Each person has a powerful combination of characteristics that influence their chances of living a long life. A 2019 study by the City Health Dashboard analyzed the data from the 500 largest cities in the U.S. provides a case in point: a baby born in the Streeterville community of Chicago, in 2015, could live to be 90 years old, while the life expectancy of another baby born just eight miles away, in the Englewood neighborhood, was 60 years. In the Englewood neighborhood, where the life expectancy was 30 years less, 97% of the population is Black and 47% live below the poverty line. Meanwhile in Streeterville, where the residents were living longer, 78% of the residents are white or Asian, with a high income. The same study showed that in 55 other cities—including New York, San Francisco, and Washington D.C.—some people could also expect to live up to 30 years less than their neighbors. At the time, this difference was the same as for people living in Monaco and the Central African Republic, the countries with the longest and shortest life expectancy in the world.
What was behind these stark differences? One larger factor is something we like to call the Toxic Stress Load (TSL). And it’s been hiding in plain sight for decades.
The TSL is the term that describes the build up of negative physical and psychological changes that result from your ongoing need to respond to challenges. It is the baggage, the scars, and the tensions collected through life. When your TSL becomes overwhelming, it triggers changes in your body that are so profound that they are equivalent to accelerated aging.
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The TSL results from our study of the scientific evidence behind two well-researched and validated components. One is “toxic stress,” namely the physical and psychological response to long-term threatening situations or events, especially those that start in early childhood. The other is known as “allostatic load,” which represents the physical price paid by being exposed to prolonged toxic stress. The term “toxic stress load” makes explicit that these two components come together, are generated by coinciding challenges, and compound each other. The TSL is what can, ultimately, kill you prematurely.
Nobody can escape the TSL. What is different, however, across people and communities, is the intensity, speed, duration, and frequency with which it accumulates—the specific sources and the way in which it influences a person’s overall longevity and health. Its effects begin before someone is born, inside the mother’s womb, and end at the time of their death.
Each of us has multiple identities and labels, as well as changing life circumstances that interact constantly and simultaneously, which contribute to our TSL. This “simultaneity” of identities and labels is captured in the term “intersectionality,” which often focuses on the combined effects of gender, race, class, ethnicity, sexuality, age, ability, religion, nationality, and social status. Many of the factors that influence the intensity, frequency, duration, and manageability of the TSL are already in place even before a person is aware of their own existence. In sum, how you are labeled in terms of race, ethnicity, or immigration status has a significant impact on your life expectancy, with consistent disparities among different racial groups, both domestically and internationally, as was seen with the case with cities in the U.S., and between countries such as Monaco and the Central African Republic.
The TSL touches people of every socioeconomic status, anywhere in the world. Business executives, for instance, tend to have a high social status, an advanced education, a comfortable financial situation, admirable resilience, and abundant resources at their disposal to protect their physical fitness, which would all normally set them up for a long and healthy life. This makes the results of a 90-year-long study from Harvard University surprising, as it found that senior managers and executives experience a mortality penalty of around three to five years compared to employees lower in the organizational hierarchy.
Many sources of TSL, however, vary through life, and can be changed. Those that tend to fluctuate and most affect your TSL are poor sleep, worries related to money, work, and family, and loneliness. Analysis of data from more than 3.4 million people found that loneliness is associated with a 26% increase in the risk of premature death, equivalent to the effect of smoking 15 cigarettes a day. These changeable sources are what usually increases the risks of building a dangerous TSL for individuals of any social status. Death by suicide among physicians is one disturbing example. In the U.S. alone, it is estimated that one physician dies of suicide every day. Male physicians are 40% more likely to die by suicide, while female physicians have double the risk of ending their own lives than their non-physician female counterparts in the general population. Although there is a dearth of data around physician suicide, there is suspicion that it emerges from intersecting risk factors such as high levels of psychological distress and burnout, sleep deprivation, and depression—compounded in many cases by racism and discrimination.
Just as it is possible to learn about the risks from those who have the highest TSLs, it is also possible to gain insights from those who manage to live a long life. Research on these longest-lived humans, namely centenarians (those who live past 100 years of age) and “supercentenarians” (those who live beyond 110 years) provide valuable clues on how to keep the TSL at bay. Although they appear to have protective genetic, immunological, and hormonal factors special to them—or to have lived so long because of luck—research on centenarians and supercentenarians has also identified several non-biological characteristics that could improve a person’s chances of getting to an advanced age. Some of these characteristics include a tendency to react with low anxiety to stressful conditions, eat in small amounts that trigger caloric restriction, maintain an ideal weight, exercise regularly, avoid smoking and excessive drinking. Most importantly, they are also actively engaged in community activities, and have close friends and strong social support systems. Rather than being found in isolated small towns of special mountainous regions or valleys, the longest-lived people tend to live in cities with at least 4 million inhabitants in warm and sunny climates, where the life expectancy at birth was already in the mid-70s or higher.
Today, these characteristics might feel like a tall order to apply to your own life. Fortunately, there are some more practical, tangible ways to lessen your TSL. It’s important to focus on on identifying the biggest contributors in your daily life. To do this, it’s worth reflecting on the following questions: What do you feel is the biggest contributor to your TSL? What do you think you need to improve your TSL? What kind of support do you need from others to reduce it? This, then, makes your efforts to manage it more feasible. Even if your levels are low, any reduction in your TSL can be protective.
At any rate, regardless of your labels and identities, which might confer disadvantages or privileges, every day, you will encounter many mental, physical, and social challenges that you will have to overcome in order to thrive. Some you can immediately recognize and tackle. But it’s how you deal with them that makes the difference between a long and healthy life, and one that is cut short.