Nancy E. Adler, a health psychologist whose research helped change the public's understanding of the relationship between socioeconomic status and physical health, died on January 4 at her home in San Francisco. She was 77 years old.
According to her husband, Arnold Milstein, the cause was pancreatic cancer.
Dr. Adler was instrumental in documenting the powerful role that education, income, and self-perceived status in society play in predicting health and longevity.
Today, this association is well known. It is a truism among public health experts that life expectancy is determined more by zip code than genetic information. However, this was a vague concept until 30 years ago.
Elissa Eppel, a health psychologist at the University of California, Sun, said, “Thanks to Nancy's work and leadership over the decades, socioeconomic status has become the largest and most consistent determinant of morbidity and mortality that we know of. “It has now been recognized as one of the most predictive factors.” Francisco, and Dr. Adler's mentor.
Since 1997, Dr. Adler has been a member of the MacArthur Institute on Socioeconomic Status and Health, a group of health economists, epidemiologists, physicians, public health experts, psychologists, and sociologists who study the relationship between socioeconomic status and health. He led the Foundation Research Network. The group is credited with bringing the concept of social determinants of health and its impact on health and social policy into the mainstream.
“They focused on the question, 'How do inequality, poverty, and stress affect your skin?'” said Claire Brindis, a public health and policy researcher at UCSF. How many years do you plan to live? ”
Their study was based on the Whitehall Study, a survey of British civil servants started in 1967 that showed a strong link between social class and mortality. The findings pointed to factors other than access to medical care and health insurance.
“What was interesting about Nancy was that the relationship continued all the way to the top,” said Dr. Milstein, a prominent health policy researcher. “Even if she had an extra year of education, or if her income was £200,000 instead of £190,000, the relationship would still exist.”
In 2000, Dr. Adler developed the MacArthur Ladder, a tool that asks people to mark their income, education, and socio-economic status on a 10-step ladder. This remains a reliable predictor of poor health and early disease, indicating that self-perception of the condition is a meaningful marker in its own right.
In a 2007 report for the MacArthur Foundation, she wrote: “Middle-income Americans are more than twice as likely to die early than those at the top of the income scale, and those at the bottom are more than three times as likely to die early.” Yo. ”
Dr. Brindis said of Dr. Adler, “Once in a lifetime, a scientist appears who changes the way we see what is right in front of us.''
Nancy Elinor Adler was born July 26, 1946 in Manhattan to Alan and Pauline (Bloomgarden) Adler. Her mother was a teacher and her father was a clothing manufacturer and salesman. When Nancy was young, her family moved west and settled in Denver.
In middle school, she became obsessed with the fictional teenage detective Nancy Drew, who became a role model of sorts. “I think I was very influenced by Nancy Drew and very excited about the idea of solving her mysteries,” Dr. Adler said in a 2015 lecture at UCSF.
She attended Wellesley College. During her sophomore year, she met Dr. Milstein, who at the time was a junior at nearby Harvard University. Dr. Milstein's sister Anne also attended Wellesley College.
“Anne invited me to meet a nice girl from Denver who lived across the hall,” recalls Dr. Milstein, now a professor of medicine at Stanford University. “After her sister introduced us, she said this was the man she was marrying.”
Dr. Adler graduated in 1968 with a degree in psychology. She married Dr. Milstein in 1975.
In addition to her husband, she is survived by two daughters, Julia Adler-Milstein and Sarah Adler-Milstein. her brother, Richard Adler; and three grandchildren.
Dr. Adler's research challenged prevailing beliefs early on. He received his Ph.D. from Harvard Graduate School. In 1973, she interviewed women before and after abortion for her doctoral thesis.
“At the time, there was a lot of talk about how abortion was a lifelong trauma for women,” said Dr. Harvey Feinberg, president of the Gordon and Betty Moore Foundation, a philanthropic organization based in Palo Alto, California. “I was there,” he says. He was a long-time friend of Dr. Adler. “But Nancy noticed just the opposite. She realized that women saw this as a chance to change the direction of their lives.”
In 1972, Dr. Adler was hired as an assistant professor of psychology at the University of California, Santa Cruz. She moved to the university's San Francisco branch in 1977, where she became professor of medical psychology and associate director of psychiatry and pediatrics. She retired in 2022.
At UCSF, we have embarked on a series of studies demonstrating the link between socioeconomic status and a variety of diseases, including diabetes and cardiovascular disease. In 1979, she edited a book with two of her colleagues there entitled “Health Psychology'' and coined the term. She started the first graduate and doctoral program in health psychology in the United States in her 1980s. Similar programs have since sprung up around the world.
Ten years ago, Dr. Adler encouraged large hospitals to build programs to measure and address social factors in individual health, spurred by growing concern about health disparities. Hospitals and clinics now routinely measure some of them, and many have programs aimed at mitigating them.
