| The Environmental "Riskscape" and Social Inequality: Implications for Explaining Maternal and Child Health Disparities Rachel Morello-Frosch1,2 and Edmond D. Shenassa2,3 1Center for Environmental Studies; 2Department of Community Health, School of Medicine; and 3Centers for Behavioral and Preventive Medicine, Brown University, Providence, Rhode Island, USA Abstract
Background: Research indicates that the double jeopardy of exposure to environmental hazards combined with place-based stressors is associated with maternal and child health (MCH) disparities. Objective and Discussion: Our aim is to present evidence that individual-level and place-based psychosocial stressors may compromise host resistance such that environmental pollutants would have adverse health effects at relatively lower doses, thus partially explaining MCH disparities, particularly poor birth outcomes. Allostatic load may be a physiologic mechanism behind the moderation of the toxic effect of environmental pollutants by social stressors. We propose a conceptual framework for holistic approaches to future MCH research that elucidates the interplay of psychosocial stressors and environmental hazards in order to better explain drivers of MCH disparities. Conclusion: Given the complexity of the link between environmental factors and MCH disparities, a holistic approach to future MCH research that seeks to untangle the double jeopardy of chronic stressors and environmental hazard exposures could help elucidate how the interplay of these factors shapes persistent racial and economic disparities in MCH. Key words: birth outcomes, environment, health disparities, stress. Environ Health Perspect 114: 1150–1153 (2006) . doi:10.1289/ehp.8930 available via http://dx.doi.org/ [Online 6 April 2006]
Address correspondence to R. Morello-Frosch, Center for Environmental Studies and Department of Community Health, School of Medicine, Brown University, 135 Angell St., Box 1943, Providence, RI 02912 USA. Telephone: (401) 863-9429. Fax: (401) 863-3503. E-mail: rmf@brown.edu We thank S. Yu for her comments on an earlier version of this manuscript. E.D.S. was supported by grant R40MC03600-01-00 from the Maternal and Child Health Bureau, Department of Health and Human Services. The authors declare they have no competing financial interests. Received 16 December 2005 ; accepted 6 April 2006.
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