APA Stress Survey: Income inequality fuels stress, compromises population health
By Esperanza Cantu
In early February, the American Psychological Association released results of a survey www.apa.org/news/press/releases/2015/02/money-stress.aspx indicating that financial stress weighed heavily on Americans nationwide. Many of us can relate to feeling stressed about money, but that stress can impact us more depending upon where we fall in society. The survey results indicated that financial concerns caused people to visit the doctor less, and disrupted their personal support systems as a source of conflict in relationships. This is troubling because we know that stress serves as a risk factor for the development of heart disease, diabetes, weight gain, anxiety, depression, and more.
A wealth of research links the relationship between low socioeconomic status (SES) and poor health, yet the causal pathway remains unclear. We know that living in poor communities can lead to poor life longevity, but recent evidence from the University of Wisconsin Population Health Institute continues to support that living in communities with high income inequality can be bad for health. Robert Sapolsky, a Stanford University professor of biology and neurology, delved into the relationship between income inequality and health in his guide to stress “Why Zebras Don’t Get Ulcers.”
Sapolsky postulates that in the health and SES gradient established by Michael Marmot and the Whitehall studies, perhaps it may not be about “being poor,” but perhaps “feeling poor.” Citing work by Nancy Adler of University of California at San Francisco, he writes that feeling poor in our socioeconomic world predicts poor health. (It certainly can be stressful to live around those much wealthier than us, and chronic stress is bad for health.) Parallel with this thought, Robert Wilkinson and others have shown that poverty amid plenty results in worse health and mortality rates.
Population health can be impacted by income inequality and “feeling poor” in a variety of ways, but a pathway proposed by Ichiro Kawachi of Harvard University points to social capital after controlling for absolute income. In a society with more social capital, we would find more trust, reciprocity, and participation in organizations for common good, and less hostility and hierarchy. To put this in context, wealthier people may have the ability to buy themselves out of social services, potentially leading to less investment in public-sponsored goods like education and public health, which we know promote life longevity. Furthermore, income inequality consistently predicts crime better than poverty, suggesting that income inequality may significantly impact health and other socioeconomic factors more than we previously thought.
Where do we go from here? Raising the income of one family will not make a huge difference as that would be a violation of the ecological fallacy—we cannot make conclusions about individuals due to trends of population-level research. Instead, to combat the ill effects of income inequality and financial distress on our health, we must continue to improve our community living conditions and social cohesion. We need to continue making systemic improvements in public transit, neighborhood safety, school quality, access to water and health care, and more. To care for our families and friends in times of financial distress, we can simply be a caring and accepting support system. The APA study reported that those with access to emotional support from family and friends experienced lower levels of stress than those who do not, and that can certainly be good for our health.
Esperanza Cantu is the W.K. Kellogg Population Health Fellow for 2015-16.