The Toxic Stress of Poverty and Its Effects

Posted on April 12, 2017

Americans are stressed out. The American Psychological Association found that 75 percent of adults reported moderate to high levels of stress in the past month. Despite its prevalence in our lives, we often deny it or ignore its effects.

But, what if stress is toxic? What if the consequences of stress on our health are far greater than we ever imagined, even more so for people in low-income communities?

The healthcare industry has made noticeable efforts, like National Stress Awareness Month in April, to promote the awareness of chronic stress and encourage Americans to mediate its debilitating consequences effectively. Stress can wreak havoc on our physical and mental health, affecting nearly every system in the body – musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems. Over the last 30 years, research about the effects of chronic stress has uncovered compelling evidence for its lasting effects, particularly for the poor. The systemic pressures of poverty include a lack of social support, financial struggles, unsafe living conditions, violent communities, and more, creating an environment of chronic stress for both children and adults.

According to the American Psychological Association, chronic stress is a “long term form of stress, derived from unending feelings of despair/hopelessness, as a result of factors such as poverty, family dysfunction, feelings of helplessness, and/or traumatic early childhood experiences.” We know poverty compromises an individual in multiple ways, from lack of educational and occupational opportunities to an increased risk for a life of crime and dependency on government programs. The risk factors common in low-income communities and poverty-stricken households expose families to chronic stress. And, children often receive the brunt of the impact, becoming at-risk for poor health, impaired learning, and disrupted cognitive, emotional, and physical development. Kids in low-income communities face significantly more adverse experiences and environmental factors than children from a higher socioeconomic status.

We talk about education and jobs, sometimes broken families and occasionally addiction, but we don’t often talk about the aggregate effect of the trauma of poverty. Like many things, it all begins in childhood.

Adverse Childhood Experiences Study

A landmark study exploring the effects of adverse childhood experiences – the Adverse Childhood Experiences (ACE) Study – compares adult health to childhood experiences for over 17,000 individuals. The study found that childhood emotional development and experiences have a profound, formative impact on emotional and physical health and mortality as adults.

Essentially, time doesn’t necessarily heal all wounds.

The ACE Study surveyed adults in detail about medical, biomedical, and social history. The study defined exposure to harmful childhood experiences in seven main categories: psychological, physical, or sexual abuse; exposure to substance abuse, mental illness, violent treatment of the mother, and criminal behavior.

These categories are not unique to low-income communities, but they are commonly linked to poverty. For example, “the risk factors that predispose people to substance abuse and addiction are more prevalent in lower economic areas and families than in others,” so consequently, substance abuse is more prevalent in low-income communities. Similar arguments have long been made for strong links to poverty (not necessarily causation) in the other categories as well.

The survey compared the number of adverse childhood experiences to health risk factors for the leading causes of death in adults (smoking, severe obesity, physical inactivity, depression, suicide attempts, alcoholism, drug abuse, parental drug abuse, high lifetime number of sexual partners, and history of sexually transmitted disease) and the presence of diseases (heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis, and bone fractures).

The results were startling.

More than half of the population surveyed experienced at least one ACE. One out of four participants experienced more than two, and one in 16 experienced more than four. And, someone exposed to one category had an 80 percent likelihood of being exposed to another.

What’s more – the prevalence and risk for increased health risk factors dramatically increased with an increase in the exposure of ACEs. For example, someone with an ACE score of 4 (experienced four of the seven categories) is 390 percent more likely to have a chronic obstructive pulmonary disease (COPD) than a person with a score of 0. A score of four or higher also led to a 460 percent increased likelihood of depression compared to someone with a score of 0. Attempted suicide increased 30-50-fold for individuals with higher ACE scores.

The presence of adverse experiences don’t just coincide with serious health risks in adulthood – they strongly and powerfully correlate. The impact of these adverse childhood experiences is both “strong and cumulative.”

So, What?

It’s often assumed that poor individuals are directly and solely responsible for unhealthy lifestyle decisions. Or, we blame a lack of access to healthcare that prevents people with low income from getting the care they need. But, stress appears to be a primary mechanism for the health toll poverty takes on both children and adults. It starts early and has lasting consequences.

This cumulative stress in both childhood and adulthood directly corresponds to the five interconnected pathways of poverty: substance abuse, educational failure, unemployment, debt, and family breakdown. It’s well-known and largely accepted that low socioeconomic status is linked to poor health. The implications of this research demand a strong call to action for healthcare professionals, community leaders, and organizations. In our next blog, we’ll explore the programs and approaches can make a difference in the lives of both children and adults, mitigating the long-term effects of chronic stress.