The link between more education, higher income and better health is well established. But now, new research suggests that the process of upward mobility can also be taxing to the health and well-being of people of lower socioeconomic status.
In a New York Times op-ed, Can Upward Mobility Cost You Your Health? Gregory E. Miller and Edith Chen of Northwestern University and Gene H. Brody of the University of Georgia report findings from a long-term study of 489 African-American youth from rural Georgia: “Those who do climb the ladder, against the odds, often pay a little-known price: Success at school and in the workplace can exact a toll on the body that may have long-term repercussions for health.”
The article struck a personal chord with my own experiences in college. Because of my undocumented status, I paid my own tuition, but was denied research opportunities and participation in some programs. Many of my experiences parallel those of the young people in the study.
For example, the researchers write: “In our studies, most participants are the first in their families to attend college. . . Many feel socially isolated and disconnected from peers from different backgrounds. They may encounter racism and discrimination.” I, too, was the first in my family to attend college. When my mother was deported I felt a responsibility to get additional jobs to help with my family’s income, and still continue as a full-time student while actively participating in a support and advocacy group for undocumented students. My school, work, personal, and family obligations left me drained and with a poor sense of belonging.
The study also found that “behaving diligently all of the time leaves people feeling exhausted and sapped of willpower. Worn out from having their noses to the grindstone all the time, they may let their health fall by the wayside, neglecting sleep and exercise, and like many of us, overindulging in comfort foods.”
My experience with the undocumented student group confirms this; it was both demanding and empowering. We relied on our limited time to strategize ways to demand the same treatment and opportunities as our non-undocumented peers, advocated for state and federal policy related to immigrant rights, and worked to increase knowledge to high students about higher education opportunities.
Despite our diligence, ambition, and dedication, our fight-or-flight responses were always on. The next meal was sometimes uncertain, so as a natural stress response we often filled up at events with free food. This illustrates how stress, sleep deprivation, poor exercise, and inadequate nutrition affect weight, blood pressure, and other chronic illnesses—as the article explains.
The researchers offer ways to mitigate the harms of being in this situation — better health education, more checkups, classes in stress management. But I personally believe that those suggestions are like putting a Band-Aid on a deep gushing wound.
Problems brought on by inequitable institutions, such as education, cannot be solved solely through health education, health screenings, and mentorship programs. My peers and I knew plenty about health education, healthy eating and exercise, and stress management. The veil of chronic stress lifted only when I got my green card, when I stopped feeling like a pariah in constant fear of deportation, and when the doors to better job opportunities opened.
Understanding the social determinants of health — our living and working conditions, and the social, economic, political, and cultural environment — is not enough unless we also act to address them. Health Impact Assessment is one of the tools that can gradually help us reach health equity because it aims to uncover the root causes of poor health.