TEDMED #GreatChallenges: How Does Poverty Affect Health Decisions?
When discussing poverty as a social determinant of health, many public health practitioners think of environmental factors associated with negative health outcomes, such as lack of access to fruits, vegetables and safe spaces to engage in physical activity. However, emerging research suggests the effects of poverty can also be seen in one’s brain structure and basic functioning.
Research indicates stress associated with poverty adversely affects cognitive function because the brain must focus on achieving basic needs for survival, which leaves limited space to process more complex issues that may have long-term negative health outcomes. Further, childhood brain development can be fundamentally altered by traumatic experiences that may be more likely to occur in poverty situations. Recently the Great Challenges Program at TEDMED hosted a panel of experts to discuss thepsychological effects of poverty and the relationship between these effects and negative health outcomes.
Laura Gottlieb is an assistant professor of family and community medicine at the University of California, San Francisco where her research focuses on health care interventions to address social factors.
James Redford is a film and television writer, producer and director. His most recent project, called Toxic Hot Seat, is a documentary that explores the possible health dangers of chemical flame retardants used in U.S.-made upholstered furniture. Redford is currently working on a new documentary on the emerging link between childhood trauma and long-term health outcomes called Paper Tigers.
Theresa Y. Barila is the coordinator for the Walla Walla County Community Network in Washington state. The Network works with family, community and state partners to help prevent child abuse and neglect, youth substance abuse and other social concerns. Currently, Barila focuses on resilience and adverse childhood experiences through the Children’s Resilience Initiative.
Mark Brown is executive director of Friends of Children of Walla Walla, a nonprofit child-mentoring organization in Washington state. Brown helped launch the Children’s Resilience Initiative to raise awareness of adverse childhood experiences and resilience.
Gwen Lawson is a doctoral student in psychology with experience in clinical services. Her research explores the ways in which environmental factors related to childhood socioeconomic status (SES) influence brain development.
Although the focus of the discussion was on the relationship between SES and health outcomes, several panelists noted that traumatic experiences and chronic stress are not exclusive to people experiencing poverty. Barila referenced the Adverse Childhood Experiences (ACE) Study, along with her own work, stating, “We know that ACEs are pervasive across all sectors of the population … [so] we do not stigmatize SES because … it would be a mistake to do that. It would also be a mistake not to recognize the impact of poverty.” Brown added that “the relationship between poverty and ACEs or social determinants … is a pretty complex relationship and we need to keep looking at it.”
Lawson helped describe the emerging research on this complex relationship by explaining that the effects of chronic or “toxic” stress may be “embedded in our brains and in our bodies … in terms of the regulation of stress hormones, in the structure of brains, [and] in the aging of our cells.”
Redford talked about the novel interventions taking place in a Walla Walla, Washington high school featured in Paper Tigers that create a safe space for students. He describes how teachers understand students’ problematic behavior as “a symptom rather than an issue of discipline that needs to be hammered down on.” By approaching students in this trauma-informed manner, teachers can develop a meaningful relationship with students, which can help students develop empathy and attachment.
For public health professionals, such as students and alumni of MPH@GW, who recognize the importance of community-level prevention, there is ample work to be done to better understand how to effectively implement such interventions. Gottlieb suggested a focus on policies and programs that seek to “build data-sharing platforms across our silos, where we could bridge education data and health data… and social services data.” She explained that professionals could then look at that data and see “what are the social programs that really support healthy development.” That information “would really catapult us to a different level of understanding around interventions.”