As we leave behind a year that was notable for its combination of natural and human disasters, no one can deny that we live in stressful times.
But stress is not equitably distributed, and neither are stress-related health outcomes. Individuals living below the poverty level have poorer mental health, are diagnosed with more chronic health conditions, and have shorter lifespans. Today, a white American can expect to live 3.5 years longer than a black American, and American men whose income is in the top 1 percent live almost 15 years longer than the poorest 1 percent.
In 2010, the Department of Health and Human Services launched Healthy People 2020, which made reducing racial and socioeconomic disparities in health a national priority.
Since then, we have learned that stress is one of the primary drivers of racial and socio-economic health disparities. Chronic stress may seem difficult to measure, but the American Psychological Association’s (APA) new report Stress and Health Disparities: Contexts, Mechanisms, and Interventions Among Racial/Ethnic Minority and Low-Socioeconomic Status Populations explains the ways that stress plays a significant role in increasing susceptibility to disease and undermining recovery from illness, and is a predictor of health outcomes.
There are potential solutions. Stress and its consequences represent feasible and meaningful targets for intervention. By paying attention to the science of stress, it is possible to improve the health of all Americans, reduce inequity, and lower the costs of chronic disease.
People experience stress when they do not have sufficient resources to meet even small demands. In the United States, stress and its consequences are not equitably distributed among racial and ethnic groups, which differ in the demands they face and the resources they can access. Look at Puerto Ricans displaced by Hurricane Maria, and Native Americans who were removed from their communities as children and forced to attend abusive boarding schools.
Black Americans face greater exposure to physical threats, and are more likely to witness violence or be victims of violent assault. More than 22 percent of black Americans live at or below the poverty level, many in communities where discrimination and deprivation undermine their ability to accumulate the social and material resources to reduce threat exposure or to mitigate its effects.
Low socioeconomic status renders people more vulnerable to stress exposure as well. People who are poor report more intense (but not more frequent) daily stress, more trauma, childhood maltreatment, and domestic violence. They have fewer material or social resources, and are less likely to marry and build supportive families and social networks.
The negative effects of stress make it harder for individuals and communities to maintain health. On a psychological level, stress affects the way people think, feel and act both towards themselves and others. They may be less trusting and more concerned about being rejected, undermining relationships with family members, educators, and health care providers.
On a physical level, chronic stress exposure also affects the bodies’ physical response to new stressors. Sometimes chronic stress sensitizes the individual, increasing the intensity of the reaction to new stressors. Other times, the physical stress response is blunted, undermining a person’s ability to access the physical and mental resources needed to meet daily challenges.
Persistent threat exposure can change brain structure and function, making it more difficult to deliberately pay attention and plan new strategies. Stress, including exposure to violence and discrimination, affects positive health behaviors, such as exercise and healthy eating, and impairs sleep.
Across a person’s lifespan, persistent stress exposure can undermine the function of physiological systems involved in behavioral self-regulation, immunity, metabolism, and cellular growth. Over time, stress alters the day-to-day functioning of the brain and body, changes that affect the mental and physical health of individuals and, possibly, their children.
To address the effects of stress on health disparities, we need to look at interventions that focus on both individuals and their social environments. Some existing initiatives have proven effective in decreasing threats by reducing neighborhood crime, child abuse, and violence.
Other programs have been effective in increasing community resources, including jobs, effective parenting, and access to healthy food. Programs that increase community resources may improve their success when they are accompanied by interventions to help people develop the skills and knowledge they need to benefit from changes in their environments.
The APA report calls for increased funding for research, training, public education, and interventions that reduce health disparities and promote health equity among underserved and marginalized populations. We believe that understanding the role of stress in health disparities can help generate new — and better — policies and programs to improve the health of all Americans.
Dr. Brondolo is a psychology professor and director of the social stress and health research unit at St. John’s University and Chair of the APA’s working group on Stress and Health Disparities.
Photography: Oladimeji Odunsi