Stress & the Social Determinants of Health

If you live in America, you are among some of the most stressed people in the world. Last year, Americans reported feeling stress, anger, and worry at the highest levels in a decade, according to Gallup’s 2019 Global Emotions report.¹

In the United States, about 55% of adults said they had experienced stress during “a lot of the day,” compared with just 35% globally. About 45% of the Americans surveyed said they had felt “a lot” of worry, compared with a global average of 39%.¹

Gallup’s research also found that lower-income Americans tended to report more stress.¹ While some stress is normal, chronic stress is connected to a range of conditions, including mental health issues, cognitive changes, and chronic disease.² This makes widespread stress a public health issue that affects underserved populations disproportionately.

In 2016, Tom Boyce, MD, chief of UCSF’s Division of Developmental Medicine within the Department of Pediatrics, made the sweeping statement that “socioeconomic status is the most powerful predictor of disease, disorder, injury, and mortality we have.”² Impoverished adults live seven to eight fewer years than those who have incomes four or more times the federal poverty level, which is $11,770 for a one-person household.² An analysis of studies measuring adult deaths attributable to social factors found that, in 2000, approximately 245,000 deaths were attributable to low education, 176,000 were due to racial segregation, 162,000 were due to low social support, 133,000 were due to individual-level poverty, and 119,000 were due to income inequality. The number of annual deaths attributable to low social support was similar to the number from lung cancer (n = 155,521).³

According to Dr. Boyce, the stress and adversity of poverty may be its most toxic component, impacting multiple systems in the body.²