Understanding Health Inequalities Through the Lens of Social Epigenetics

Abstract

Longstanding racial/ethnic inequalities in morbidity and mortality persist in the United States. Although the determinants of health inequalities are complex, social and structural factors produced by inequitable and racialized systems are recognized as contributing sources. Social epigenetics is an emerging area of research that aims to uncover biological pathways through which social experiences affect health outcomes. A growing body of literature links adverse social exposures to epigenetic mechanisms, namely DNA methylation, offering a plausible pathway through which health inequalities may arise. This review provides an overview of social epigenetics and highlights existing literature linking social exposures—i.e., psychosocial stressors, racism, discrimination, socioeconomic position, and neighborhood social environment—to DNA methylation in humans. We conclude with a discussion of social epigenetics as a mechanistic link to health inequalities and provide suggestions for future social epigenetics research on health inequalities.

Ethnic inequities in multimorbidity among people with psychosis: a retrospective cohort study

“…Studies show that exposure to stress is associated with the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and related cortisol awakening response (CAR), with implications for metabolic and inflammatory processes, further dysregulation of the immune response and multi-illness onset (O'Connor et al ., 2021 ). Furthermore, social epigenetics studies report evidence of change in DNA methylation leading to epigenetic ageing amongst people who faced childhood adversity, low socioeconomic status in childhood and adulthood, perceived discrimination and neighbourhood disadvantage (Martin et al ., 2022 ).…”

Air Pollution, Built Environment, and Early Cardiovascular Disease

“…Increasing evidence also suggests that common social determinants of health often interact with air pollution, built environment attributes, and green space in affecting CVD outcomes. 147 Social deprivation and PM 2.5 exposures were independently associated with county-level age-adjusted CV mortality. 148–150 The associations between PM 2.5 and CV mortality were stronger in counties with high versus low social deprivation.…”

The impact of systemic racism on health outcomes among Black women

“…18 Alteration of genes over generations causes predisposition to cardiomyopathies, diabetes, and hypertension. 34 Socioeconomic disadvantage, food deserts, dietary factors/choices, weight control, and lifestyle, among other factors, likely also play a role. 18 These conditions result from generations of oppression that often manifest in individuals with age due to decompensation from continued insults.…”

“…Geronimus' concept of weathering posits that Black women's physical health deteriorates over time, beginning as early as young adulthood, because of the stressors of a constantly oppressive society 18. Alteration of genes over generations causes predisposition to cardiomyopathies, diabetes, and hypertension 34. Socioeconomic disadvantage, food deserts, dietary factors/choices, weight control, and lifestyle, among other factors, likely also play a role 18.…”