Social Inequalities and the Road to Allostatic Load: From Vulnerability to Resilience

Abstract

Vulnerability and resilience are intertwined yet unraveling constructs in the allostatic load literature centered on stress‐disease pathways. In examining this paradigm shift, this chapter focuses on allostatic load indices of multisystemic physiological dysregulations among marginalized populations. Social inequalities reviewed include early adversity, socioeconomic health gradients, race/ethnicity and discrimination, Brazil's shifting economy, the struggles of North American and Australian Indigenous peoples, and finally sex/gender diversity and sexual orientation as key determinants of allostatic load. We then present innovative biochemical, neurological, and cognitive approaches for future empirical consideration, with conclusions centered on clinical and social policy implications. In espousing a developmental psychopathology approach that emphasizes causal processes, developmental mechanisms, and diverse conceptualizations of health, we highlight allostatic load studies that focus on resilient pathways and how these trajectories can be promoted to protect populations otherwise considered vulnerable.

Childhood poverty and adult psychological well-being

“…On a 0-6 range of allostatic load, movement from a poor to a middle-class childhood would reduce allostatic load in adulthood by about a third of a risk factor. Given the rapidly expanding evidence that elevated allostatic load marks accelerated aging (2,30,31), this prospective longitudinal evidence for social inequalities in allostatic load may prove fundamental in understanding how poverty gets under the skin and stays there.…”

“…Another limitation is the allostatic load index, which reflects the simple summation of a set of dichotomous indicators of dysfunction across multiple, biological systems. This crude index, which appears to reflect some aspects of chronic wear and tear on the body, likely does not fully capture the more dynamic and systematic interplay between multiple biological systems as they are challenged by chronic environmental demands (26)(27)(28)(29)(30)(31).…”

“…Allostatic load was calculated separately at ages 9 and 24. This simple, additive model of allostatic load across multiple response systems predicts morbidity and mortality better than singular components of allostatic load (26)(27)(28)(29)(30)(31).…”

“…Allostatic load is assessed by the accumulation of biomarkers across multiple environmental response systems such as cardiovascular, sympathetic nervous system, hypothalamic pituitary adrenal axis (HPA) axis, and metabolic processes. Allostatic load has generated considerable interest in the health and life sciences because it predicts morbidity and mortality better than singular risk factors (28)(29)(30)(31). Furthermore, childhood disadvantage is associated with greater allostatic load in children (25,27,28), but little is known about adult allostatic load in relation to childhood risk factors such as poverty.…”

‘Multimorbidity’ as the manifestation of network disturbances

“…When prolonged, this multisystemic response exerts ‘wear and tear’ on various cellular components, accelerating age‐related functional decline and susceptibility to disease affecting multiple organ systems – colloquially termed ‘multimorbidity’. Together, these systems interact with energy‐producing mitochondria, represent the cellular basis for ‘multimorbidity’, and constitute the mechanisms of vulnerability and resilience to environmental challenge .…”