Compounding Inequity: Structural Racism, Allostatic load, and Implications for Behavior Change

The impact of modifiable health behaviors (smoking, alcohol consumption, lack of exercise, etc.) on downstream health disparities has become a subject of magnified interest amongst researchers, practitioners, and policymakers alike. This interest stems from the significant impact that modifiable health behaviors have on the total burden of disease in the United States, with almost 40% of deaths each year attributed to these behaviors. This burden of harmful health behaviors disproportionately impacts Black Americans - as the prevalence of these behaviors amongst Black Americans is responsible for both premature and excess mortality. Adding to the challenge, healthcare operates downstream of inequality-producing institutions with tremendous strength – education, income, employment, housing, transportation, criminal justice, etc. These upstream forces manifest in a myriad of harmful ways, including increased allostatic load - the cumulative health effect of chronic exposure to stressful events. In turn, allostatic load has been shown to lead to higher rates of many modifiable health behaviors, like lack of physical activity, unhealthy diet, poor sleep habits. Although clearly an important component cause of negative modifiable health behaviors, existing behavior change methodologies do not adequately account for systematic disparities or physiologic dysregulation built in by the compounding inequity of preexisting stressors and allostatic load. With those gaps in mind, this research seeks to provide both a systematic review of the existing literature surrounding inequity/allostatic load and extend a roadmap for providers to approach behavior change interventions with a more complete understanding of compounding inequity in the context of behavior change.

2022 UVA Health Disparities Conference - Breakout Session 1: Health Outcomes in Disadvantaged Populations