Higher stress among minority and low-income populations can lead to health disparities, says report

"Good health is not equally distributed. Socio-economic status, race and ethnicity affect health status and are associated with substantial disparities in health outcomes across the lifespan," said Elizabeth Brondolo, PhD, chair of an APA working group that wrote the report. "And stress is one of the top 10 social determinants of health inequities."

Stress-related illnesses and injuries are estimated to cost the United States more than $300 billion per year from accidents, absenteeism, employee turnover, lowered productivity and direct medical, legal and insurance costs, according to the report.

People with lower incomes report more severe (but not more frequent) stress and having had more traumatic events in their childhood, said the report. African-Americans and U.S.-born Hispanics also report more stress than their non-Hispanic white counterparts, stemming in part from exposure to discrimination and a tendency to experience more violent traumatic events.

And all that stress can lead to mental and physical health problems.

"Stress affects how we perceive and react to the outside world," Brondolo said. "Low socio-economic status has been associated with negative thinking about oneself and the outside world, including low self-esteem, distrust of the intentions of others and the perceptions that the world is a threatening place and life has little meaning. Stress is also known to contribute to depression."

Stress may also play a role in physical health disparities by affecting behavior. High levels of stress have been consistently associated with a wide variety of negative health behaviors, including smoking, drinking, drug use and physical inactivity. These behaviors and their outcomes (e.g., obesity) are closely linked to the onset and course of many diseases, including diabetes, cancer, cardiovascular disease and cognitive decline later in life, according to the report.

A 2016 analysis indicated that men whose income is in the top 1 percent live almost 15 years longer than those in the bottom 1 percent, according to the report. For women, that difference is almost 10 years.

A number of interventions at the individual, family, health care provider and community levels that could be useful in helping to ameliorate the negative effects of stress on low-income and minority populations and potentially address some of the health disparities are identified in the report. For instance, at the individual level, mind-body interventions, such as yoga or meditation, were found to be accepted by disadvantaged groups and showed some effectiveness at improving mental and physical health outcomes. Other interventions cited included improving the quality of communication between patients and their health care providers and teaching parenting skills to promote positive parent-child attachments.

The report concludes with a series of recommendations, including calling for additional multidisciplinary research on the interrelationship of barriers to health experienced by disadvantaged individuals. It also recommends improving psychology training programs to make sure clinicians are capable of adequately discussing and addressing the effects of inequality on individual health. Increasing awareness among the public and policymakers on the stress-inducing implications of persistent exposure to implicit biases and microaggressions is also important, according to the report.

"Disparities in both stress and health may not be visible to those who have more advantages or who have relatively limited direct contact with those affected," said Brondolo. "A well-informed community is critical to improving the health of racial/ethnic and poor communities."