Cited by 79Health disparities and outcomesHealth, Environment, Cognitive AgingBirth, Development, and Health

From the outside in: biological mechanisms linking social and environmental exposures to chronic disease and to health disparities

Open access
Bagby, Susan P., Martin, Damali, Chung, Stephanie T., Rajapakse, Nishadi·2019·American Journal of Public Health

Abstract

The ongoing epidemic of chronic diseases involves a spectrum of clinical entities now understood to represent late manifestations of progressive metabolic dysfunction initiated in early life. These diseases disproportionately affect disadvantaged populations, exacerbating health disparities that persist despite public health efforts. Excessive exposure to stressful psychosocial and environmental forces is 1 factor known to contribute to population-level disparities in at-risk settings. Yet increasing evidence reveals that even a single adverse environmental exposure—especially during very early developmental years—can become literally biologically embedded, inducing long-lasting disease-promoting pathways that amplify responses (e.g., cortisol, immune, inflammatory) to all future adverse stressors, thus enhancing their disease-promoting impacts. The same pathways may also interact with ancestrally linked genetic variants to modify chronic disease risk. We address how, in at-risk populations, environmentally activated disease-promoting pathways can contribute to a biologically based disease-susceptible phenotype; this is likely to be uniquely damaging in populations with multiple adverse exposures and is capable of cross-generational transmission. Intended to complement existing models, this biological perspective highlights key research opportunities and life-stage priorities with potential to enhance the reduction of health disparities.

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Crossref · 10.2105/ajph.2018.304864

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Authors
Bagby, S. P., Martin, D., Chung, S. T., & Rajapakse, N.
Affiliations
National Institutes of Health (US)
Venue
American Journal of Public Health
Published
2019-01
Volume
109
Issue
S1
Pages
S56-S63
ISSN
  • 0090-0036 (ISSN-L)
  • 1541-0048
OpenAlex
W2914448975
Cited by
79
References
39
Citations by year
2026: 7 · 2025: 8 · 2024: 13 · 2023: 12 · 2022: 10 · 2021: 8 · 2020: 14 · 2019: 6
FWCI
9.27
Type
journal article
Language
en
Open access
Locations
  • American Journal of Public Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
health disparities, chronic disease, environmental exposure, psychosocial stress, developmental origins of health and disease, biological embedding, cortisol, inflammation, immune response, gene-environment interaction, intergenerational transmission, disadvantaged groups
MeSH terms
Chronic Disease, Environment, Humans, Longitudinal Studies, Risk Factors, Vulnerable Populations, Racial Groups, Healthcare Disparities

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