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Primary Care, Stress, and Public Health

This week’s New Yorker (3/21) features a fascinating story (“The Poverty Clinic”) about the link being established between high stress in early childhood and subsequent poor health outcomes. It’s starting to look like these stresses cause poor health even if they don’t lead to unhealthy behaviors (like smoking, drinking, poor eating habits, and so on). The stress, it turns out, has a long-term effect on the body’s immune system and leads to greater susceptibility to a host of chronic, life-threatening diseases (including heart disease and possibly cancer). (You need a subscription to access the full on-line article, but here is the abstract.)

The results aren’t surprising, but they do highlight the need for a more integrated approach to primary care. The pediatrician featured in the piece, who has a Masters in Public Health as well as a medical degree,  has in fact initiated a team approach to the problem. Her clinic draws on a number of specialists outside the medical field to develop a cohesive approach to combating the social factors that cause elevated stress levels.  Given the depth of the social, behavioral, and economic problems that lead to stress, this won’t be easy. But this new approach could be revolutionary.

It’s at least promising, when so little else is.

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