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How Does Poverty Get Under One's Skin and Affect Health?

Wear and tear on the body’s biological systems can lead to premature disease.

Key points

  • Childhood poverty is associated with a greater risk for diabetes in adulthood.
  • Childhood poverty may lead to faster immune cell aging and the belief that one will have fewer opportunities for success.
  • Faster immune cell aging is associated with greater insulin resistance, a precursor to diabetes.

Childhood Poverty and Physical Health

Childhood poverty is associated with a number of physical health problems in adulthood, including Type II diabetes. Childhood poverty can exert a lasting effect on health, with biological and behavioral processes leading to disease starting in childhood but typically manifesting as clinical disorders such as diabetes or heart disease in middle to late adulthood.

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Tools and medications for managing diabetes
Source: Towfiqu Barbhuiya/Unsplash

Black Americans are more likely to live in poverty and to develop diabetes than White Americans, and rates of diabetes in Black young adults have drastically increased. On average, Black Americans develop diabetes around 10 years earlier than White Americans (Thorpe et al., 2016). As a result, these disease processes leading to diabetes may be sped up and could lead to greater health problems and shorter life expectancy. We know that factors such as the disproportionate burden of poverty and racism lead to poorer health for Black Americans. However, we know less about the specific biological, psychological, and behavioral processes by which factors such as poverty lead to poorer health. If we know how they happen, it is possible that we can create interventions that target the processes and improve health.

Weathering and Biological Aging

One way that researchers think that stressful life conditions like poverty influence health is through a process termed “weathering” (Geronimus et al., 2006). Weathering suggests that stressful conditions may lead to wear and tear on the body’s biological systems, which can lead to premature disease, aging, and death, especially if the stressful conditions are chronic. Researchers have used several methods to assess weathering, including a measure of cellular aging, which estimates the difference between a person’s chronological age and their cells’ biological age. Biological age is determined by measuring DNA methylation, which is a process by which both internal and external factors change how the DNA code is used without changing the actual DNA code.

Processes such as aging change DNA methylation patterns so the body uses genetic code in a different way at different points in a lifespan. In the case of weathering, if a body’s biological age is much older than chronological age, then researchers would say that the person has greater weathering than someone with a biological and chronological age that are similar to one another. This measure of cellular aging has been associated with a greater risk for diabetes as well as death, and it could be one of the ways that poverty affects later health outcomes such as diabetes.

Psychological Mechanisms

Poverty does not solely affect biological processes. There is strong evidence that poverty impacts psychological processes, including how individuals think about the future. Specifically, adolescents growing up in poverty may perceive that they will have fewer life chances for success, which could change their future behaviors and how their body responds to future challenges. This negative mindset towards the future is associated with biological changes related to weathering, suggesting that these psychological and biological processes may co-occur.

Current Study Results

A recent paper in the peer-reviewed journal Child Development aimed to test the biological aging of immune cells and the perception of fewer opportunities for success as two possible pathways between family poverty experienced during childhood and adolescence, and insulin resistance in adulthood, which is a precursor to developing Type II diabetes (Barton et al., 2022). This study specifically focused on a group of 342 African Americans living in the US South starting at age 11 through their late 20s.

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DNA molecule
Source: Sangharsh Lohakare/Unsplash

The researchers found that adolescents who had lived more years in poverty were more likely to feel like they had fewer opportunities for success when they were in their late teens, and they were more likely to have greater biological aging of their immune cells when they were 20 years old. Individuals with greater biological aging at age 20 were then more likely to have insulin resistance in their late 20s, which is a precursor for diabetes.

This study suggests that two of the ways that poverty in adolescence affects the risk for diabetes are through feeling that one has fewer life chances and through premature biological aging. This study is one of the first to link poverty to advanced biological aging as well as later pre-clinical markers of disease (insulin resistance, a precursor to diabetes) in the same study. Although experiencing poverty can have immediate negative effects on health (through higher stress or not being able to access medical care), many of poverty’s effects on chronic diseases such as diabetes can take years or even decades to be observed.

As a result, it’s important to have these studies following individuals over many years to understand how factors such as poverty affect health so we can learn the best ways to intervene. An optimistic take on this work is that because some of the effects of poverty can take many years to be observed, it gives us as a society several years in which to intervene to improve life outcomes and prevent chronic disease. We have a window of opportunity to intervene; we just need the resources and political will to act.

References

Barton, A. W., Yu, T., Gong, Q., Miller, G. E., Chen, E., & Brody, G. H. (2022). Childhood poverty, immune cell aging, and African Americans' insulin resistance: A prospective study. Child Development.

Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American journal of public health, 96(5), 826-833.

Thorpe, R. J., Fesahazion, R. G., Parker, L., Wilder, T., Rooks, R. N., Bowie, J. V., ... & LaVeist, T. A. (2016). Accelerated health declines among African Americans in the USA. Journal of Urban Health, 93(5), 808-819.

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