Beyond the Genome: The Racialized Exposome, Flourishing, and Stress Biology in African Americans, a Non-Exhaustive Review

Racial health disparities remain an enduring challenge in the United States, disproportionately impacting African American communities through higher rates of chronic disease and premature mortality. This non-exhaustive literature explores how the racialized exposome - a term denoting the totality of social, environmental, and structural stressors rooted in systemic racism - biologically embeds itself via stress-responsive pathways. Specifically, it examines the interaction between racial stress, flourishing, and key biological markers, including allostatic load and telomere length, considering the gut-brain axis. The review highlights robust evidence that chronic exposure to racial discrimination and structural adversity contributes to multisystem dysregulation and accelerated cellular aging. Telomere shortening and elevated allostatic load emerge as physiological signatures of these exposures, yet research also underscores the modifiable role of psychological resilience factors. Flourishing - defined here through eudaimonic well-being, racial identity, cultural pride, social support, and community grounding- is framed as a biopsychosocial buffer that may moderate the health impacts of chronic racial stress. However, flourishing is not a universal shield; under persistent adversity, even adaptive coping may carry physiological costs. This paper calls for a deeper, more intersectional understanding of how flourishing interacts with adversity across the life course and advocates for future longitudinal, culturally grounded, multi-omic research. By integrating psychosocial assets and biological pathways, we can better understand how systemic inequities "get under the skin" and inform strengths-based, community-relevant interventions to advance health equity.