Biological inequity

Biological inequity , also known as biological inequality, refers to “systematic, unfair, and avoidable stress-related biological differences which increase risk of disease, observed between social groups of a population”.[1][2][3][4] The term developed by Centric Lab[5] aims to unify societal factors with the biological underpinnings of health inequities – the unfair and avoidable differences in health status and risks between social groups of a population - such that these inequalities can be investigated in a holistic manner.[6][7]

Mechanism

Biological inequity posits that health inequity in urban populations is a result of structurally racist processes executed through the built environment. Specifically, particular social groups are disproportionately exposed to physical and psychosocial stressors in the urban environment. For example, studies show Black, Asian and Minority Ethnic (BAME) groups inhabit more deprived[8] and environmentally polluted neighbourhoods.[9] Through this, these groups experience prolonged exposure to physical (e.g. air pollution[10]) and psychosocial (e.g. discrimination[11]) stressors resulting in chronic stress.[11] Chronic stress increases the individuals ‘allostatic load’ level – which refers to the wear and tear of stress-related biological systems e.g., neuroendocrine, metabolic, immune systems. In turn, these stress-related biological differences increase the risk of disease and poorer health outcomes.[12][13]

Measures and predictors of biological inequity

Measures have been developed to quantify biological inequity by combining physical (e.g., air pollution, noise pollution, light pollution) and psychosocial factors (e.g., deprivation) that define the phenomena such as the ‘Biological Inequity Index.[14]

As a phenomenon, biological inequity is situated at the intersection between poverty, structural racism, and place. As such, biological inequity as expressed through allostatic load is correlated with factors such as socioeconomic status,[15] ethnic and racial grouping,[16] and urban factors e.g. green space,[17] housing quality.[18][19]

Health outcomes

Biological inequity increases the risk of disease and poor health outcomes for a social group through;

  1. disproportionate exposure to the cause(s) of the disease brought about by direct exposure to physical and/or psychosocial stressors, or
  2. greater adverse effects of the cause(s) of a disease brought about from accumulated stress-related biological differences i.e. higher levels of allostatic load.[1][20]

Non-communicable diseases
Further information: Non-communicable disease

Obesity has been linked to biological inequity factors such as air pollution[21][22] and psychosocial stress.[23] Similar findings have shown diabetes to be associated with physical[24] and psychosocial[25][26] stressors.

Mental health

Mental health conditions such as depression, anxiety have been linked to biological inequity factors such as air pollution,[27][28] noise pollution[29][30] and area deprivation[31][32]

Infectious disease

Measures of Biological inequity such as psychosocial stress and environmental stress have been shown to correlate with Covid-19 mortality rates, suggesting possible increased exposure to Covid-19 or increased vulnerability to the virus.[1]

References
  1. Camargo, Araceli; Hossain, Elahi; Aliko, Sarah; Akinola-Odusola, Daniel; Artus, Josh; Kelman, Ilan (2021-01-25). "Using an Ecological and Biological Framing for an Anti-racist Covid-19 Approach". medRxiv 10.1101/2021.01.24.21250397v1.
  2. Questioning Identity and The Past - Encoding Inequalities in our Infrastructures M1S3, retrieved 2021-10-21
  3. "Centric Lab — What is Health". Centric Lab. Retrieved 2021-10-21.
  4. "Neuroscience, urban regeneration and urban health". Research Gate. March 2020.
  5. "Centric Lab". Centric Lab. Retrieved 2021-10-22.
  6. "Health inequities and their causes". www.who.int. Retrieved 2021-10-21.
  7. Braveman, Paula (2006). "Health disparities and health equity: concepts and measurement". Annual Review of Public Health. 27: 167–194. doi:10.1146/annurev.publhealth.27.021405.102103. ISSN 0163-7525. PMID 16533114.
  8. "People living in deprived neighbourhoods". www.ethnicity-facts-figures.service.gov.uk. Retrieved 2021-10-21.
  9. Brulle, Robert J.; Pellow, David N. (2006). "Environmental justice: human health and environmental inequalities". Annual Review of Public Health. 27: 103–124. doi:10.1146/annurev.publhealth.27.021405.102124. ISSN 0163-7525. PMID 16533111.
  10. Thomson, Errol M. (2019). "Air Pollution, Stress, and Allostatic Load: Linking Systemic and Central Nervous System Impacts". Journal of Alzheimer's Disease. 69 (3): 597–614. doi:10.3233/JAD-190015. ISSN 1875-8908. PMC 6598002. PMID 31127781.
  11. Egan, Matt; Tannahill, Carol; Petticrew, Mark; Thomas, Sian (2008-07-16). "Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: a systematic meta-review". BMC Public Health. 8: 239. doi:10.1186/1471-2458-8-239. ISSN 1471-2458. PMC 2503975. PMID 18631374.
  12. McEwen, Bruce S.; Wingfield, John C. (February 2010). "What's in a name? Integrating homeostasis, allostasis and stress". Hormones and Behavior. 57 (2): 105–111. doi:10.1016/j.yhbeh.2009.09.011. ISSN 0018-506X. PMC 2815096. PMID 19786032.
  13. McEwen, B. S. (February 2000). "Allostasis and allostatic load: implications for neuropsychopharmacology". Neuropsychopharmacology. 22 (2): 108–124. doi:10.1016/S0893-133X(99)00129-3. ISSN 0893-133X. PMID 10649824. S2CID 206088437.
  14. "Centric Lab — Biological Inequities Index". Centric Lab. Retrieved 2021-10-22.
  15. Seeman, Teresa; Epel, Elissa; Gruenewald, Tara; Karlamangla, Arun; McEwen, Bruce S. (February 2010). "Socio-economic differentials in peripheral biology: Cumulative allostatic load". Annals of the New York Academy of Sciences. 1186 (1): 223–239. Bibcode:2010NYASA1186..223S. doi:10.1111/j.1749-6632.2009.05341.x. ISSN 0077-8923. PMID 20201875. S2CID 21391140.
  16. Geronimus, Arline T.; Hicken, Margaret; Keene, Danya; Bound, John (May 2006). ""Weathering" and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States". American Journal of Public Health. 96 (5): 826–833. doi:10.2105/AJPH.2004.060749. ISSN 0090-0036. PMC 1470581. PMID 16380565.
  17. Egorov, Andrey I.; Griffin, Shannon M.; Converse, Reagan R.; Styles, Jennifer N.; Sams, Elizabeth A.; Wilson, Anthony; Jackson, Laura E.; Wade, Timothy J. (October 2017). "Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions". Environmental Research. 158: 508–521. Bibcode:2017ER....158..508E. doi:10.1016/j.envres.2017.07.009. ISSN 1096-0953. PMC 5941947. PMID 28709033.
  18. Riva, Mylene; Plusquellec, Pierrich; Juster, Robert-Paul; Laouan-Sidi, Elhadji A.; Abdous, Belkacem; Lucas, Michel; Dery, Serge; Dewailly, Eric (April 2014). "Household crowding is associated with higher allostatic load among the Inuit". Journal of Epidemiology and Community Health. 68 (4): 363–369. doi:10.1136/jech-2013-203270. ISSN 1470-2738. PMID 24385548. S2CID 506997.
  19. Jung, Chien-Cheng; Liang, Hsiu-Hao; Lee, Hui-Ling; Hsu, Nai-Yun; Su, Huey-Jen (2014-04-23). "Allostatic Load Model Associated with Indoor Environmental Quality and Sick Building Syndrome among Office Workers". PLOS ONE. 9 (4): e95791. Bibcode:2014PLoSO...995791J. doi:10.1371/journal.pone.0095791. ISSN 1932-6203. PMC 3997416. PMID 24759685.
  20. Gochfeld, Michael; Burger, Joanna (December 2011). "Disproportionate Exposures in Environmental Justice and Other Populations: The Importance of Outliers". American Journal of Public Health. 101 (Suppl 1): S53–S63. doi:10.2105/AJPH.2011.300121. ISSN 0090-0036. PMC 3222496. PMID 21551384.
  21. Kim, Jeniffer S.; Chen, Zhanghua; Alderete, Tanya L.; Toledo-Corral, Claudia; Lurmann, Fred; Berhane, Kiros; Gilliland, Frank D. (December 2019). "Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study". Environment International. 133 (Pt A): 105180. doi:10.1016/j.envint.2019.105180. ISSN 1873-6750. PMC 6884139. PMID 31622905.
  22. Parasin, Nichapa; Amnuaylojaroen, Teerachai; Saokaew, Surasak (May 2021). "Effect of Air Pollution on Obesity in Children: A Systematic Review and Meta-Analysis". Children. 8 (5): 327. doi:10.3390/children8050327. PMC 8146513. PMID 33922616.
  23. Cuevas, Adolfo G.; Chen, Ruijia; Thurber, Katherine A.; Slopen, Natalie; Williams, David R. (2019-10-07). "Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study". Annals of Behavioral Medicine. 53 (11): NP. doi:10.1093/abm/kaz008. ISSN 1532-4796. PMC 6779073. PMID 30917198.
  24. Bowe, Benjamin; Xie, Yan; Li, Tingting; Yan, Yan; Xian, Hong; Al-Aly, Ziyad (July 2018). "The 2016 global and national burden of diabetes mellitus attributable to PM 2·5 air pollution". The Lancet Planetary Health. 2 (7): e301–e312. doi:10.1016/s2542-5196(18)30140-2. ISSN 2542-5196. PMID 30074893. S2CID 51911901.
  25. Steptoe, A.; Hackett, R. A.; Lazzarino, A. I.; Bostock, S.; La Marca, R.; Carvalho, L. A.; Hamer, M. (2014-10-20). "Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load". Proceedings of the National Academy of Sciences. 111 (44): 15693–15698. Bibcode:2014PNAS..11115693S. doi:10.1073/pnas.1410401111. ISSN 0027-8424. PMC 4226108. PMID 25331894.
  26. Hackett, Ruth A.; Steptoe, Andrew (September 2017). "Type 2 diabetes mellitus and psychological stress - a modifiable risk factor". Nature Reviews. Endocrinology. 13 (9): 547–560. doi:10.1038/nrendo.2017.64. ISSN 1759-5037. PMID 28664919. S2CID 34925223.
  27. Ali, Naureen A.; Khoja, Adeel (2019). "Growing Evidence for the Impact of Air Pollution on Depression". The Ochsner Journal. 19 (1): 4. doi:10.31486/toj.19.0011. ISSN 1524-5012. PMC 6447209. PMID 30983893.
  28. Power, Melinda C.; Kioumourtzoglou, Marianthi-Anna; Hart, Jaime E.; Okereke, Olivia I.; Laden, Francine; Weisskopf, Marc G. (2015-03-24). "The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study". BMJ. 350: h1111. doi:10.1136/bmj.h1111. ISSN 1756-1833. PMC 4373600. PMID 25810495.
  29. Floud, Sarah; Vigna-Taglianti, Federica; Hansell, Anna; Blangiardo, Marta; Houthuijs, Danny; Breugelmans, Oscar; Cadum, Ennio; Babisch, Wolfgang; Selander, Jenny; Pershagen, Göran; Antoniotti, Maria Chiara (July 2011). "Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study". Occupational and Environmental Medicine. 68 (7): 518–524. doi:10.1136/oem.2010.058586. ISSN 1470-7926. PMID 21084328. S2CID 43114848.
  30. Orban, Ester; McDonald, Kelsey; Sutcliffe, Robynne; Hoffmann, Barbara; Fuks, Kateryna B.; Dragano, Nico; Viehmann, Anja; Erbel, Raimund; Jöckel, Karl-Heinz; Pundt, Noreen; Moebus, Susanne (May 2016). "Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study". Environmental Health Perspectives. 124 (5): 578–585. doi:10.1289/ehp.1409400. ISSN 1552-9924. PMC 4858388. PMID 26606640.
  31. "Local area deprivation and urban- rural differences in anxiety and depression among people older than 75 years in britain". Primary Health Care. 15 (4): 8. May 2005. doi:10.7748/phc.15.4.8.s11. ISSN 0264-5033.
  32. Chiavegatto Filho, Alexandre Dias Porto; Kawachi, Ichiro; Wang, Yuan Pang; Viana, Maria Carmen; Andrade, Laura Helena Silveira Guerra (2013-11-01). "Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil". Journal of Epidemiology and Community Health. 67 (11): 966–972. doi:10.1136/jech-2013-202626. ISSN 1470-2738. PMID 23908459. S2CID 45759310.

Further reading
  1. Camargo, A. et al. Using an Ecological and Biological Framing for an Anti-racist Covid-19 Approach. medRxiv 2021.01.24.21250397 (2021) doi:10.1101/2021.01.24.21250397.
  2. UNDP Eurasia. Questioning Identity and The Past - Encoding Inequalities in our Infrastructures M1S3. (2021).
  3. Centric Lab — What is Health. Centric Lab https://www.thecentriclab.com/what-is-health.
  4. Aliko, S., Camargo, A., Artus, J., Akinola-Odusola, D. & Hossain, E. Neuroscience, urban regeneration and urban health. J. Urban Regen. Renew. 13, 280–289 (2020).
  5. www.thecentriclab.com
  6. WHO. Health inequities and their causes. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes.
  7. Braveman, P. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health 27, 167–194 (2006).
  8. People living in deprived neighbourhoods. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/people-living-in-deprived-neighbourhoods/latest#main-facts-and-figures.
  9. Brulle, R. J. & Pellow, D. N. ENVIRONMENTAL JUSTICE: Human Health and Environmental Inequalities. Annu. Rev. Public Health 27, 103–124 (2006).
  10. Thomson, E. M. Air Pollution, Stress, and Allostatic Load: Linking Systemic and Central Nervous System Impacts. J. Alzheimers Dis. 69, 597–614.
  11. Egan, M., Tannahill, C., Petticrew, M. & Thomas, S. Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: A systematic meta-review. BMC Public Health 8, 1–13 (2008).
  12. Schulz, A. J. et al. Associations Between Socioeconomic Status and Allostatic Load: Effects of Neighborhood Poverty and Tests of Mediating Pathways. Am. J. Public Health 102, 1706–1714 (2012).
  13. McEwen, B. S. & Wingfield, J. C. What’s in a name? Integrating homeostasis, allostasis and stress. Horm. Behav. 57, 105 (2010).
  14. McEwen, B. S. Allostasis and Allostatic Load: Implications for Neuropsychopharmacology. Neuropsychopharmacology 22, 108–124 (2000).
  15. Centric Lab. Biological Inequities Index. Centric Lab https://www.thecentriclab.com/biological-inequities-index (2021).
  16. Seeman, T., Epel, E., Gruenewald, T., Karlamangla, A. & McEwen, B. S. Socio-economic differentials in peripheral biology: Cumulative allostatic load: SES peripheral biology. Ann. N. Y. Acad. Sci. 1186, 223–239 (2010).
  17. Geronimus, A. T., Hicken, M., Keene, D. & Bound, J. “Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States. Am. J. Public Health 96, 826–833 (2006).
  18. Egorov, A. I. et al. Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions. Environ. Res. 158, 508–521 (2017).
  19. Riva, M. et al. Household crowding is associated with higher allostatic load among the Inuit. J. Epidemiol. Community Health 68, 363–369 (2014).
  20. Jung, C.-C., Liang, H.-H., Lee, H.-L., Hsu, N.-Y. & Su, H.-J. Allostatic load model associated with indoor environmental quality and sick building syndrome among office workers. PLOS ONE 9, e95791 (2014).
  21. Gochfeld, M. & Burger, J. Disproportionate Exposures in Environmental Justice and Other Populations: The Importance of Outliers. Am. J. Public Health 101, S53–S63 (2011).
  22. Kim, J. S. et al. Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study. Environ. Int. 133, 105180 (2019).
  23. An, R., Ji, M., Yan, H. & Guan, C. Impact of ambient air pollution on obesity: a systematic review. Int. J. Obes. 42, 1112–1126 (2018).
  24. Cuevas, A. G., Chen, R., Thurber, K. A., Slopen, N. & Williams, D. R. Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study. Ann. Behav. Med. 53, NP (2019).
  25. Bowe, B. et al. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. Lancet Planet. Health 2, e301–e312 (2018).
  26. Steptoe, A. et al. Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load. Proc. Natl. Acad. Sci. U. S. A. 111, 15693–15698 (2014).
  27. Hackett, R. A. & Steptoe, A. Type 2 diabetes mellitus and psychological stress — a modifiable risk factor. Nat. Rev. Endocrinol. 13, 547–560 (2017).
  28. Ali, N. A. & Khoja, A. Growing Evidence for the Impact of Air Pollution on Depression. Ochsner J. 19, 4 (2019).
  29. Power, M. C. et al. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ 350, h1111 (2015).
  30. Floud, S. et al. Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study. Occup. Environ. Med. 68, 518–524 (2011).
  31. Orban, E. et al. Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study. Environ. Health Perspect. 124, 578–585 (2016).
  32. Walters, K. et al. Local Area Deprivation and Urban–Rural Differences in Anxiety and Depression Among People Older Than 75 Years in Britain. Am. J. Public Health 94, 1768–1774 (2004).
  33. Filho, A. D. P. C., Kawachi, I., Wang, Y. P., Viana, M. C. & Andrade, L. H. S. G. Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in São Paulo, Brazil. J Epidemiol Community Health 67, 966–972 (2013).
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