Abstract
The global burden of chronic diseases (CD) has resulted in significant negative societal impacts, such as long-term disability, premature death and costs to health care systems (Cohen et al. 2007; Daar et al. 2007); a recent estimate suggests that such diseases account for approximately 60% of all deaths worldwide (Daar et al. 2007). As social epidemiologists begin to more closely investigate how environmental circumstances contribute to social disparities in CD, such as cardiovascular disease, diabetes, obesity and asthma, there has been growing interest in the mediating role of chronic stress. To date, many studies have speculated about the relevance of this pathway. However, stress-related mediation is rarely examined directly in epidemiologic research; and when it has been, it has often not been rigorously conceptualized and a biomedical focus has been predominant. As a result, the potential mediating role of stress in CD disparities has been vaguely described and, arguably, over-simplified in epidemiology. In this chapter, a multidisciplinary narrative review of the stress discourse is presented to facilitate a deeper understanding of inter-relationships among these factors, including how social and physical attributes of the environment can shape the experience of stress and how physiological and behavioural responses that characterize chronic stress can directly and indirectly foster chronic disease via multiple, overlapping pathways over time. In particular, the experience of stress is described in terms of sources, mediators and manifestations based on work from the disciplines of sociology, psychology and psychoneuroimmunology, and then integrated with notions of place from geography in order to facilitate a complex understanding of sociospatial disparities in CD. A conceptual framework is also presented that articulates a systems view of two key general pathways describing environmental determinants of chronic stress and CD. This tool can be used to support the development of elaborate hypotheses and study designs on this topic in social epidemiology and to support translational work related to chronic disease prevention.
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Notes
- 1.
There is also a substantial discourse on the relationship between chronic stress and mental health outcomes that are often chronic, particularly in sociology. This includes much work based on the stress process paradigm utilized in this chapter (e.g., Avison et al. 2010); in fact, the stress process paradigm was originally created in order to understand the onset of depression (Pearlin et al. 1981). There is also growing interest in incorporating broader social contexts in the use of the stress process to study mental health outcomes (e.g., Aneshensel 2010). Although the conceptual framework outlined in this chapter may be relevant to mental health researchers in terms of how environmental attributes can shape the experience of chronic stress, implications for sociospatial disparities in chronic mental health conditions may be fundamentally different in comparison to other chronic diseases. For example, addictions are commonly studied as a chronic mental health outcome having some antecedent role for chronic stress; whereas in this chapter, we consider the healthy and unhealthy habits reflected by addictive behaviour as manifestations of chronic stress that ought to be considered as on the pathway to the onset of other chronic diseases.
- 2.
Wheaton (1994) further examines the meaning and inter-relationships of similar domains of “stressors, stress, and distress.”
- 3.
It is also important to note that stressors can be positive in nature such that the emotional rush of participating in (or watching) a thrilling sporting event can also elicit stress responses. Selye (1975) referred to this type of stress as eustress. It is less clear to what extent positive stressors can be damaging in the long-term.
- 4.
Mediation in how the sources of stress are manifested is not to be confused with the role of chronic stress as a mediator of sociospatial disparities in CD.
- 5.
Incidentally, while the relevance of environmental confounders for both of these pathways depends on the co-incidence of stressful and hazardous or otherwise unhealthy environments, the literature on environmental justice highlights many examples where this confluence does exist in areas of low socioeconomic status (e.g., Morello-Frosch and Lopez 2006).
- 6.
Interestingly, Pearlin (1999) describes primary and secondary stressors to distinguish how an environmental stressor experienced at a specific place and time can contribute to personal stress at a later point in time. On the other hand, it is less clear to what extent environmental resources from one context are relevant to secondary appraisal of stressors in other settings.
- 7.
At the same time, studies examining environmental determinants of stress and CD of specific places and smaller populations can lead to broadly generalizable theory about these relationships to facilitate an increasingly detailed understanding of these relationships.
Abbreviations
- CD:
-
Chronic diseases
- GIS:
-
Geographic Information Systems
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The author thanks Patricia O’Campo and James Dunn for their thoughtful and constructive advice.
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Shankardass, K. (2012). Place-Based Stress and Chronic Disease: A Systems View of Environmental Determinants. In: O’Campo, P., Dunn, J. (eds) Rethinking Social Epidemiology. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2138-8_6
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