Homeostasis and Allostasis
By Albert B. Kelly
When it comes to urban communities, specifically lower
income areas, a great deal of attention is focused on things like food
insecurity, affordable housing, transportation, affordable daycare, and host of
other things that generally come under the heading of “quality of life”.
This is as it should be- a focus on these areas makes
sense because these basics form the pillars or supports necessary to live a halfway
decent life.
Addressing such concerns allows people to have the
reasonable expectation that they too might, individually or collectively,
better their lot in life.
And when you think about it, isn’t bettering your
situation or the expectation that you could, a big part of what it means to
live as an American?
But there is a whole different layer to this idea of
one’s quality of life; one I hadn’t really considered until I came across a recent
Times opinion piece by cardiologist Sandeep Jauhar, entitled “When Blood
Pressure is Political.”
Dr. Jauhar talks about homeostasis; how the body’s systems
work together to maintain balance and something called allostasis, which is the
body’s reaction to external and internal conditions.
The article uses the example of hypertension or high
blood pressure. 70 million people in the country suffer from high blood
pressure and for most of those cases; doctors have no idea as to the cause.
Doctors do know that the incidence of high blood pressure
is so much higher among African-Americans in poor communities, but again, they
don’t necessarily know why.
Science for the longest time thought it was mostly about
genetics and when it wasn’t, it was about poor diet and lack of exercise.
There’s not much that can be done about genetics, so we’re left with diet and
exercise.
In that mix of health and wellness; allostasis- the
body’s reaction to external or internal stress- becomes very relevant. This
makes sense, especially if you live your life constantly on the edge.
Whether that edge is homelessness, poverty, hunger,
violence, unemployment, or any one of a dozen other calamities makes no
difference- your body is going to react to the stress, perhaps in the form of
high blood pressure or diabetes or heart disease.
That’s why in the discussion about health, wellness, and
quality of life, we have to consider that the bigger connection may be with
external stresses (i.e. poverty, crime, employment, etc.), as opposed to just eating
healthy foods and getting exercise.
As the article went on to state, “ today it is clear that
chronic diseases like hypertension, diabetes and heart failure are inextricably
linked to the state of our neighborhoods, jobs, and families”.
There’s a direct connection between the health of our
citizens and what gets decided in Washington DC, Trenton, and City Hall.
And while there may be a little delay between a policy decision
and its impact- a new form of trickle-down economics- it’s always there and it
will eventually show itself.
I imagine, and even hope, that one day some enterprising
scientist will show a direct connection between some vote in a statehouse or in
Congress to defund a program or eliminate eligibility and the onset of hypertension
or a spike in heart attacks among whichever group is most impacted.
Allostasis implies that if we’re ever going to get serious
about improving a populations’ health and lowering health care costs, we’ll
need to work at the issues that affect health like income inequality, crime,
public safety, and systemic racism as opposed to treating these as separate and
distinct issues.
Maybe this connection comes as no big surprise to those who
live on the struggling side of life every day. Maybe they’ve always known that
living with a smoldering rage at one injustice or another will shorten your
life, whether through high blood pressure, diabetes, or heart attacks- if
something else doesn’t kill you first.
Of course the flip side of that coin is the possibility that
nurturing a smoldering hatred for one group or another may also shorten your
life in much the same way.
Maybe the difference between the two is simply this;
those nurturing hatred have the power to stop hating, while those living with a
smoldering rage at injustice and inequality are often powerless to change the
policies or the politics.
Who would have thought that politics could have such
profound impacts on health? If that’s true, and I think it is, then maybe achieving
more homeostasis in government will improve allostasis everywhere else.