The stresses of poverty are well known among scientists and public policy experts. The effects of erratic sleep while homeless, the constant worry low-income people feel about whether their paychecks will pay the bills, fear of harassment or discrimination while living on the street, and other experiences of living in poverty are recognized for leading to poor physical and mental health.
New research suggests that young people who escape poverty by doing well in school may suffer from negative health as they age — simply because they work hard.
A study published in July in the Proceedings of the National Academy of Sciences followed 496 black teenagers from working-poor families living in rural Georgia. The teenagers were “strivers” – children who exhibit more self-control and resilience and, despite their impoverished backgrounds, do well in school, go on to lead successful careers and live lives better than their parents’. a
Their hard work and resilience does not come without cost. The researchers found the cells of teenagers who grow up in low socioeconomic circumstances, but work hard and succeed, age much faster than children from more affluent backgrounds. To come to that conclusion, researchers measured the teens’ DNA methylation, the process in which hydrocarbon molecules are added onto DNA, which can impact how genes express themselves at the cellular level.
The study refers to the phenomenon as “skin-deep resilience” – on the surface, poor teens who work hard are just that: kids who overcome all obstacles to better their lives. But underneath that surface, that hard work could be causing irreparable damage.
Dr. Gregory Miller, a professor of psychology and medical-social sciences at Northwestern University, led the study and spoke with Street Roots about self-control among poor teens and the ramifications of the study.
Amanda Waldroupe: Your study concludes that kids from low-income, disadvantaged backgrounds who succeed in school and go onto college – unlike many people in their demographic – end up having poor health. That seems counterintuitive. You would think that their education would teach them to treat themselves well.
Greg Miller: The finding is a little counterintuitive, and why it is intriguing and sobering. We generally believe, and the data supports, the idea that upward mobility is associated with access to more resources like better health care, more money for better food, more time for physical activity, et cetera. All the expectations (are) that strivers’ health is better. But that’s not what we find. We still don’t know why. The research is still in its early stages. What we think is going on is that the striving itself is costing. It is taxing for the body. Maybe it is something unique to this population that faces multiple kinds of disadvantage or a more general phenomenon. It’s a little bit early to make any firm conclusions. The general theory coming out of this study is that this single-minded focus on achievement may be good for achievement, but the downside may be health.
A.W.: What do you find sobering about the findings?
G.M.: What is so sobering for me is that the traits that allow kids from disadvantaged backgrounds to succeed in school and have good mental health (are the) same traits that seem to forecast worse physical health. What’s sobering is that you have these kids who are beating the odds, doing exactly what you’d want them to do in many domains of life and who at the same time are, we think, experiencing a health cost. That’s sobering because it’s unjust and unfair for the kid and it’s bad for our country in terms of human capital and the economy and public health. If the very people who are succeeding are the ones getting the sickest, it makes you worry a lot about what we can do to reduce disparity.
A.W.: Underlying your answer seems to be a critique of the American Dream – the idea that if you work hard, you can improve your life, climb up the socioeconomic ladder, have a more financially secure life. You seem to be saying that comes with a cost.
G.M.: There might be. We need more research to be sure. This certainly suggests that in low-income kids in our sample, the American Dream is costly. What is even more sobering is that this is not more true for the kids in our sample who are less disadvantaged. What we are seeing happening happens amongst the worst-off kids in the study — the really, really disadvantaged. For the somewhat disadvantaged, the not-disadvantaged, these same traits of self-control and perseverance and striving are related to better physical health. It suggests that for the most vulnerable among us, the American Dream is not only hard to attain, but could be quite costly to attain in terms of physical health.
A.W.: Why does the study focus solely on African-American teens living in the rural South? I imagine the findings of your research apply to other segments of the disadvantaged population.
G.M.: African-American kids, particularly in the rural South, face a lot of different and unique challenges. The most at-risk kids demographically can be identified when you look at a combination of outcomes academically, occupationally, in criminal justice and mental health. These kids by virtue of race, class and geography stand out for their risks. We’re interested in what places these children at risk and what protective options exist to create better outcomes.
A.W.: Your study refers to these high-achieving, disadvantaged kids as “strivers.” What does that mean?
G.M.: In disadvantaged communities, there are kids who statistically you would expect to be at-risk for poor outcomes in school, in the workplace, mental health-wise, criminal justice-wise. But there is a significant subset of these kids who beat these numbers and beat those odds. What we see in talking with them and interviewing them is that they are striving for better outcomes, to go further in school than their parents have, their grandparents, and they’re striving in putting in lots and lots of effort. They seem, relative to other groups of kids, to be very intensely focused on achievement and doing well. What we often hear with middle-class and upper-class kids is that they’re trying to succeed in school (and) get into prestigious colleges and universities, but at the same time, they’re really busy filling out their résumés with extracurriculars like music or cultural efforts. These kids, by contrast, are solely focused on school.
A.W.: Why do they focus so intensely on school? What is at stake for them?
G.M.: We have not studied why that is yet. My hunch is that they realize the deck is stacked against them. The normal trajectory is to move from high school into an industrial job. Going to college isn’t the normative thing to do. So you have to strive and you have to work differently and pour yourself more into school than average.
A.W.: Tell me about the concept of resilience from a psychological perspective.
G.M.: You can think of self-control as the ability, which varies from person to person and context to context, to stay focused on long-term goals and achieving them. And to do that, you need to both resist the temptation to take detours on short-term gratification and engage in behaviors that may not be immediately gratifying or rewarding, but over the long term are going to move you toward the larger abstract goals.
A.W.: What is epigenetic aging?
G.M.: Epigenetic aging is just a way to measure how old people's blood cells look, relative to chronologically, and how much turbulence those cells have taken.
A.W.: What is the connection between self-control and aging faster at the cellular level?
G.M.: Self-control is hard for everybody, right? It is a limited resource regardless of how privileged or disadvantaged you might be financially. That’s why we all need vacations, that’s why we all need to relax, why we all lose willpower and dive into that chocolate cake or cigarette or television. What we know about self-control is, in general, is that it is depletable, but also renewable if you have a little respite.
But this having to be on all the time, focused and watching yourself, is hard work. Eventually, people just become physiologically taxed. If you’re African-American from a low-income family from a rural area, you have to work many more times as hard to get to the same place as your peers from an affluent suburb. It’s a lot more effort, discipline and a lot more self-control. And there aren’t as many respites.
A.W.: Does that mean if you’re looking at a 30-year-old person in this cohort, at the cellular level they are closer to 45, for instance?
G.M.: We don’t know yet exactly what that means. Other studies show that they have higher blood pressure, they seem to have higher body mass and more fat. It seems like they are farther down the road toward eventual health problems than their peers. We know that a lot of the problems people eventually have with diabetes and heart disease don’t start in middle age. They start in childhood and adolescence, and they progress at a slow pace. With strivers, these problem seems to be starting faster.
A.W.: Is it normal to have such a disparity between biological and chronological aging? What is the relationship between the two?
G.M.: They are highly related. The distance between them tell us something about how much stress people are under and what underlying health risks there are. For example, if you look at cancer cells from a 20 year old, those cells look like they are 50 or 60. If you look at liver cells from someone who is obese, (those cells) look about five years older than someone who is not obese. What we know is that agitation from chronological age is a risk factor (for) already having health problems, or that you will have them in the future.
A.W.: Suppose you sat one of these high-achieving people down and you told them their health is poor because they’ve worked so hard to have a good career and a stable life. Do you think that is something they would realize about themselves?
G.M.: That’s a good question. We don’t know the answer yet.
A.W.: You’ve said repeatedly during this interview that this area of research is new. What are the questions you now have?
G.M.: This is very early stage work and raises more questions than answers. The next steps are figuring out some of the most pressing questions about how generalizable (the findings are). Is it something about the kids we’re studying, or more broadly applicable to other kids, other places, other classes? That’s the main thing we want to know right now.
There is still uncertainty about what this means for actual health problems or mortality. What does it mean for long-term disease? Everything we studied so far is a biomarker — a precursor of disease. It doesn’t mean you have the health problems. Finding out whether these kids are the ones who go on to have heart attacks and strokes is 40 years down the line. We can’t get answers immediately like we could if we were studying fruit flies or bacteria. If you want to do studies with kids, you have to follow them for decades and decades.
This interview has been edited for length and clarity.