The Health Cost of Upward Mobility

Every human endeavor has a cost. The question is whether the objective gained is worth it. JL

James Hamblin reports in The Atlantic:

“What we're finding, is that there seems to be a cost to self-control and/or to the successes that it enables.”

Denying instant gratification in deference to long-term goals is virtuous, people tell me. Those people might be right. Psychologists call it self-regulation or self-control. And together with conscientiousness, it’s at least a trait (or a coping mechanism) that’s reasonably good at predicting a young person’s future. People with less self-control are more likely to end up where the world tells them to go.
Even in the worst circumstances, people with the most self-control and resilience have the highest likelihood of defying odds—poverty, bad schools, unsafe communities—and going on to achieve much academically and professionally. Except that even when that is possible, those children seem to age rapidly during the process. That is, their cells visibly age before their time (based on DNA methylation) among other undesirable effects on the body, according to research published this week from Northwestern University and the University of Georgia.

Meanwhile the opposite effect is seen in high-achieving people from highly advantaged backgrounds, where achievement goes hand-in-hand with health. The psychological phenomenon known as “John Henryism” posits that when goal-oriented, success-minded people strive ceaselessly in the absence of adequate support and resources, they can—like the mighty 19th-century folk legend who fell dead of an aneurysm after besting a steam-powered drill in a railroad-spike-driving competition—work themselves to death. Or, at least, toward it. It’s an idea that resonated with health researchers including Gregory Miller, a professor of psychology and medical-social sciences at Northwestern, who led this week’s investigation.

“There seems to be a health cost to self-control and/or to the successes that it enables.”

For the past several years, Miller and colleagues have studied the relationship between stress and physical health, and how self-control translates one into the other. For people who manage unlikely feats of upward mobility, how does that affect their bodies? On Monday the research team released findings that build out the picture of just how detrimental that rise can be. In Proceedings of the National Academy of Sciences, Miller and Tianyi Yu, Edith Chen, and Gene Brody build on their body of existing research showing that self-control among disadvantaged youth is associated with poorer physical health—higher blood pressures, more body fat, and higher levels of the stress hormone cortisol—compared to peers who are more impetuous (and, then, less upwardly mobile).

“We're talking about kids where the family is likely to be on multiple forms of government assistance, often single-parent caregivers with a high-school diploma or less,” Miller explained to me. “Those kids—who come from really, really challenging backgrounds but nonetheless do well in terms of psychosocial outcomes—by their early 20s have cells that look quite aged relative to their chronological age.”
The effect is related to the idea that chronic stress breaks down every bodily process and induces or at least catalyzes unknowably many diseases. The current case, a familiar one, opens with 496 black teenagers in rural Georgia, most from working-poor families. They are kids who begin with the panoply of disadvantages, related to race, geography, class—kids who, demographically, don’t do as well by traditional academic standards as others across the country, have more problems with mental and physical health, and have more contact with the juvenile justice system.
But there were outliers in that population, a subset of kids who despite the “odds being stacked against them,” as the researchers put it, excelled in school, exemplified mental health, didn't engage in criminal behavior or substance abuse, et cetera. “There's this group of kids that everybody is really excited about,” Miller said. “They beat the odds, and that's absolutely fantastic.”
As a psychologist, Miller brings an interest in the mindset that may have facilitated that success, and at what cost it was enacted. Though none of that excitement is meant to detract from the basic point that these odds ought ideally not to exist. Instead playing fields are so far from level that they make for effective experimental grounds, a study in psychosocial mediators of health requiring no laboratory-induced circumstances.

Meanwhile, the disadvantaged people who are not in the outlier super-conscientious group don't end up in those higher-pressure “successful” situations, and their bodies don't suffer for it. They are apparently spared the physical consequences

of upward mobility. “What we're finding,” said Miller, “is that there seems to be a cost to self-control and/or to the successes that it enables.”

* * *

When things don’t go the way I want them to, that just makes me work even harder.
I’ve always thought that I could make my life pretty much what I want to make of it.
Agreeing with those statements, among others, is diagnostic of John Henrysim. At least, in the right disadvantaged cultural context, according to the JHAC-12 scale. In the 1980s a now-renowned socio-epidemiologist studying public policy in Chapel Hill, North Carolina set about figuring out why black Americans in his state suffered so disproportionately from heart disease and strokes. His name was Sherman James, and what he landed on was the term John Henryism as a description for the “determined, hopeful manner” in which black Americans engage in day-to-day stressors, “not merely to make ends meet ... but to leave something behind.”
Sherman inspired decades of research that would weigh the health costs of upward mobility against its social and economic returns. After 42 years of teaching (now a professor emeritus at Duke and part-time professor of public health at Emory), he’s “delighted” that the next generation of scientists is taking up the concept and beginning to elucidate the physiologic mechanisms that appear to underlie the health disparities he first observed as a student.

“Public policies shape the landscape on which goal-striving is practiced, and the physiologic costs can be high,” James told me. “That's what the different socioeconomic trajectories in this case are telling us. Some young people are climbing mountains that are not so steep. Wealthy white folks aren't climbing a mountain at all.”

Age Acceleration as a Function of Self-Control

Miller et al., PNAS / The Atlantic

To James, the influence of race and class on the slopes shown here is profound, a reflection of culture and differential value placed on different people as a function of physical appearance and some perceived state of being, known as race. Researchers at Harvard School of Public Health recently found that the greatest disparities between blacks and whites in sleep quantity were among people with high-level professional jobs; that high socioeconomic status is beneficial in terms of sleep among whites but detrimental among blacks. The high prevalence of poor sleep among African-American executives, the researchers wrote last year in The New York Times, “can be attributed partly to limited professional and social networks that can provide financial and emotional support; discrimination or microaggressions experienced in the workplace; hypervigilance because of a perceived high work ethic needed to succeed; or greater levels of neighborhood and home stress.”
Of course with a correlation like Miller’s, between aging cells and self-control, the inverse of Miller’s suggested mechanism could be true—aging cells and poor health indicators could be driving psychosocial success rather than resulting from it. He believes that unlikely, though. Because if you just go a little bit up the income/education ladder, these same traits are associated with slower aging and better health. The exact opposite correlation exists in advantaged kids: Self-control is associated with all sorts of positive health outcomes. Only in the disadvantaged communities does this paradox exist: good outcomes on the behavioral/educational/psychosocial side, but apparently at a cost to physical health.

Where's this pressure coming from? There are a couple of proposed explanations, and largely they come down to the physiology of stress.
One is that it's the climb up the ladder that takes the toll. It's a long slog to success. When you come from disadvantaged class/race/place, you have greater obstacles to overcome. You're likely in schools that are underfunded and understaffed. You come from a small town that had fewer resources and opportunities, and your parents were struggling in challenging economic conditions. You don't have the tutors and after-school resources that affluent suburban kids do. So to get to the same place—say, to graduate from college—takes a lot more energy and bandwidth. Miller considers that “a very plausible explanation.”

“It's the extreme unfairness of the circumstances in which people find themselves that's problematic, not the self-control.”

“When you talk to these kids, you see tremendous drive and focus,” Miller said. Part of what may be going on is when you get to a competitive environment like college, and thereafter competition only becomes more fierce, these kids double down on their tendency to overcome—to be focused and persistent. And they do that to the exclusion of social lives, physical activity, eating well. They become so focused on this definition of success that they just neglect some of the lifestyles that happen naturally for the kids who are having an easier time. “There's other work showing that unrelenting effort toward goals has a cost,” said Miller. “People who pour their hearts and souls into achieving certain things often do so at some risk to their health. We’ve known that for quite a while.”

The other is the simple a stark state of being an outlier as the primary cause of stress. In addition to discrimination and alienation, having to manage competing demands of a professional life and a “family-of-origin” life where expectations and norms are dramatically different. Add systemic discrimination on top of alienation from both one’s root-community and from other high-achievers, and the stress is compounded immeasurably.
“These are somewhat novel findings, but a trend is emerging,” said Miller, “and this helps understand observations by other researchers, and then you pull them all together, you start to get a story.” That story seems at its core to be one of belonging. “The ironic and sobering thing that we find is that if you just focus in on the most disadvantaged kids in our studies, the ones who look physically healthiest in terms of blood pressure, obesity, and cellular aging, those are the ones who aren't doing well in school,” said Miller, “the ones who are having occasional run-ins with the law related to aggressive behaviors or substance use.”
In the most disadvantaged group, that means an almost full trade-off between physical health and behavioral/educational barometers of success. So the kids who followed the demographically normative path tend to be the healthiest, even considering that relative poverty and lack of education are health risk factors. The message could be to never be an outlier, but that’s no message.

“I do think the construct of self-control is an ambiguous one, and somewhat problematic,” James said. “Because most people would say self-control is a good thing. To say that in some circumstances it's not, that requires a little bit of verbal jujitsu. It's the extreme unfairness of the circumstances in which people find themselves that's problematic, not the self-control.”
With this work, researchers like Miller are drawing closer and closer to the mechanisms that that lead to cardiometabolic disorders James sought to understand as a student. “It happens in young people who are doing their damnedest to be successful,” James says with consternation as visceral as it reads in the words he wrote on the subject decades ago. “This is what I came to appreciate and be profoundly disturbed by. We’re talking about people hardly being given a chance to pursue their goals without having to pay with their health. This is really, really important work.”