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 10 Things to Know about Health (pdf) E-mail to a friend
UNNATURAL CAUSES, 2008

A two-page handout that briefly describes ten key messages about health equity, as  presented in the PBS series UNNATURAL CAUSES, useful for spurring discussion and raising awareness.
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Image Thumbnail A Longitudinal Study of Job Strain and Ambulatory Blood Pressure: Results From a Three-Year Follow-up E-mail to a friend
SCHOLARLY ARTICLE, Schnall et al, 1998

This follow-up study to "Relation Between Job Strain, Alcohol, and Ambulatory Blood Pressure" (Schnall, et al, 1992) replicates the results of the original, providing further evidence that job strain is an occupational hazard in the etiology of hypertension.

Image Thumbnail A Tale of Two Smokers E-mail to a friend
ONLINE INTERACTIVITY based on UNNATURAL CAUSES

Two people, one rich and one poor, are told by their doctor to stop smoking and lose 30 pounds in six months. See the challenges they face as they try to follow their doctor’s orders.

Image Thumbnail Allostatic Load and Allostasis E-mail to a friend
ARTICLE from the MacArthur Research Network on SES and Health

An overview of the science behind chronic stress's effects on the body.

Image Thumbnail Backgrounders on Health Equity Topics (pdf) E-mail to a friend
UNNATURAL CAUSES

This document by California Newsreel provides an overview of how social concerns such as income, jobs, education, housing, and racism relate to health outcomes and inequities. The short pieces in this document are taken from the topic introductions in the Health Equity database on the UNNATURAL CAUSES Web site.

Image Thumbnail Brains of Babes E-mail to a friend
RADIO SHOW, CBC,  Ideas

New research into brain development, human biology and behavior is showing how early experience can affect our health and well-being for the rest of our lives. Jill Eisen's three-part series reports that even so-called "life-style" illnesses like heart disease and diabetes may have their roots in early childhood.

Image Thumbnail Bridging the Great Divide: Health Disparities in America E-mail to a friend
VIDEO - Kaiser Permanente

Kaiser Permanente's short video on health disparities presents some of the causes and costs of differences that result in poor health outcomes, and offers solutions to this nationwide problem. It includes more discussion of health care and insurance disparities than UNNATURAL CAUSES, but also mentions many of the social, environmental, and economic factors that generate health inequities.<br>
<br>Kaiser's Health Disparities site also includes other information and resources.

Image Thumbnail Camara Jones Interview (mp3) E-mail to a friend
PODCAST, Web-exclusive content from UNNATURAL CAUSES

In this original interview, Dr. Camara Jones, research director on the social determinants of health at the Centers for Disease Control in Atlanta, discusses her pioneering work on measuring racism and health. She describes three levels of racism (personally mediated, internal and institutional), the stress of everyday racism, and the need to expand our thinking about how racism, opportunity and health inequities are structured and intertwined.

ENHANCED PODCAST (m4a)

Image Thumbnail Center on the Developing Child E-mail to a friend
WEBSITE

The Center on the Developing Child was founded in 2006 on the belief that the vitality and sustainability of any society depend on the extent to which it equalizes opportunities early in life for all children to achieve their full potential and engage in responsible and productive citizenship. They view healthy child development as the foundation of economic prosperity and strong communities, and our mission is to advance that vision by leveraging science to enhance child well-being.

The site includes a list of the Center's excellent publications.

Image Thumbnail Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease E-mail to a friend
Bruce S. McEwen and Peter J. Gianaros

The brain is the key organ of stress reactivity, coping, and recovery processes. Within the brain, a distributed neural circuitry determines what is threatening and thus stressful to the individual. Importantly, such stress processes arise from bidirectional patterns of communication between the brain and the autonomic, cardiovascular, and immune systems via neural and endocrine mechanisms underpinning cognition, experience, and behavior. In one respect, these bidirectional stress mechanisms are protective in that they promote short-term adaptation (allostasis). In another respect, however, these stress mechanisms can lead to a long-term dysregulation of allostasis in that they promote maladaptive wear-and-tear on the body and brain under chronically stressful conditions (allostatic load), compromising stress resiliency and health. This review focuses specifically on the links between stress-related processes embedded within the social environment and embodied within the brain, which is viewed as the central mediator and target of allostasis and allostatic load.

Image Thumbnail Comfort Food, For Monkeys E-mail to a friend
NEWS ARTICLE, New York Times, May 20, 2008

Research on rhesus monkeys found that subordinant monkeys were more likely than dominant monkeys to overindulge in high-calorie snacks when they were made available, and more likely to "binge" on this food at night. This and other studies with humans provide emperical evidence for what many of us already know from personal experience: we are more likely to eat poorly when we're under stress.audemars piguet replica

Image Thumbnail Cultural Loss - Impact on Native American Health E-mail to a friend
WEB-EXCLUSIVE VIDEO, Unnatural Causes

Dr. Donald Warne talks about how cultural loss impacts the health of Native American tribes in Arizona. The damming of rivers plunged local tribes into poverty, dependence and ultimately poor health. Deprived of their language, land, livelihood and traditions, many Native Americans have developed a fatalistic view about  diseases like diabetes.

Image Thumbnail Culture of Diabetes - Native Americans and Futurelessness E-mail to a friend
WEB-EXCLUSIVE VIDEO, Unnatural Causes

In some Native American communities, diabetes is so common that people grow up feeling that it is in some ways, inevitable. "I don't have diabetes yet," is what Dr. Warne often hears from his patients. Yet hope for the future is an important factor in preventing and controlling diabetes - something health care practitioners need to take into account when treating patients.
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Image Thumbnail Data Set Directory of Social Determinants of Health at the Local Level (pdf) E-mail to a friend
DATA SETS  REFERENCE, Social Determinants of Health Work Group at the Centers for Disease Control and Prevention

The directory contains an extensive list of existing data sets that can be used to address the need for improved conceptualization and availability of data on how the social environment impacts the health of populations. bebek escort The data sets are organized according to 12 dimensions, or broad categories, of the social environment. Each dimension is subdivided into various components.

This directory grew out of a project based at the University of Michigan School of Public Health and funded by the Centers for Disease Control and Prevention (CDC).

Image Thumbnail Diabetes in the Marshall Islands E-mail to a friend
WEB-EXCLUSIVE VIDEO, Unnatural Causes

Their traditional diet and way of life disrupted by globalization and the American military presence in the equatorial Pacific, Marshall Islanders now struggle with high rates of diabetes, among other health problems.

Image Thumbnail Disparities In Infant Mortality Not Related To Race, Study Finds E-mail to a friend
Science Daily

The cause of low birth weights among African-American women has more to do with racism than with race, according to a report by an associate professor of pediatrics at the University of Illinois at Chicago.  Minority women are subject to stress caused by perceived racial discrimination, the researchers said.  They asked the mothers if they had ever been treated unfairly because of their race when looking for a job, in an educational setting or in other situations.  Those who felt discriminated against had a twofold increase in low birth weights. And for those who experienced discrimination in three "domains," the increase was nearly threefold.

Image Thumbnail Early aging tied to chronic stress E-mail to a friend
NEWS ARTICLE by David Perlman, San Francisco Chronicle, 2004

Researchers at UC San Francisco say they have found the first direct evidence that severe and chronic emotional stress can age people biologically.

Image Thumbnail Finding Hope for the Future by Reclaiming the Past E-mail to a friend
CASE STUDY based on UNNATURAL CAUSES

O’odham Indians, living on reservations in southern Arizona, have perhaps the highest rates of Type 2 diabetes in the world. Forty years of poking and prodding by medical researchers have yielded few improvements, as disease rates continue to rise. But the O’odham and other Native communities are taking matters into their own hands – finding hope for their health by strengthening ties to traditional culture, fighting for their rights, and trying to regain control over their destinies.cartier imitacion

Image Thumbnail Forum #5: Your Position in Society (pdf) E-mail to a friend
ASK THE EXPERTS, UNNATURAL CAUSES

Nancy Adler, Bruce McEwen, and Peter Schnall answer questions from Web site visitors about chronic stress, the wealth-health gradient, unemployment, and why women live longer than men.bolsos louis vuitton falsos

Image Thumbnail Healing the Hurt: Trauma-Informed Approaches to the Health of Boys and Young Men of Color E-mail to a friend
The California Endowment

 The project is founded on the understanding that trauma and adversity have a direct impact on health. The authors also understand that African-American and Latino young men are disproportionately affected by various forms of trauma and adversity including violence, poverty, incarceration, lack of access to health care, marginalization and low social status.

The project has two main goals:
  • To identify, analyze and synthesize existing knowledge about the health status of boys and men of color across disciplines, and interpret it through the lens of trauma.
  • To identify promising trauma-informed models and approaches to addressing the health needs of boys and young men of color.

Image Thumbnail Health Education Resources for ESL Educators E-mail to a friend
LESSON PLANS (ESOL/ESL) - KQED

KQED has developed lesson plans for use with ESL/ ESOL student, using clips from UNNATURAL CAUSES and other media to broaden students' understanding of factors affecting health.

Lessons using the series:
Stress: The Bigger Picture (Not Just a Paycheck / When the Bough Breaks)
This Place Matters: The Impact of Neighborhood on Health (Place Matters and online video)
Living in the United States: Is It Good for Our Health? (Becoming American / In Sickness and In Wealth)
Food Pyramids: What We Eat and Who We Are (Becoming American)

Other lesson plans explore health literacy, the social contexts of drug and alcohol addiction, stress management, and cultural differences in medical practice.

Image Thumbnail How Racism Impacts Pregnancy Outcomes E-mail to a friend
WEB-EXCLUSIVE VIDEO, Unnatural Causes

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

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Image Thumbnail How social injustice becomes embodied in differential disease and mortality rates (pdf) E-mail to a friend
DIAGRAM designed by Richard Hofrichter, National Association of City and County Health Officials

A graphical representation of the complex interactions between history, social structure, policy, personal psychology and behavior, and health. Hofrichter provides the caveat that any attempt to visually represent a complex reality will appear somewhat oversimplified and linear.

Image Thumbnail How U.S. Laws and Social Policies Influence Chronic Stress and Health Disparities E-mail to a friend
SCHOLARLY ARTICLE, Holly Avey, Politics of Race, Culture, and Health Symposium, Ithaca College, Nov. 14, 2002

A clear, thorough overview explaining the stress process (exposures and vulnerabilities to stressors), physiological response to stressors (how stress "gets into the body"), and why people of color and lower socioeconomic status tend to be more negatively affected by stress. Concludes with policy implications.

Image Thumbnail How U.S. Laws and Social Policies Influence Chronic Stress and Health Disparities - A Response (pdf) E-mail to a friend
SCHOLARLY ARTICLE by Thomas C. Shevory, Ithaca College, 2002

A short response to Holly Avey's literature review that provides additional background and references regarding misconceptions of the character traits of "the poor" vs. "the affluent," chronic stressors, and the need for structural policy intervention.

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