Guest blogger Beti Thompson, PhD, is a Member and Associate Program Head and Associate Director of Minority Health and Health Disparities at the Cancer Prevention Program (Fred Hutchinson Cancer Research Center). To learn more about some of her innovative work please click here. When I previously interviewed Beti, we began to discuss the plethora of factors that make up the cycle of poverty. She told me about recent research that has shown that events that transpire throughout one’s life (many of which involving circumstances outside of one’s control) can have lasting health repercussions. These health repercussions often lead to tragic results such as overwhelming medical bills, the death of a family’s income provider, depression, etc. Each of the aforementioned, as well as many more, can perpetuate cycles of generational poverty and can become an obstacle to upward mobility. In the post that follow, Beti discusses the most recent research and what it demonstrates.
In today’s society, we see more chronic diseases than at any other time in history. Part of this is due to treatments of such diseases so that death does not immediately ensue; part of this is due to the increasing longevity of individuals in general; and part of this is due to the nature of disease itself. It is important to note that diseases generally are the result of an evolving process. For example, one does not contract diabetes overnight; nor is the onset of cancer a sudden occurrence. Even more disconcerting is the understanding that disease is shaped by one’s life course; for example, events that occur early in one’s life may contribute to later disease onset. Here, we will discuss how cancer onset may be explained by events in one’s past that seem to have nothing to do with obtaining cancer later in life.
Events that occur during the life-course fall into a variety of types. Some events are continuous, such as poor dietary habits, while others are episodic, such as menarche. Further, some are internal, such as the hormones generated with age, while others are external, such as environmental factors that have an impact on one’s genetic makeup. In addition, some are emotional, such as stress, anxiety, and obsessions, while others are physical, such as abuse, sedentary behavior, and poor dietary habits.
One such external factor is war. War provides examples of real-life situations that can be examined for later consequences. World War II is an example of a time when exposures around diet varied by country. In Europe, during World War II, a number of countries were occupied by Germany and this often led to rationing for food and thus lower caloric intake of residents than compared to non-war times. For our purposes, we will examine two countries that were occupied by Germany and we will examine the effects of diet relative to cancer outcomes. Two countries occupied by Germany included Norway and the Netherlands, and both have examined dietary intake with subsequent cancer outcomes. In Norway, occupied by Germany from 1940 to 1945, food restrictions were enacted early in the occupation with individuals receiving two-thirds to three-fourths of calories compared to their usual diets. A 2002 analysis of Norwegian women who lived in food-producing areas compared to non-food-producing during World War II found decreased incidence of breast cancer among women who lived in the non-food areas, lending some credence to the suggestion that caloric restriction is protective against some cancers.
In the Netherlands, a short eight month famine that lasted from September 1944 to May 1945, cut the daily rations for adults from 1500 kilocalories to 700 kilocalories, an amount less than half of the usual intake. Many individuals died as a result of the famine. More disconcerting were the results of a study of women who were born between 1911 and 1945 and their subsequent incidence of breast cancer. Women were questioned about their exposure to the famine during World War II. They were classified as severely exposed, moderately exposed, or unexposed. Using a scientific design, investigators found that subsequently women who were severely exposed had a four times greater chance of contracting breast cancer compared to those who were not exposed. Those who were moderately exposed had a two times greater risk of getting breast cancer. Further analysis indicated that women who were older during their exposure to the famine had the greatest risk of breast cancer.
A recent paper from Israel indicated that individuals exposed to the Holocaust had increased risks of subsequent cancers. The stressors of Holocaust survivors went far beyond those of victims of the Norway food restrictions and those that suffered from the Dutch famine. Stressors were emotional and physical and the duration of the abuses was both long and continuous. Such stressors are very likely to have an impact on subsequent disease outcomes such as cancer.
These studies indicate that something that happens during the life course may have an effect on some diseases, such as cancer. When considering today’s population distribution in the United States, it may account for some of the disparities we see in cancer and other chronic diseases among the underserved. Poverty may lead to poor health habits, stress, environmental risk, and other long-term stressors which may, subsequently, lead to disease. Thus, one’s past may have severe consequences in one’s future.
Please let me know your thoughts about this research, and what it means in regards to how we view and perceive poverty, by commenting below.