Healthy Aging and Inequality

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“Healthy aging” has become a big concern of the public, as coverage on neurodegenerative disease increases with the increasing body of knowledge and interest in research on neurodegeneration and diseases of old age. Aging people fear memory loss, decreased mobility, and loss of independence, but healthy aging promises a delay in these natural processes. Popular articles and news reports encourage people to eat well, sleep well, exercise frequently, and reduce stress, promising a healthier brain for many years to come. However, such media seems to be geared towards people that make middle to high income. Popular articles about healthy aging make the physical aspects of aging seem like a choice, all while touting expensive products and instructing their audience to “destress”. These articles disregard people of lower income, for whom it may not be possible to make these lifestyle changes, if they are even effective for this group at all.

Poverty in older adults is a growing problem in the US. From 2015 to 2016, poverty decreased among all groups, other than in people over the age of 65, for which the poverty rate increased (Semega, Fontenot, & Kollar, 2017). In 2018, the United States Census Bureau reported that 9.7% of people over the age of 65 live in poverty in the United States; 52,788 people (Semega, Kollar, Creamer, & Mohanty, 2019). In 2018, the NYC Center for Economic Opportunity reported that approximately 20% of elderly living in New York City are living in poverty. Many seniors in New York survive on about $14,000 in income per year, which is not enough to pay rent and afford food and other necessities (NYC Center for Economic Opportunity, 2018). Thousands of elderly people are on waiting lists to receive affordable senior housing, but the wait is so long that many seniors may not even live to their acceptance (Kaiser Family Foundation, 2014).

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Poverty, which the World Health Organization has described as “the most ruthless killer and the greatest cause of suffering on earth” (The World Health Organization, 2001), has been linked to negative physical and mental health outcomes in studies performed all over the world (Chiavegatto Filho, Lebrão, & Kawachi, 2012; Dalstra, Kunst, Mackenbach, & EU Working Group on Socioeconomic Inequalities in Health., 2006; Feng, Wang, Jones, & Li, 2012; Matheson, Moineddin, Dunn, Creatore, Gozdyra, & Glazier, 2006). Living with a lower income can make leading a healthy lifestyle difficult or impossible, as poverty is often associated with reduced access to healthcare, education, clean water, and nutrition and less time for sleep and exercise.

Low socioeconomic status is associated with experiencing higher levels of stress than middle or high socioeconomic status (Algren, Ekholm, Nielsen, Ersbøll, Bak, & Andersen, 2018). According to the income inequality hypothesis, the health of an individual is affected by both their individual income as well as inequality where they reside (De Maio, 2014). The income inequality hypothesis suggests that the stress that results from inequality plays a crucial role in the negative health outcomes that result from being of lower socioeconomic status. Baum, Garofalo, & Yali (1999) observed that people residing in areas of low socioeconomic status live under potentially stressful environmental conditions, such as “crowding, crime, noise pollution, discrimination, and other hazards or stressors” (Baum, et al. 1999). In a systematic review of poverty and mental illness involving 115 studies (Lund, et al., 2010), 79% of studies investigated found a positive association between common mental illnesses and poverty. Common mental illnesses, including anxiety, somatoform disorders, and depression, are also consistently positively associated with factors that are associated with poverty in many countries, including food and housing security, access to education, and socioeconomic status. Common mental illnesses, depression in particular, have been linked to neurodegeneration in old age (Hurley & Tizabi, 2013), neurodegenerative disorders (Ishihara & Brayne, 2006; Schneider & Bennett, 2010; Chen, Zhang, & Huang, 2016; Baquero & Martín, 2015), neurodegenerative pathways (Chen, Zhang, & Huang, 2016), and may present a significant risk factor.

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In a cross-sectional study examining the associations between stress, economic status, and health-risk behaviors in Denmark (Algren, Ekholm, Nielsen, Ersbøll, Bak, & Andersen, 2018), perceived stress, physical inactivity, and health-risk behaviors were more strongly associated in people of medium to high socioeconomic status than in people of low socioeconomic status (Algren, et al. 2018). Therefore, the techniques for healthy aging did not appear to be as effective for low income populations, again pointing to the more pressing issue of the effects of chronic stress and inequality.

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While diet, exercise, and social interaction are important to a healthy life, mental health management and stress reduction throughout life are paramount to survival and neurological function in old age. In countries were making lower income equates to rampant inequality and threat of loss of basic human needs and security, poverty means stress and poorer aging, utilizing techniques for “healthy aging” as advertised in popular media becomes futile.

Sources

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