Nancy E. Adler, a health psychologist whose work helped transform public understanding of the relationship between socioeconomic status and physical health, died Jan. 4 at her home in San Francisco. She was 77 years old.
The cause was pancreatic cancer, said her husband, Arnold Milstein.
Dr. Adler has been instrumental in documenting the powerful role that education, income, and societal self-perception play in predicting health and longevity.
Today, the connection is well known: A truism among public health experts is that life expectancy is determined more by your ZIP code than your genetic code. But it was an obscure notion just 30 years ago.
“It is because of Nancy’s decades of work and leadership that we now recognize socioeconomic status as one of the most important and consistent predictors of morbidity and mortality that we know of,” said Elissa Epel , health psychologist at the University of California, San. Francisco and a mentee of Dr. Adler.
From 1997, Dr. Adler led the MacArthur Foundation Research Network on Socioeconomic Status and Health, a group of health economists, epidemiologists, physicians, public health experts, psychologists, and sociologists who have studied the relationship between socioeconomic status and health. The group was credited with introducing the concept of social determinants of health, and their implications for health and social policy.
“They asked themselves: ‘How does inequality, poverty or stress bother you?’ “, said Claire Brindis, a public health and policy researcher at UCSF. “How does this affect your life?” How many years will you live?
Their work was based on Whitehall Study, a survey of British civil servants launched in 1967, which showed a strong link between social class and mortality. This finding highlights factors beyond access to medical care or health insurance.
“What intrigued Nancy was that the relationship persisted even up to the upper echelons,” said Dr. Milstein, a leading health policy researcher. “If you had an extra year of study, or if you earned £200,000 instead of £190,000, the relationship still existed.”
In 2000, Dr. Adler developed the MacArthur Scale, a tool that asks people to indicate their perceived income, education and socioeconomic status on the rungs of a 10-step ladder. It remains a reliable indicator of worsening health and early illness, indicating that self-perception of one’s status is a significant marker in itself.
In a 2007 report for the MacArthur Foundationshe wrote: “Premature deaths are more than twice as likely for middle-income Americans as those at the top of the income scale, and more than three times as likely for those at the top of the income scale. found at the bottom of the ladder than those at the top. »
Dr. Brindis said of Dr. Adler, “Once in a lifetime comes a scientist 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. His mother was a teacher, his father a clothing manufacturer and seller. When Nancy was a young child, her family moved west and settled in Denver.
In middle school, she was captured by Nancy Drew, the fictional teenage detective, who became something of a role model. “I think I really stuck with Nancy Drew and got really excited about the idea of solving mysteries,” Dr. Adler said in a statement. talk at UCSF in 2015.
She attended Wellesley College. During her sophomore year, she met Dr. Milstein, then a student at Harvard, whose sister, Ann, also attended Wellesley.
“Ann invited me to meet a lovely girl from Denver who lived across the street from her,” recalls Dr. Milstein, now a professor of medicine at Stanford University. “After introducing us, my sister told me that this was the girl I would marry.”
Dr. Adler graduated in 1968 with a degree in psychology. She married Dr. Milstein in 1975.
Besides her husband, she is survived by two daughters, Julia Adler-Milstein and Sarah Adler-Milstein; his brother, Richard Adler; and three grandchildren.
Dr. Adler’s research challenged mainstream thinking from the start. In graduate school at Harvard, where she earned a Ph.D. In 1973, for her doctoral thesis, she interviewed women before and after an abortion.
“At the time, there was a lot of talk about abortion equating to lifelong trauma to the woman,” said Dr. Harvey Fineberg, president of the association. Gordon and Betty Moore Foundation, a philanthropic organization based in Palo Alto, California, and which was a longtime friend of Dr. Adler. “But Nancy discovered exactly the opposite. “She discovered that women saw it as a chance to reposition their lives. »
In 1972, Dr. Adler was hired as an assistant professor of psychology at the University of California, Santa Cruz. She joined the university’s San Francisco branch in 1977, where she became professor of medical psychology and vice chair of the departments of psychiatry and pediatrics. She retired in 2022.
At UCSF, she embarked on a series of studies demonstrating the link between socioeconomic status and a range of diseases, such as diabetes and cardiovascular disease. In 1979, with two colleagues, she edited a book called “Psychology of Health”, thus coining the term. She launched the first graduate and postdoctoral programs in health psychology in the United States in the 1980s. Since then, similar programs have emerged around the world.
A decade ago, encouraged by growing attention to health disparities, Dr. Adler recommended that large hospitals establish programs to measure and address social factors in personal health. Today, hospitals and clinics measure some of them regularly, and many have programs to mitigate them.