UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
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Chronic Stress

Background: Turn on the stress response for five minutes and it can save your life. But as Stanford biologist Robert Sapolsky observes, turn on the stress response for 30 years, even at a low level, and it can increase your risk for every chronic disease.

Chronic stress, like other conditions that threaten or promote health, is distributed unevenly through society along class and racial lines. Our ability to manage the pressures that might upset our lives is not simply a matter of personality or character; it's tied to our access to power, resources, support networks and opportunities. Both exposures to stressors and access to the resources we need to manage them are tied to our class and social status.

We all experience stress. Our body's stress response is actually a way of protecting us from a perceived danger. In the face of peril, hormones like cortisol and epinephrine increase our heart rate and blood pressure to supply oxygen and glucose to muscles and the brain while shutting down "non-essential" functions like growth and reproduction.

Rockefeller University's Bruce McEwen and UCLA's Teresa Seeman are among those studying how long-term or chronic stress throws our body out of balance, especially our neuro-endocrine, immune and cardiovascular systems. McEwen calls the measurable wear and tear of persistent "micro-insults" to the body allostatic load. He and other researchers are demonstrating how chronic stress increases the risk of metabolic syndrome, obesity, diabetes, hypertension, heart and artery disease, stroke, depression, auto-immune diseases, impaired memory, even failure to ovulate in females and erectile dysfunction in males.

There's also increasing evidence that repeated activation of the stress response early in life can literally affect the wiring of the brain, inhibit children's ability to develop "resilience," and increase the chances they will develop helplessness, anger and depression later in life and become more susceptible to obesity and illness.

All of us face pressures in our lives, but our ability to cope - and consequently stay healthy or not - depends on our position on the class pyramid. It's not CEOs who are dropping dead of heart attacks, it's their subordinates. Why? Because those with access to power, resources, support and opportunity have more control over the forces that impinge upon their lives and are better able to manage or escape the demands placed upon them.

People who are lower on the socioeconomic pyramid tend to be exposed to more formidable and ongoing stressors, e.g., job insecurity, unpaid bills, inadequate childcare, underperforming schools, and dangerous or toxic living conditions, crowded homes, even noisy streets. They are also less likely to have access to the money, power, status, knowledge, social connections and other resources they need to gain control over these many tempests that threaten to upset their lives.

But it's not only those at the bottom of the pyramid harmed by stress. So are many middle managers, working people and especially people of color, whose aspirations to succeed are often thwarted by interpersonal and institutional barriers over which they have little control, including prejudice and racism. High demand / low control jobs are particularly stressful.

Today, chronic stress is widely recognized as a health threat. But suggested solutions usually are limited to individually based interventions like taking vitamin supplements, practicing yoga, or meditating. Although these are helpful, they aren't the whole picture. We also need strategies that challenge the underlying economic and social conditions that imperil our chances for health in the first place.

Social policies like living wage jobs, greater autonomy and control at work, safe, walkable neighborhoods, efficient public transportation, good schools, and quality, affordable housing and paid vacations are all effective ways to reduce stress, though they require a political commitment, not just a personal one. But political engagement is an effective remedy in more ways than one: while improving social conditions improves health, research suggests that the very act of engagement can also be empowering and thus stress reducing. That's a double victory.

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Image Thumbnail Sir Michael Marmot Interview (pdf) E-mail to a friend

In an original interview, Michael Marmot discusses how he got into public health issues, then addresses a wide range of issues, from the healthy immigrant effect to social gradients in smoking to why the wealthy should care about health inequities... and what we can do about them.

Image Thumbnail Socio-economic differentials in peripheral biology: Cumulative allostatic load E-mail to a friend
Bruce S. McEwen and Peter J. Gianaros

This piece focuses on evidence linking socio-economic status (SES) to “downstream” peripheral biology. Drawing on the concept of allostatic load, the authors examine evidence linking lower SES with greater cumulative physiological toll on multiple major biological regulatory systems over the life course. They conclude with a discussion of the question of interactions between SES (and other such environmental factors) and genetic endowment, and their potential consequences for patterns of physiological activity—an area of research that appears poised to contribute significantly to our understanding of how social conditions “get under the skin” to affect health and aging.

Image Thumbnail Socioeconomic Status, Race, and Diurnal Cortisol Decline in the Coronary Artery Risk Development in Young Adults (CARDIA) Study E-mail to a friend
SCHOLARLY ARTICLE by Sheldon Cohen, PhD, et al, Psychosomatic Medicine, 2006

This study studied cortisol levels throughout the day to determine if there is an association with socioeconomic status (SES) and race, considering whether the difference could be explained by health practices, emotional and social factors. The study found that lower SES was associated in a graded fashion with a weaker decline in cortisol levels during the evening, independent of race. Blacks also showed a smaller cortisol decline at the end of the day, independent of SES, and unexplained by other factors.

Full article available online only with subscription.

Image Thumbnail Strategic Review of Health Inequalities in England Post 2010 E-mail to a friend

Professor Sir Michael Marmot has been asked by the British government to Chair an independent Review to propose the most effective strategies for reducing health inequalities in England from 2010. This review is a response to the recommendation of the WHO Commission on Social Determinants of Health that national governments develop and implement strategies and policies suited to their particular national context aimed at improving health equity.

Image Thumbnail Study suggests economic insecurity boosts obesity E-mail to a friend

In a study in the journal Economics and Human Biology, Oxford University researchers found that Americans and Britons are much more likely to be obese than Norwegians and Swedes, and suggested that the stress of life in a competitive social system without a strong welfare state may cause people to overeat.

"Policies to reduce levels of obesity tend to focus on encouraging people to look after themselves, but this study suggests that obesity has larger social causes," said Avner Offer, a professor of economic history who led the study.

Image Thumbnail The biggest asthma trigger of them all? New studies indicate how poverty itself Is inflammatory E-mail to a friend
 Edith Chen, Ph.D at the Psychobiological Determinants of Health Lab at the University of British Columbia

Scientists such as Edith Chen, Ph.D, have found evidence that the very experience of poverty and the stress it induces might itself be an asthma “trigger.” Dr. Chen co-founded the Psychobiological Determinants of Health Lab at the University of British Columbia to better understand the pathways by which class gets under the skin and influences our heath.  Rather than focus on how material pollutants, like soot, disrupt our physiology Chen and her colleagues are investigating how ‘social pollutants’ – that is, toxic social environments can become embedded in our bodies and increase susceptibility to disease. 

Image Thumbnail The Biology of Disadvantage: Socioeconomic Status and Health E-mail to a friend
JOURNAL Nancy E. Adler  and Judith Stewart, eds. Annals of the New York Academy of Science

How does socioeconomic status get under the skin? This book summarizes the decade of research by the MacArthur Foundation Research Network on Socioeconomic Status and Health “exploring the pathways and mechanisms that contribute to the gradient relationship between socioeconomic status and health.”

PDFs of each article are available online.  You may also purchase a complete copy of the journal.

Image Thumbnail The Effects of Childhood Stress on Health Across the Lifespan E-mail to a friend
REPORT from the Centers for Disease Control and Prevention

This report summarizes the research on childhood stress and its implications for adult health and well-being. Of particular interest is the stress caused by child abuse, neglect, and repeated exposure to intimate partner violence (IPV). This publication provides violence prevention practitioners with ideas about how to incorporate information on childhood stress into their work.

Image Thumbnail The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare E-mail to a friend
Vincent J. Felitti, MD and Robert F. Anda, MD, MS

The focus of this chapter will be an examination of the relationship between traumatic stress in childhood and the leading causes of morbidity, mortality, and disability in the United States: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking, and alcohol and drug abuse.  To do this, the authors will draw on their experience with the Adverse Childhood Experiences (ACE) Study, a major American epidemiological study providing retrospective and prospective analysis in over 17,000 individuals of the effect of traumatic experiences during the first eighteen years of life on adolescent and adult medical and psychiatric disease, sexual behavior, healthcare costs, and life expectancy.4

Image Thumbnail The Science and Epidemiology of Racism and Health in the United States: an Ecosocial Perspective E-mail to a friend
VIDEO PRESENTATION, Nancy Krieger, February 29, 2008

In her keynote lecture to the 29th Annual Minority Health Conference, Dr. Krieger explores how racism harms health and creates the very categories of "race." The idea that racial/ethnic health inequities are a biological expression of racism, that their origins lie in injustice, not biology, is not an ideological argument but a scientific statement that rests on rigorous scientific testing. Using ecosocial theory, Krieger explains the myriad ways racial inequality becomes biologically embodied over the lifecourse and across generations, through pathways including adverse exposure to: economic and social deprivation; toxic substances, pathogens, and hazardous conditions; social trauma; targeted marketing of harmful commodities; and inadequate and degrading medical care. In this presentation, Krieger discusses conceptual and methodological aspects of analyzing how racial and economic injustice produce health inequities, coupled with empirical examples drawn from her own research as a social epidemiologist.

Image Thumbnail Too Young to Die: Part 1, Life's Toll E-mail to a friend
NEWS ARTICLE, San Francisco Chronicle, October 2004

In Bayview-Hunters Point, the stress created by environmental problems, racism, poverty and crime may explain why so many babies die young. Infant mortality is twice as high here as in the rest of San Francisco.

Image Thumbnail Understanding and Eliminating Racial Inequalities in Women's Health in the United States (pdf) E-mail to a friend
SCHOLARLY ARTICLE, Arline T. Geronimus, Journal of the American Medical Women's Association, 2001

Argues that "weathering" framework best describes complexities of inequality. Explains how this model suggests that African-American women experience early health deterioration  as a consequence of the cumulative impact of repeater experience with social, economic, or political exclusion. This includes the physical cost of engaging actively to address structural barriers to achievement and well-being.

Unemployment is Hard on the Heart, and the Harm May Add Up E-mail to a friend

In a study published in the Archives of Internal Medicine, researchers report that repeated job losses may be as damaging to the heart health as smoking, high blood pressure, or diabetes. Among Americans aged 50 to 75, the unemployed suffer heart attacks at a rate that is 35% higher than that among employed people with otherwise similar risk factors, and the rate seems to rise with every new period of unemployment.

Image Thumbnail Unemployment May Be Hazardous to Your Health E-mail to a friend
NEWS ARTICLE by Roni Caryn Rabin, New York Times, May 8, 2009

Even as the U.S. Labor Department released figures showing that the economy lost more than half a million jobs in April, researchers made public a large study with an unsettling finding: Losing your job may make you sick.

Image Thumbnail Unfair Treatment Can Harm the Heart E-mail to a friend
NEWS ARTICLE, HealthDay News, May 2007

Researchers at University College London analyzed responses from a few thousand senior civil servants working for the British government in London, gathered over 11 years. The findings indicate that a nagging sense of being unfairly treated at work or at home can raise a person's risk of heart attack. The study was published in the British Medical Journal.

Image Thumbnail Unraveling the Mystery of Black-White Differences in Infant Mortality E-mail to a friend
VIDEO EXCERPT, Unnatural Causes

Neonatologists James Collins and Richard David specialize in the care of infants born too soon or too small. Their research on differences in birth outcomes between African American and white American women points to a provocative idea: the cumulative stress of racism is taking a toll on African American families even before they are born.

Image Thumbnail Violence Ages Children's DNA, Shortens their Chromosomes E-mail to a friend
ARTICLE from USA Today, 2012

According to a new study in Molecular Psychiatry, violence leaves long-term scars on children's bodies, altering their DNA and causing changes that are equivalent to seven to 10 years of premature aging. Scientists measured this cellular aging by studying the ends of children's chromosomes, called telomeres.

Image Thumbnail Water Rights and Diabetes in Arizona E-mail to a friend
VIDEO EXCERPT, Unnatural Causes - Episode 4

The Tohono O'odham and Pima Indians of southern Arizona have perhaps the highest rate of diabetes in the world. Yet the disease was virtually unknown here 100 years ago. Over the last century, the diversion of river water to upstream white settlements cost the O'odham their crops,  livelihood, traditional diet, culture and health. Today, community advocates hope that restoring water and renewing culture can help improve health.

Why Being a Leader is Less Stressful than Following E-mail to a friend
ARTICLE by Maia Szalavitz, TIME Health & Family, September 26, 2012

Research increasingly suggests that it’s actually people lower down on the social scale — not those in leadership positions at the top — who suffer the worst health effects of stress. Now a new study of military officials and government staffers at a Harvard executive-training program confirms these findings, showing that as people climb the organizational rungs, their stress hormone levels and anxiety typically go down.


Image Thumbnail Why Our Greatest Health Concern Isn't Diet or Exercise - It's Neighborhood E-mail to a friend
OP-ED by Larry Adelman on AlterNet.org, February 19, 2009

Series Creator and Executive Producer Larry Adelman expands upon economist Robert Evan's analogy of health care as a repair shop to illustrate the crucial role that "road conditions" play in determining our health status.

Download as PDF.

Image Thumbnail Why Zebras Don't Get Ulcers E-mail to a friend
BOOK by Robert Sapolsky, 1994

This link is to a brief overview at brainconnection.com of a Sapolsky lecture based on his book of the same name. The book's title stems from Sapolsky's thesis that animals in the wild are less likely suffer from the chronic stress that contributes to a variety of human maladies. Sapolsky focuses on the effects of stress hormones on the human body. Praised as "One of the best science writers of our time," by Oliver Sacks, Sapolsky offers witty footnotes and several anecdotes which make the reading that much more interesting. While most of the book focuses on the biological machinery of the body, the last chapter of the book addresses self help.

Image Thumbnail Youth Empowerment Strategies (YES!) Anti-Violence Program in Richmond, California E-mail to a friend

Learn more about YES! - the after-school youth anti-violence program featured in "Place Matters."

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