1. Sick of Poverty by Robert Sapolsky
Presented by:
Ernesto Villasenor
Sustainability Studies
Rensselaer Polytechnic Institute

2. Sick of Poverty Published in 2005 on the Scientific American Journal
Examines as to how the stress of being poor affects health
Looks at psychosocial stresses that are associated with poverty and how they increase the risk of illnesses
Examines the correlation between socioeconomic status (SES) and it’s correlation to poorer health, as well as cross examines the psychosocial stresses inhibited by SES on poor health
Done through the analysis of other publications and examples seen through American Society and cross-comparison of other countries
Observes areas where universal health care is in place and where there isn’t universal health care
Robert Sapolsky "Sick of Poverty"

3. Robert Sapolsky American Neuroscientist
Professor of Biology, Neuroscience, and Neurosurgery at Stanford University
Research Associate at the National Museums of Kenya
Bachelor’s in Biological Anthropology from Harvard
Ph.D in Neuroendocrinology from Rockefeller University
Research focused on the social behaviors of baboons in the wild
Neuroendocrinologist: his research focuses on issues of stress and neuronal degeneration
Baboon study focuses on identifying the sources of stress in their environment, and the relationship between personality and patters of stress-related diseases in these animals
Robert Sapolsky "Sick of Poverty"

4. Key Terms Socioeconomic Status (SES) Psychosocial Stress
Composite measure that includes income, occupation, education, and housing conditions
When examined (starting with the wealthiest stratum of society), every step down in SES correlates with poorer health
Psychosocial Stress
A threat that disrupts the balance in the body that is caused by members within the species (in this case, stressors caused by humans)
Involve the anticipation of an impending challenge
Can be long-term
Robert Sapolsky "Sick of Poverty"

5. Rudolph Virchow
19th century German neuroscientist, physician, and political activist
Exposed to two dramatic events in Germany:
Typhoid outbreak in 1847
Failed revolution of 1848
“Physicians are the natural attorneys of the poor”
-The spread of disease has much to do with appalling living conditions
-those in power have enormous means to subjugate the powerless
Robert Sapolsky "Sick of Poverty"

6. Socioeconomic Status and Health
Beginning with the wealthier stratum of society, every step downward in socioeconomic status correlates with poorer health
SES “gradient” has been documented throughout Westernized societies for problems that are stress-sensitive diseases.
What causes this correlation between SES and health?
Lower SES may give rise to poorer health, but conversely, poorer health could also give rise to lower SES.
Bulk of facts suggest that the arrow goes from economic status health.
Robert Sapolsky "Sick of Poverty"

7. Or does it?
Robert Sapolsky "Sick of Poverty"

8. Inadequate Explanations for SES and Health?
So how does socioeconomic status get under our skin and influence health?
Health care may be less easily accessible and of lower quality?
Unhealthy lifestyles?
Low-income communities within Westernized societies are less likely to have access to clean water, healthy food and clubs, heat in the winter and a/c in the summer.
Robert Sapolsky "Sick of Poverty"

9. Psychosocial Stress
Health care access, health care utilization, and exposure to risk & protective factors the SES gradient far less than one might have thought.
Must look at another gradient with different considerations
What about the psychosocial consequences of socioeconomic status? Why are psychosocial consequences of SES more plausible than the previously stated examples?
Answer to first question: psychosocial stresses associated with poverty are the culprits behind the risks of poor health. Stress-sensitive diseases increase if individuals lack social support and feel that their circumstances are worsening.
Answer to question dos: Usually the explanations that are derived within one community (such as no health care in the US), do not hold ground in another place (such as the UK where there is socialized health care). Health and wealth among nations do not show nor indicate that the more financial resources available for their citizens, the better off they should be, but it isn’t the case. Among the wealthiest ¼ of countries in this planet, there isn’t a relation between the wealth of the country and health of the people.
Robert Sapolsky "Sick of Poverty"

10. Homeostasis and Psychosocial Stress
Stimulus (Change occurs in internal environment)
Receptors
Effectors (muscles or glands)
Control Center (set point)
Most stressors concern interactions
with our own species, and few physically disrupt homeostasis. Instead, they involve anticipation of an impeding challenge.
Striking attribute of psychological and social stressors are the chronicity.
Example: 30 year mortgage
Body is equipped to handle physical stress, but isn’t equipped to handle psychosocial stressors.
Response (change is corrected)
Robert Sapolsky "Sick of Poverty"

11. How well does the argument hold its water?
Individuals are more likely to activate a stress response and are more at risk for a stress-sensitive disease if they:
Feel as if they have minimum control over the stressor(s)
Feel as if they have no predictive information about the duration and intensity of the stressor(s)
Have few outlets for the frustration caused by the stressor
Interpret the stressor as evidence of circumstances worsening
Lack social support for the duress caused by the stressor
How does this hold it’s water? Psychosocial stressors are not evenly distributed across society. Poor already have a disproportionate share of physical stressors (hunger, manual labor, chronic sleep deprivation because of a second job, bad mattress that can’t be replaced, etc), they have a disproportionate share of psychosocial stressors as well.
Poverty doesn’t allow for stress-relieving options either. The saying goes that it can be a “poor but loving community” but the working poor typically have less social support than the middle and upper classes because of extra jobs, long commutes on pub trans, and other burdens to say the least
Robert Sapolsky "Sick of Poverty"

12. Subjective Feelings and Objective Results
A relatively poor person in the US may objectively have more financial resources to purchase health care and protective factors than a relatively wealthy person in a less developed country, yet, on average, will still have a shorter life expectancy.
People in Greece on average earn half the income of Americans yet have a longer life expectancy.
Once the minimal resources are available to sustain a basic level of health through adequate food and housing, absolute levels of income are of remarkably little importance to health.
Nancy E. Adler research on the difference between objective and subjective SES and the relation of each to health.
Robert Sapolsky "Sick of Poverty"

13. Psychosocial Stress of Income Inequality on Health and Social Capital
An analyzed study conducted by Richard Wilkinson from the University of Nottingham in the UK stated that the psychosocial stress of income inequality on health is higher in countries where there are larger gaps between the rich and the poor.
The more unequal income in a community is, the more psychosocial stress there will be for the poor
Higher income inequality intensifies a community’s hierarchy and makes social support less available
Social capital refers to the broad levels of trust and efficacy in a community
Low social capital predicts bad health, bad self-reported health, and high mortality rates.
The strongest route from income inequality to poor health is observed through social capital measures
SES/health gradient comes from Richard Wilkinson of the University of Nottingham in the UK
Ichiro Kawachi of Harvard
Robert Sapolsky "Sick of Poverty"

14. Final Remarks and Summary
Psychosocial factors and their implications on SES/health generate a critical conclusion: when it comes to health, there is far more to poverty than simply not having enough money.
Some of the arguments that are made within one community/country would not hold water in another country.
Psychosocial stress causes further health implications, and needs to be thoroughly investigated within the US.
Robert Sapolsky "Sick of Poverty"

15. Possible Investigation to Consider
Are there various psychosocial stressors that are felt much stronger within one ethnic/racial group than another?
If so, how much more intense are the consequences from such psychosocial stressors?
Why are they not seen within other groups?
Robert Sapolsky "Sick of Poverty"

16. Bibliography
Sapolsky, Robert. Sick of Poverty. Scientific American (December 2005): pg
Edge.org: People, Robert Sapolsky. Retrieved on 20 Nov from:
Wilkinson, Richard. Mind the Gap: Hierarchies, Health and Human Evolution. Weidenfield and Nicolson (2000).
Kawachi, Ichiro & Kennedy, Bruce. The Health of Nations: Why Inequality is Harmful to Your Health. New Press (2002)
Robert Sapolsky "Sick of Poverty"