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ANTC68 WINTER 2013 Week # 12: Socioeconomic Determinants of Health – Stress and the Biology of Inequality by Eric Brunner Summary  Dominance hierarchy in society leads to metabolic differentials that elicit a fight or flight response which produces chronic physiological and metabolic alterations (such as cortisol)  Biological effects of the psychosocial environment could explain health inequalities between relatively affluent groups Impact of Early Experience  Deprivation in childhood is linked to poor educational attainment and behavioral problems such as hyperactivity and other conduct disorders which may be precursors of a lifetime of material and emotional insecurity  Childhood social disadvantage leads to unfavorable stress history and physical and psychological vulnerability  These disadvantages are not permanent and can be recovered with timely interventions o Premature cardiovascular death is sensitive to early deprivation o Cancer and risk of death from noncardiovascular non cancer causes depends more on circumstances o Rhesus monkeys experiment o Psychogenic dwarfism is usually reversible o Vogelnest orphanage by the affectionate Fraulein Grun Stressors in the hierarchy  Psychosocial influences such as self esteem, relate to the social distribution of behavioral risks  Direct connections between the psychological characteristics of social position and biological functioning  Prevalence of health inequalities is linked with lower socioeconomic status  Key contenders are those who have perceived financial strain, job insecurity, low control and monotony at work, stressful life events and poor social networks, low self esteem and fatalism All Stress out and nowhere to go?  Chronic stresses linked with social position and may result in modified neuroendocrine and physiological functioning leading to increased vulnerability to disease  Our bodies have evolved to be prepared to stressors such a lethal threats but that works optimally in the short term  Having prolonged external potentially lethal threats resulting in chronic activation of the stress system is maladaptive  This is important as prolonged time in a social position that is not the highest on the rung throughout life leads to a social distribution in prevalence of cardiovascular and other diseases  Main axes of neuroendocrine response – prepare body for physical exertion in flight or fight response o Hypothalamic-pituitary-adrenocortical system  Cortisol release  Unevenly distributed across social classes  Glucocortids result in suppression of immunity  Prolonged high levels of cortisol, such as in Cushing’s syndrome, may provoke paranoia or depression  Loss in hippocampal neurons as well o Sympathethic-adrenomedullary  Release of adrenaline and noradrenaline  Leads to arousal, sensory vigilance, bronchodilation, raised blood pressure, haemoconcentration, energy mobilization o Exercise limits effects of stress by blocking production of cortisol ANTC68
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