Stress and Health

There was a really interesting article in the business section of the New York Times recently entitled “The mental strain of making do with less.” In it, Sundhil Mullainathan shares some insights from his new book, “Scarcity: why having too little means so much.”

The basic premise is that each of us has only so much “mental bandwidth,” and that coping with psychological stress – in particular the stress associated with poverty – leaves the poor with less mental energy or capacity to deal with everyday life. It is a fascinating and profound proposition. As Mullainathan points out, looking at the world this way could turn a lot of stereotypes on their heads: what if “poor people make bad choices in life” is really a reflection of “being poor makes you less able to make good choices”?

When I read the article, I was also struck by the connection between the stress of poverty and health. Of course, being poor affects one’s health in many ways: diminished access to care, fewer options for healthy eating, more environmental health hazards, fewer social supports and more. This work adds another layer that may be just as profound: the poor have less “bandwidth” to apply to health issues, because they are so overwhelmed with being poor.

For years, patients and their family members have asked me if “stress” can lead to heart disease. I often get the question from the worried spouse of a “type A” executive. I have typically reassured them that “stress” (which can lead to cardiovascular disease) is more closely associated with being unable to control one’s life circumstances than it is with having a “hard-driving” personality, and that it is much more stressful to be a single mother struggling to put food on the table for her children than it is to be a Wall Street executive. This recent work only strengthens that conclusion.

What do you think?

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