Health Disparities, Social Stress, and Asthma – Rosalind Wright MD, MPH

This is what motivated me early on in my
career when I was pulmonary fellow looking at the rising trends in asthma and seeing it disproportionately
burdening lower-income ethnic minority populations
particularly in the inner city and this is a smaller scale than what
you were just seeing for California but this is the Boston
metropolitan area and again as you go darker you see increased asthma morbidity this looking at asthma hospitalization rates
and in this case as well. Also those are the communities where
there’s lower SES They’re primarily ethnic minority. They’re
the ones that are being particularly impacted. Folks who
live in inner-city environments where they’re more perhaps polluted may also be at increased risk of experiencing
greater amount of psychological stress, and
that’s really what we started to look at how did these things co-vary, what are the independent contributions
of the psychosocial factors and also how might to the psychosocial
factors even enhance the effect of the other environmental toxins so looking
more at cumulative risk. These aren’t new ideas just to sort of let you know, we’re not first currently to think that psychological
problems have a role to play in asthma; you can go back all the way to the 12th
century there’s treaties written on the role, the
link, between the mind and the body related to asthma. Actually as early as the middle part of
the last century, asthma was really thought to be something that was in your
head, it was this one of the seven psychosomatic illness is called asthma nervosa and then we sort of took a
shift we understood there’s a huge component of asthma that’s related to
allergy and we all started looking at the
biology and the immunology of asthma and really what we’re trying to do now
is try to bring those things back together. And this is shown here in this
cartoon there’s a lot of evidence for
the link between mind body sort anecdotally we all understand in
ourselves when we experience stress, we’re more likely to get sick in different ways and there’s a lot of biology to show the connections between
the brain where you emotionally experience your and respond to the stressors that
you’re facing and there’s release if neuro
hormones and neurotransmitters that go systemically and can have a broad health
effects including on the lung, and this cartoon just shows that there’s
a lot of evidence to suggest there’s strong links and back and forth talk between the
brain and the lung Through the immune system, through
the autonomic nervous system, through the hypothalamic-pituitary-adrenal
axis and neurohormonal systems and connections with cortisol exposures and all sorts of things and
those are the things that we try to measure in our work to see if we can actually show these mechanisms are operating And then to think that: well what is health?
It’s an optimal balance of these key regulatory system and there’s a lot of work in
animal studies as well as human data now that suggests that in a lot of the
environmental toxins that we talk about whether we think about psychosocial
stressors or many of the physical toxins like
air pollutants, tobacco smoke, allergen exposures They’re all pushing on these systems. These systems, these key regulatory systems in the body like
to live in some optimal balance and they’re all talking back and forth to each
other she can see how it starts to get complex and when those are shifted over time
when you have chronic exposure to these environmental toxins you start to see adverse health
affects So I put that picture
there because that’s kind of what we try to keep in mind when we are developing our studies. So, well, we’re all under stress, why are
we all sick? Well stress in and of itself isn’t necessarily bad, and we all need a little bit of motivation in our lives
so too little stress can actually also have adverse affects and there
some optimal level that each of us have, our
own, our tolerance level, our own ability to cope with. And it’s when you’re in a situation
where you tip over, you’re no longer able to cope, there are just too many stressors, they’re cumulative, ongoing, they just never
go away in your living with them chronically that’s where you start to
see adverse affects and you start to see shifts in these key regulatory systems and this imbalance. And this slide just says, well we
know that’s true for stress, stress can disrupt those pathways but boy if you
get into the literature you start to understand the science in these other
fields of environmental health you can see shifts in these same
systems that some overlap directly with how
stress is operating, some do these through different mechanisms:
tobacco smoke, ambient pollutants, and allergens they’re pushing on the same
systems and so you can start to see additive or cummulative effects when you have co-exposure