How Poverty Gets Under the Skin: A Life Course Perspective

There is a large epidemiological literature documenting inverse relations between socioeconomic status (SES) and morbidity as well as mortality. In this chapter we focus on biological mechanisms to explain how disadvantage gets under the skin. We adopt a life course perspective on this topic because it illuminates several issues: whether the timing and duration of exposure to disadvantage over the life course matter, and factors that may cause biological mechanisms, changed by deprivation in early life, to persist throughout the life course. This chapter is organized into 5 major sections. Sections 1 through 3 review evidence linking SES or one of its primary constituents to disease-relevant biological mechanisms during childhood, during adulthood, and prospectively from childhood to adulthood, respectively, and section 4 examines the durability of early life deprivation and altered trajectories in biological mechanisms over the life course. We conclude with section 5, which presents a research agenda and discusses intervention consequences of a life course perspective on the biology of disadvantage.