What The Body Carries

by Andrea Caupain Sanderson, BFCF co-architect and Interim Managing Director.

There is a pain that arrives unannounced. It throbs in the low back at the end of the month, when the numbers don’t add up. It roots itself in the clenched jaw, the recurring headache, the stiff neck and shoulders — places the body holds what the mind can’t set aside.

We are taught to read this pain as a private mechanical failure of muscle and nerve, separate from our circumstances. But a convergent body of peer-reviewed research says otherwise: the pain and the circumstance are the same story, told twice.

For Black communities in America, up against a never-level economic playing field, that story is written into the tissue with particular force. It is not only that poverty hurts. It is that poverty provokes worry, which hurts too. Not having enough money is one hardship; carrying the chronic anxiety of that scarcity is another. The second is not less real or damaging.

The Worry That Never Stops

Multiple studies have shown a clear link between financial hardship and physical pain. [1] Researcher Eileen Chou and colleagues found, based on six studies, that economic insecurity generates physical pain, lowers pain tolerance, and even predicts use of over-the-counter painkillers. [2]

The mechanism is clear. Economic insecurity robs people of the sense of solid ground underfoot. It steals the comfort of predictable choices that others take for granted. That loss of control triggers a stress response and activates the same neural circuitry the body uses to process physical threat. [2]

A 2018 study using a nationally representative sample of men 50 and older found that four separate hardship indicators — ongoing financial strain, difficulty paying bills, food insecurity, and skipping medication because of cost — were each independently associated with both the presence and the severity of pain, even after accounting for age, education, and marital status. [3] In a 2017 analysis of chronic pain, Mary Janevic and colleagues wrote, “our findings suggest that racial inequalities in wealth — along with other established factors such as inequitable pain care – may be a major contributor to the pain burden among older African Americans.” [4]

Why the Load Falls Harder on Black Bodies

For most people, worry has an off-switch — the crisis passes, and the nervous system stands down. But for many Black people, scarcity is a chronic condition rather than an event. This scarcity is not just economic — it is also a scarcity of access, of trust, and of physical safety. So, the worry does not resolve; it churns. For many Black people, life in America is a life lived on red alert.

Elevated inflammation and stress hormones provoke dysregulation and a somatic burden that builds steadily over time. When a state of emergency becomes baseline, Black bodies stay in survival mode — perpetually braced for whatever is coming next.

Researchers call the accumulated cost of that readiness allostatic load — the cumulative wear and tear on the body from constantly adapting to stress. [5] Chronic stress sustains a low-grade inflammatory state, sensitizes the nervous system, and lowers the threshold at which ordinary sensation becomes hurt.

Weathering

Public health researcher Arline Geronimus has spent decades developing a structural framework and gathering evidence for what she calls “weathering”. This term describes the reality that Black people experience earlier deterioration of health because of the cumulative burden of coping, over a lifetime, with social and economic adversity and racial marginalization. [6] The body weathers — like stone left too long to wind and rain.

When tested against national data, the pattern was stark:

Black adults carried higher allostatic load scores than white adults at every age.

• On average, a Black person’s biological wear-and-tear resembled that of a white person a full decade older.
• By age 45, roughly half of Black women had high allostatic load scores; by 64, more than 80 percent did. [7]

Related research has traced this weathering all the way to the cellular level, linking it to shortened telomeres — a signature of accelerated aging — among Black women. [8]

And here is a finding that should inform how we fund: this disparity could not be explained by poverty alone. It held across income levels. [7] Financial comfort did not buy a Black body out of it. The worry weathering Black bodies is not limited to the worry over an empty account. Yes, the cascading harms of financial hardship disproportionately impact Black people. And in addition, there is the pervasive, fundamental worry of moving through a world that assigns you risk and scarcity regardless of what you have earned.

Geronimus writes, “Weathering is not measured in number of steps walked, cigarettes smoked, opioids used, alcohol drunk, or calories eaten. It’s not primarily measured by your years of education, the size of your paycheck, or your bank balance. It’s not essentially about emotional despair, either. Weathering is about hopeful, hardworking, responsible, skilled, and resilient people dying from the physical toll of constant stress on their bodies, paying with their health because they live in a rigged, degrading, and exploitative system.” [9]

When Resilience Becomes a Trap

There is a cruel twist inside the data about health disparities, and it has a name: John Henryism, coined by Black epidemiologist Sherman James, who set out to study the cardiovascular health of Black Americans. John Henryism describes high-effort coping — meeting relentless structural obstacles with relentless personal determination — and its potential consequences. [10]

In the folk song of a century ago, Black steeldriver John Henry refused to let a steam drill defeat him in a direct contest. He outworked the machine — winning the battle — then “he laid down his hammer and he died.” How many Black people today are valiantly swinging a 2026 version of that hammer, battling a 2026 version of that machine, as their blood pressure rises and cardiovascular risk grows? What prize awaits all that perseverance?

James found that this tireless striving exacts a physiological toll, and that the highest cost tends to fall on those who combine the most limited resources with the most determined effort. [10, 11] The very resilience we celebrate — “she never let anyone see her struggle, she just worked” — can be the mechanism through which the struggle enters the body and inflicts real damage. [12]

Black Scholars Have Been Naming This

This is not a pattern that outside observers discovered and explained back to Black communities. Much of the foundational research tracing scarcity, resilience, and pain in Black bodies comes from Black scholars studying their own communities. Sherman James built his John Henryism framework on interviews with Black men in the Jim Crow South, listening to how they described surviving it.

Tamara Baker, a professor of psychiatry at the University of North Carolina at Chapel Hill, has spent her career on a research agenda centered on the behavioral and psychosocial predictors and outcomes of chronic pain among older Black adults, along with the broader question of how pain is managed, and how access to pain care is distributed, across marginalized populations. Her work — including studies on arthritis pain and on chronic pain specifically among older Black Americans, as well as the hardship-and-pain research on older men cited above — sits at the exact intersection this piece is trying to make visible: not just that Black people hurt more, but that Black researchers have been doing the painstaking work of proving it, publishing it, and pushing it into clinical and policy conversations for decades.

When the Pain Reaches the Clinic, It Is Disbelieved

And still, when Black pain is reported to a doctor, it is often handwaved away. Research has documented for decades that Black Americans are systematically undertreated for pain relative to white Americans. [13, 14] A 2016 study found that about half of the white medical students and residents surveyed endorsed false beliefs about biological differences between Black and white bodies — for instance, that Black skin is thicker — and that those beliefs led them to rate Black patients’ pain as lower and to make less accurate treatment recommendations. [13]

The pain that scarcity and weathering write into the body arrives at the clinic already discounted.

What This Means for How We Fund

This evidence does not point toward a counsel of despair. It is a map of leverage points — and much of that leverage sits with philanthropy.

Stability is the intervention; precarity is a cost we impose. Short-term, restricted, reapply-every-year grantmaking manufactures the very insecurity shown to produce harm. Multi-year, general-operating, trust-based support removes a chronic physiological stressor. [2]

Fund the release from pain, not only the coping with it. John Henryism shows that heroic individual resilience carries a body cost. Capacity, rest, staffing, and collective care must be legitimate, funded line items. They must be understood as cornerstones of success, not afterthoughts or mission-peripheral extras. [10, 12]

Believe Black voices describing Black pain. Resource Black researchers studying it. If Black pain is discounted in the clinic, funders can practice belief internally: trusting communities’ own accounts of what they need, rather than asking them to prove their suffering through burdensome documentation. That same principle extends to who gets funded to do this research in the first place. Black scholars like Baker and James did not arrive at these findings from a distance. [15, 16]

Releasing the Burden

To say that scarcity, worry, and weathering live in the body is not to pathologize Black life. Just the opposite. It is to insist that the aching back and the tight chest are not evidence of weakness but signs of a load too heavy to bear. Nervous systems do what they have evolved to do; under stress, no body can tolerate it indefinitely.

At the Black Future Co-op Fund, we know that healing and wealth-building belong in the same sentence — that stability, trust, and rest are not luxuries but the ground on which thriving Black communities stand.

The body has been faithfully keeping its ledger for such a long time. Our collective work now is to determine what gets written on the next page.

Sources:

1. Song, C., Marshall, G. L., Reed, A., Baker, T. A., & Thorpe, R. J., Jr. (2021). Examining the association of pain and financial hardship among older men by race in the United States. American Journal of Men’s Health, 15(5), 1–11. https://doi.org/10.1177/15579883211049605
2. Chou, E. Y., Parmar, B. L., & Galinsky, A. D. (2016). Economic insecurity increases physical pain. Psychological Science, 27(4), 443–454.
3. Marshall, G. L., Baker, T. A., Song, C., & Miller, D. B. (2018). Pain and hardship among older men: Examining the buffering effect of Medicare insurance coverage. American Journal of Men’s Health, 12(5), 1707–1716.
4. Janevic, M. R., McLaughlin, S. J., Heapy, A. A., Thacker, C., & Piette, J. D. (2017). Racial and socioeconomic disparities in disabling chronic pain: Findings from the Health and Retirement Study. The Journal of Pain, 18(12), 1459–1467.
5. Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I., & McEwen, B. S. (1997). Price of adaptation — allostatic load and its health consequences: MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259–2268.
6. Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity & Disease, 2(3), 207–221.
7. Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. American Journal of Public Health, 96(5), 826–833.
8. Geronimus, A. T., Hicken, M. T., Pearson, J. A., Seashols, S. J., Brown, K. L., & Cruz, T. D. (2010). Do US Black women experience stress-related accelerated biological aging? Human Nature, 21(1), 19–38.
9. Geronimus, A. T. (2023). Weathering: The extraordinary stress of ordinary life in an unjust society. Little, Brown Spark.
10. James, S. A., Hartnett, S. A., & Kalsbeek, W. D. (1983). John Henryism and blood pressure differences among Black men. Journal of Behavioral Medicine, 6(3), 259–278.
11. James, S. A., Keenan, N. L., Strogatz, D. S., Browning, S. R., & Garrett, J. M. (1992). Socioeconomic status, John Henryism, and blood pressure in Black adults: The Pitt County Study. American Journal of Epidemiology, 135(1), 59–67.
12. James, S. A. (1994). John Henryism and the health of African-Americans. Culture, Medicine and Psychiatry, 18(2), 163–182.
13. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301.
14. Mathur, V. A., Richeson, J. A., Paice, J. A., Muzyka, M., & Chiao, J. Y. (2014). Racial bias in pain perception and response. The Journal of Pain, 15(5), 476–484.
15. Baker, T. A. (2005). Chronic pain in older Black Americans: The influence of health and psychosocial factors. Ethnicity & Disease, 15(1), 179–186.
16. Baker, T. A. (2003). Arthritis symptoms as indicators of pain in older African Americans. Ethnicity & Disease, 13(4), 513–520.