Learning objectives
By the end of this lesson, you will be able to:
- Explain the difference between proximal stressors, distal stressors, and epigenetic changes in relation to minority stress.
- Understand how chronic stress from minority stress affects the body.
- Recognize physical health problems linked to minority stress in different groups facing inequality.
Why this matters
Understanding how minority stress affects physical health helps highlight the importance of:
- Reducing discrimination and stigma to improve public health.
- Recognizing the long-term health effects of stress on marginalized communities.
- Developing better support systems for people experiencing chronic stress.
Understanding key terms
A person’s physical health can be affected by both external and internal stressors related to their minority identities.23
Distal stressors (external)
These are stressors that come from outside a person, like prejudice, discrimination, and exclusion. They are often easy to measure.
Example: Brian faces microaggressions at work because he is openly gay. These experiences are a distal stressor in his life.
Proximal stressors (internal)
These are stressors that come from within — such as worrying about being judged or hiding one’s true identity.
Example: Anandi is afraid to go to a Pride event at school because she hasn’t told her friends she is bisexual. Her fear of judgment is a proximal stressor.
Epigenetic changes
These are changes in a person’s genes caused by life experiences, not by what they inherit from their parents. Long-term stress, such as social isolation or discrimination, can trigger these changes.
Epigenetic changes can lead to higher levels of inflammation-related genes, which may increase the risk of chronic health problems.
Example: After years of facing racial discrimination at work, Maria experiences chronic stress. Over time, this stress triggers epigenetic changes that raise her risk of heart disease and other long-term health issues.
Biological effects of minority stress
Minority stress and the HPA axis
The hypothalamic-pituitary-adrenal (HPA) axis helps the body manage stress by releasing cortisol, a key stress hormone.
When someone experiences long-term stress, such as minority stress, the body produces too much cortisol. Over time, this can disrupt the body’s ability to handle new stress and increase the risk of anxiety, depression, and other health problems.24
Minority stress and ANS reactivity
The autonomic nervous system (ANS) controls automatic functions like heart rate and blood pressure. Chronic minority stress can disrupt the ANS, leading to irregular heart rate, high blood pressure (hypertension), and increased risk of heart disease.24
Minority stress and the immune system
Long-term social stress can weaken the immune system, making it harder for the body to fight infections. This happens because:24 25 26
- Stress increases inflammation, which is linked to conditions like heart disease.
- The immune system becomes less effective, which can reduce the body’s ability to fight illness or respond to vaccines.
Examples of physical health problems
| Health issue | How minority stress contributes23 24 |
|---|---|
| Obesity | Discrimination can lead to higher stress eating and weight gain. |
| Cancer | Hiding one’s sexual orientation has been linked to higher cancer risk. Gay men, for example, have higher rates of non-Hodgkin’s lymphoma, Hodgkin’s disease, and anal cancer. |
| Metabolic syndrome | Chronic stress increases the risk of diabetes and heart disease. |
| Hypertension (high blood pressure) | Awareness of negative social messages may raise blood pressure, harming the heart. |
| Heart disease | Lesbian and bisexual women have higher rates of heart disease than heterosexual women. |
| Physical disability | Older lesbian and bisexual women are more likely to develop disabilities compared to heterosexual women. |