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Lack of Control at Job Causes Stress, Leading to Cardiovascular Disease

(p. 6) Allostasis is not about preserving constancy; it is about calibrating the body's functions in response to external as well as internal conditions. The body doesn't so much defend a particular set point as allow it to fluctuate in response to changing demands, including those of one's social circumstances. Allostasis is, in that sense, a politically sophisticated theory of human physiology. Indeed, because of its sensitivity to social circumstances, allostasis is in many ways better than homeostasis for explaining modern chronic diseases.

Consider hypertension. Seventy million adults in the United States have it. For more than 90 percent of them, we don't know the cause. However, we do have some clues. Hypertension disproportionately affects blacks, especially in poor communities.

. . .

Peter Sterling, a neurobiologist and a proponent of allostasis, has written that hypertension in these communities is a normal response to "chronic arousal" (or stress).

. . .

Allostasis is attractive because it puts psychosocial factors front and center in how we think about health problems. In one of his papers, Dr. Sterling talks about how, while canvassing in poor neighborhoods in Cleveland in the 1960s, he would frequently come across black men with limps and drooping faces, results of stroke. He was shocked, but today it is well established that poverty and racism are associated with stroke and poor cardiovascular health.

These associations also hold true in white communities. One example comes from the Whitehall study of almost 30,000 Civil Service workers in Britain over the past several decades. Mortality and poor health were found to increase stepwise from the highest to the lowest levels in the occupational hierarchy: Messengers and porters, for example, had nearly twice the death rate of administrators, even after accounting for differences in smoking and alcohol consumption. Researchers concluded that stress -- from financial instability, time pressures or a general lack of job control -- was driving much of the difference in survival.

For the full commentary, see:

SANDEEP JAUHAR. "When Blood Pressure Is Political." The New York Times, SundayReview Section (Sun., AUG. 7, 2016): 6.

(Note: ellipses added.)

(Note: the online version of the review has the date AUG. 6, 2016.)

The commentary quoted above is distantly related to Jauhar's book:

Jauhar, Sandeep. Doctored: The Disillusionment of an American Physician. New York: Farrar, Straus and Giroux, 2014.

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