Social inequality and wellbeing

The "allostatic load" on children caused by chronic stress is a major health problem that needs addressing.

The moral and economic case for action on poverty, particularly among young people, has never been more pressing. In his recent update to the UN General Assembly, the special rapporteur on extreme poverty and human rights, Philip Alston, reported that close to 40 per cent of children in the UK are predicted to be living in poverty by 2021.

Assessment by the Social Metrics Commission found that last year, 4.5 million of the nation's children are in poverty.

Now, a new report by the Health Foundation examines why rising inequalities are not only a serious cause for concern for young people and society as a whole, but how this trend could drastically impact this generation's ability to be healthy, well into adulthood.

A growing body of research is beginning to expand our understanding of the consequences of social and economic disadvantage experienced as a child or young person, and how this contributes to health inequalities later in life.

‘Allostatic load'

Applying the concept of "allostatic load" - the wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress - the report looks at which aspects of our social environment are most likely to lead to biological differences that reflect people's social and economic circumstance. These can contribute to, or exacerbate, health inequalities.

This isn't just the toll on physical health, but also the social and psychological impacts.

Using a range of indicators including those commonly associated with cardiovascular and metabolic diseases, it measures blood pressure and heart rate, inflammation and nervous system markers including cortisol and dopamine levels, and a variety of other systems to demonstrate the physical toll on the body.

Initial findings indicate that young people who are exposed to stressors early on in life - whether that be challenging family structures, living in poverty, or lack of access to the building blocks of health such as quality housing or education - suffer a heightened allostatic load, which in turn poses a significant risk of poor health and chronic disease later in life.

This is because as humans, we physically adapt to our environments, and this process of adaptation is more pronounced during the years of our lives when we are undergoing rapid development, such as during childhood and early adolescence.

What is fascinating about this concept is that it allows us the opportunity to take action on health inequalities by addressing factors that contribute to a high allostatic load.

Policy initiatives to relieve poverty and disadvantage among children and young people may do more than just help them in the short term, and also provide a buffer against other stressors which will contribute to better long-term health. This is vital not just for our young people, but also to help ensure a flourishing and prosperous society for everyone.

Understanding the factors

Over the past two years as part of the Health Foundation's inquiry into young people's future health, it has conducted research and engagement across the UK to understand the factors that might affect the future health of young people aged 12 to 24.

The inquiry seeks to understand the extent to which young people can access the core building blocks of health - a place to call home, secure and rewarding work, and supportive relationships with their friends, family and community.

Through this work, we have identified that while this generation's aspirations for adult life remain largely unchanged from those of their parents - steady and rewarding work, owning their own home and stable relationships - many are struggling to realise these most basic of ambitions.

This is due to a combination of factors including an insecure job market and prevalence of zero-hours contracts, poor and unaffordable housing and mental health stressors.

We cannot continue to ignore these growing health inequalities and must urgently address the broader societal factors that impact on the health of the next generation. At a time of political change, we need to see policymakers tackling these deeper issues, something that the recent prevention green paper failed to do.

If we want to give young people the foundations for a healthy life, we need a whole-government response across departments, whether that's protecting youth services, ensuring we have a housing a policy that does not disadvantage young people, or ensuring they have proper employment conditions with a decent living wage.

There must be a reframing of how policymakers think about social policy, recognising that we are not just addressing social problems but long-term health issues.

Allostatic load is arguably one of the biggest untold health stories of our time. Unless we address the root causes now, society will ultimately pay the price.

The Health Foundation is an independent charity running a two-year inquiry into the future health of young people in the UK. It will report its policy recommendations in the autumn


Allostatic load - how stress in childhood affects life-course health outcomes, August 2019

Report of the Special Rapporteur on extreme poverty and human rights, United Nations, July 2019

A new measure of poverty for the UK, the Social Metrics Commission, September 2018

Young people's future health inquiry, The Health Foundation

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