’ve chosen to pursue. “I’m so fascinated by this generation, especially with my children, and how they’ve picked up core values from our ancestors,” says Geronimus. “I can see why each of my children chose their path. I see those permutations combined with their own passion and their own approach. And in that sense, the apple doesn’t fall far from the tree.”