Why poverty is a disease

According to the description of my achievements today, you would never have guessed that I grew up in poverty and hunger.

My last salary for the year has passed for $ 700,000. I am a member of the Truman National Security Society [ engaged in the search and promotion of future leaders of the American nation - approx. trans. ] and a member of the Council on Foreign Relations . My publisher recently released my latest series of books on the quantitative distribution of global finance.
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And all this is not enough for me. I constantly feel in a state of " beat or run, " I wait for a trick, or the onset of hungry days. I even decided not to have children, because, despite all the successes, I do not feel that there is a safe financial pillow. The minimum state of the account in which I am ready to think about children is a very big figure. If you were personally acquainted with me, you could sense the signs of stress, self-doubt, anxiety, and depression. And hear about Tennessee.

Not a single resident of Tennessee will tell you that he is just from Tennessee. He will definitely add: Eastern, Western or Middle. My life began in East Tennessee, in the town of Rockwood in the Appalachia region. I was the oldest of four children in a family, whose income did not allow me to keep one. Every Pentecostal church of this heroin outback smelled the same: a heavy mixture of cheap detergent and even cheaper oil, with a small amount of forgotten hope. One of these abandoned churches was, in fact, my children's home and school.



The training class consisted of one room in which 20 people, from kindergarten to 12th grade, were engaged according to the “ accelerated Christian learning ” manual. We were handed out booklets that we had to read on our own. We ourselves put down marks for homework. There were no lectures, and I did not have a teacher. Sometimes the preacher's wife handed out tests. We were not allowed to do anything. There were no films or music. Years could pass during which nothing happened that would distinguish one year from another. There was no talk about any social events.

I spent all my time pondering simple questions. Where will my next dinner come from? Will I have electricity tomorrow? I watched my mom try to hide food stamps at the grocery store’s checkout in shame. I remember when, at eight years old, I experienced panic because of the constant uncertainty about absolutely all aspects of life, from food to clothing and learning. I knew that my life could not be normal. Something was wrong with the tiny microcosm in which I was born. I just did not know what.

Growing up, I thought I understood what was wrong there. I have always believed that my upbringing made me cautious and prudent. But over the past few decades, many new things have emerged. We have learned that the stress associated with poverty can change your biology in ways that we never imagined before. It can reduce the surface of the brain, shorten telomeres and longevity, increase the chances of obesity and the propensity for excessive risk.

And now there is information about the fact that these changes can be even deeper - down to the level at which our bodies collect themselves, changing the types of cells from which they are made, perhaps even to the expression of the genes with which the body plays, as with the Rubik's cube, thrown into the washing machine. If the research results are confirmed, it will mean that poverty is not just a socio-economic condition. This will be a set of related symptoms that can be prevented and treated, and even inherited. In other words, the results of poverty begin to resemble the symptoms of the disease very much.

The word "disease" carries a negative connotation. I do not mean that poor people are bad or corrupt. I mean that poor people are sick, and everyone else tells them that their condition is a necessary, temporary, and even positive part of modern capitalism. We tell the poor that they have a chance to break free simply by working hard enough; that we are all equally involved in a system that distributes equally rewards and punishments. We point to rare stories “from the poor to the rich,” as happened to me, and it all fits into the pattern of meritocracy [ lit. - “the power of the worthy” - approx. trans. ].

But my virtues are irrelevant to how I escaped from there.

We may not remember the year 1834 as a record year, but it was such in the field of organic chemistry. It was then that Jean Baptiste Dumas and Eugene Peligo were distilled from heated sawdust and analyzed a clear liquid, which they called methylene, and we call it methanol , wood alcohol. It is based on a methyl group consisting of one carbon atom bound to three hydrogen atoms. And as it turned out 150 years later, the methyl groups play a crucial role in gene expression .

In the fall of 1991, Aaron Razin and Howard Tsedar published an unusual work, DNA Methylation and Gene Expression, in which they showed that the work of gene expression very much resembles a snake tightly curled around Asclepius's staff . [Razin, A. & Cedar, H. DNA methylation and gene expression. Microbiological Reviews 55, 451-458 (1991)] On the strong weaves of our genetic code, there are methyl groups that control how tightly our genetic code is wrapped around special proteins called histones . The tighter the part of the code is twisted, the less likely it is to influence something, that is, the less likely it is to “express”. This is one of the pillars of the epigenome : your human appearance is determined not only by DNA, but also by what part of it your epigenome allows for expression.

Six years later, Michael Mini, a professor at McGill University who specializes in stress biology, published a revolutionary result along with colleagues: the quality of maternal care affects rat epigenomes, glucocorticoid stress receptors in the hippocampus, and the reaction of the hypothalamic-pituitary-adrenal axis (HPA) ) to stress. [Liu, D., et al. Maternal care, hippocampal glucocorticoid receptors, and hypothalamic-pituitary-adrenal responses to stress. Science 277, 1659-1662 (1997)] Similar effects were later found in zebra hornas , which, like humans, are socially monogamous, and in which both parents raise children. The levels of messenger RNA glucocorticoid and mineralocorticoid receptors in birds deprived of their mothers were reduced, and therefore, in adult birds, stress hormones remained elevated much longer. Researchers wrote that epigenetic mechanisms may be responsible for these changes - but they have not proven this. [Banerjee, SB, Arterbery, AS, Fergus, DJ, & Adkins-Regan, E. Deprivation of the hypothalamic-pituitary-adrenal axis of zebra finches. Proceedings of the Royal Society B 279, 759-766 (2012)]



In human children, epigenetic changes in the expression of stress receptor genes, leading to an increased stress response and mood problems, have been associated with child abuse. [McGowan, PO, et al. Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience 12, 342-348 (2009)] Last year, researchers at Duke University found that "low socioeconomic status during adulthood is associated with an increase in methylation of the nearest serotonin transporter promoter, " which causes the amygdala to be susceptible to "reactivity associated with a threat. " [Swartz, JR, Hariri, AR, & Williamson, DE] Molecular Psychiatry 22, 209-214 (2017)] And although the predisposition to high levels of stress has its advantages (for example, learning under stress can be accelerated [Champagne, DL, et al. Maternal care and hippocampal plasticity: Evidence for experience-dependent structural plasticity, altered synaptic functioning, and differential responsiveness to glucocorticoids and stress. Journal of Neuroscience 28, 6037-6045 (2008)]), the main essence of these studies is that chronic stress and uncertainty in childhood leads to the fact that in adulthood with stress is more difficult to handle.

On the one hand, epigenetics offers an intriguing presentation of our life, going backwards to the main “program” that makes you who you are. But in this area there are fundamental contradictions. Last June, a team of researchers from the Albert Einstein College of Medicine at the University of Bristol and the European Institute of Bioinformatics published a paper that described how this area was polluted by misinterpretation of research results. For example, researchers often confuse the cause with the effect (diseases can lead to epigenetic markers, and vice versa); falsify or misinterpret statistics; mixing of variables leads to a visible correlation of parameters; does not take into account the great variability of the epigenome from cell to cell.

John Grilli, one of the co-authors of the study, believes that some notable results in this area, including those that Mini received, suffer from these problems. "During the Mini study, it was believed that if I observe a change in DNA methylation in the cells of rats that my mother did not lick, or in the cells of children from a lower socioeconomic group, or anyone else, then I will learn how people reprogrammed under the influence environmental conditions ". But a change in DNA methylation explains not only whether a cell has been reprogrammed or not. They are also associated with proportions of cell subtypes, each of which has its own epigenomes that are present in the compared organisms. Grilli et al. Call this a meta-epigenome.

But Grilli notes that even if this molecular mechanism is not reprogramming of cells through methylation, but a shift in the cell subtype, there is still something to think about. “Even if you find a change in the proportions of, say, cell subtypes in peripheral blood, which is associated with such things as low socioeconomic status, it will be a very interesting discovery,” he says. “Then we will again return to the question of defining what epigenetics is.” It is possible that the shift in cell subtypes is inherited, although this does not include reprogramming cells through methylation. Tim Spector from King’s College, London, for example, found variants of DNA sequences associated with variations of cell subtypes.

The study of the biological effect of stress associated with poverty is still in its early stages. At the same time, it has already given us many mechanisms capable of providing such effects, many of which contain an inherited component. If, say, a pregnant woman is exposed to the stress of poverty, her fetus and gametes of the fetus may suffer from this, with the result that these effects extend to at least her grandchildren. Or maybe further.



Studies of mice and fruit flies have shown that epigenetic features similar to those mentioned by Mini, can be inherited and persisted for at least dozens of generations. The effects of such things as diet and prenatal stress are inherited not only through modification of histones , but also through DNA methylation and non-coding RNA [Lim, JP & Brunet, A. Bridging the transgenerational gap with epigenetic memory. Trends in Genetics 29, 176-186 (2013)]. In a study from 2014, scions of a mouse trained to fear a certain smell also feared this smell, although they had not felt it before. This effect has persisted for two generations. Nature Neuroscience 17, 89-96 (2014)]. In humans, the inherited effects of stress have been observed for at least three generations in people whose ancestors suffered from massive hunger (the hungry winter of 1944 in the Netherlands [Heijmans, BT, et al. Persistent epigenetic differences associated with prenatal exposure to famine in humans). the National Academy of Sciences 105, 17046-17049 (2008)]), food interruptions ( Everkalik experiment [Pembrey, M., Saffery, R., Bygren, LO, & Network in Epigenetic Epidemiology. experience: Potential impact on development, health and biomedical research, Journal of Medical Genetics 51, 563-572 (2014)]) and during the Holocaust. The consequences of smoking or chewing tobacco by parents at a young age can be passed on to their children depending on gender, which proves the presence of epigenetic effects in people [Pembrey, ME, Bygren, LO, & Golding, J. The nature of human transgenerational responses. In Jirtle, RL & Tyson, FL (Eds.) Environmental Epigenetics in Health and Disease Springer Publishing, New York, NY (2013)]. According to observations from 2014, "several human studies indicate the existence of epigenetic effects along the male line that cannot be explained by cultural or genetic inheritance."

Even at the current stage, we can extract some information from science. First, the stresses associated with poverty have biological consequences that last a lifetime. Secondly, there is evidence that these effects can be inherited, either through effects on the fetus, or through epigenetics, through cell subtypes, or something else.

And this scientific evidence compels us to revise the cornerstone of American mythology and our policies aimed at the poor: the opportunity to get upstairs without any help. Stories about people who have made themselves, escaped from their surroundings through hard and hard work. A pillar of the meritocracy platform, where the rewards supposedly rightly fall on those who deserve them the most.

What kind of independent exit from the environment or fair distribution can we talk about if poverty injures the participants of the “competitions”? Especially if it is also transmitted through generations? And the ugly consequence of the “self-exiting” hypothesis, suggesting that people who did not get out of difficult circumstances deserve them, makes even less sense in the light of the gloomy biology of poverty. When the shotgun of a starting pistol sounds, the poor are far behind the starting line. I was definitely there, despite my current success.

So how did I get out of there? By chance.

It would be very easy to tell my story, explaining everything with talents and hard work, because that's what feeds us, from Hollywood to politicians. But that would be untrue. My flight was due to a succession of surprisingly unlikely events, none of which were under my control.

By the age of 14, for 8 years I had been trying to teach myself with the help of photocopied booklets, without textbooks, lesson plans, help, or at least a teacher. I was desperate to get out and was terribly afraid of becoming the same as the people around me. So I picked up the phone book and started calling vocational schools, colleges, everyone and everything who could give me the opportunity. Accidentally and unexpectedly, I came to the president of a community college [a two-year college that prepares specialists of medium qualification to work in the local community - approx. trans. ] Sherry Hopp. When I first met her, I was probably 12 years old, and even at that age I could understand that my story was not unique to her.

In the same college, I met Bruce Cantrell, a professor who replaced my father when I was 15, and I was poor. He also grew up in poverty, but as a result, he became a people. We did not particularly talk about our experience, but somehow we immediately found a common language. A few years later, he went into politics and made me the manager of his election campaign. We won, and I received an invaluable education in the real and arrogant politics of Roan County . I will forever be grateful to Bruce and Sherry. With their help, I finally got a college degree.

Did I take the initiative? Of course. Many interpreted my escape from poverty as confirmation of the existence of a meritocracy, justifying the entire system. But the backwoods are filled with people who are just as desperately trying to get out of there as I, and are taking the same inventive measures. So I - the exception, confirming the rule - the rule that escape from poverty is possible only by chance, and not because of certain merits.

I have relatives and friends, as smart and hardworking as I myself, and about the same, or with the best, education. But none of them got out of poverty. One of them also went to community college, but only after he witnessed how his best friend had committed suicide under the influence of drugs. It turned out to be a one-way ticket to life, filled with emotional issues. Another was lucky to get into an accredited free secondary school, where they give much more knowledge than in the course of “accelerated Christian education”. He became a heroin addict. For them, the path to education did not, as for me, wonderfully free from obstacles. They have not become, like me, the head of a company trading Wall Street derivatives. They do not write, like me, about poverty. They live in it. And today I can count about 20 relatives and friends who have said goodbye to life through weapons or heroin. I have no doubt that this year their number will increase.



Why do so few people escape poverty? I can testify by experience - not due to the fact that some have more dignity than others. This is because being poor means taking big risks. The asymmetry of the results for the poor is so huge, because being poor is very expensive.Imagine that you lost your job, because your telephone did not work, or you did not pass the exam, because you spent a whole day in intensive care because of an illness that would be eliminated by timely treatment. Such simple misfortunes can trigger a whirlpool of failures from which one cannot escape. The reality is that if you are poor, and made only one mistake - you are finished. Life turns into a gamble with death in the form of loss.

Now imagine that your brain is designed to multiply the subjective feeling of stress by 10. As a result, you focus on short-term plans. Those lucky enough to get acquainted with the calculus of the poor by birth, it seems that the poor once and again make less than optimal decisions. But the choice of the poor in their circumstances is very reasonable. You can not talk about optimal solutions, designed for a long period, if you have two days of food left. Stress acquires a completely new meaning, and it is very difficult to get rid of it.

The standard American myth of meritocracy misjudges stories like mine. The accumulated social capital of American institutions - a stable transfer of power, the rule of law, entrepreneurship - of course, creates economic wonders every day. But these institutions are primarily suitable for exponential growth of capital, where it already exists, and not for creating new capital, where society needs it. Stories like mine are considered archetypes, and we all unjustifiably believe that a way to reach the speed of runaway exists for entire segments of the population. But here I am presenting a story of success “from rags to riches”, and I declare that this story is a myth. The term "meritocracy" was invented in 1958 to mock the very idea of ​​getting rewards for dignity. We forgot to laugh,and the joke turned against us.

It’s time we take a different attitude to poverty and take into account new scientific data describing it.

Take education. One of the most active researchers of the link between poverty and academic achievement, as well as subsequent economic problems, is Roland Fryer from Harvard. Together with his colleagues, he may not need the help of the whole village for this: increasing the achievements of the poor ”[ an allusion to the saying“ raising a child is needed by the whole village ”, meaning that the child is raised by the entire local community - approx. trans. ] focused on reducing the difference in achievement between rich and poor, using different strategies for learning in school.

But the standard measure of difference in achievement — success in mathematics — is a symptom, not a cause. When support for social programs for schoolchildren ceases, their positive effect diminishes, and we begin to be skeptical about the eradication of poverty. But academic success is not the main problem. The problem is uncertainty and stress. When the national assessment of educational progress in 2011 did not find a single city in America where more than at least 25% of eighth-graders from black or Latin American families would have mastered reading and reading at the level of their class, we should blame for this school, or conclude that we lost in the neurobiological race even before we tested these children?



We should use the knowledge gained by science about poverty, and not ignore them. Poverty eradication programs, such as conditional cash benefits, reward parents or guardians for specific actions, such as tracking school attendance or preventing health. They encourage stress relief and long-term planning, and this goes far beyond just passing exams — they provide exactly the sense of confidence that the brain-afflicted brain needs. In a 2009 paper, Leah Fernald and Megan Ganer showed that such programs reduced cortisol levels in saliva and the risk of mental and physical illness throughout life [Fernald, LCH & Gunnar, MR . Social Science & Medicine 68, 2180-2189 (2009)].There should be more such programs. For example, the so-called long-term care programs for a child: they are engaged in the development of children from birth and the first three years of their growth [in the United States, federal law gives a mother the right to take unpaid maternity leave for 12 weeks, starting no earlier than 2 weeks before the expected date of birth, provided that the expectant mother has worked in the company for more than a year - approx. trans. ].

Our new scientific understanding of the effects of poverty can change the health care of adults. In 2009, Michael Mini, Gustavo Turetsky, Moishe Zif and their colleagues took samples of the hippocampus from suicide victims who had experienced child abuse, and tested DNA methylation that controls the expression of the NR3C1 gene. They found increased methylation in the promoter region of NR3C1, which other studies directly associated with a decrease in protein expression called brain neurotrophic factor(BDNF). BDNF is among the most active neurotrophic factors that drive the growth and development of new neurons even in adulthood. And the expression level can be inherited. In a 2015 study, a link was found between NR3C1 and a decrease in BDNF expression in infants whose mothers reported symptoms of prenatal depression [Braithwaite, EC, Kundakovic, M., Ramchandani, PG, Murphy, SE, & Champagne, FA Maternal prenatal depressive symptoms predict infant NR3C1 F and BDNF IV DNA methylation. Epigenetics 10, 408-417 (2015)].

It may be that BDNF is your best friend if you are an adult and you want to change your neurobiology. It can open the way to a change in the structure of the brain in precisely those areas that have suffered the most from early stress and poverty: the prefrontal cortex, hippocampus, and the entire hypothalamic-pituitary-adrenal axis. And these parts of the brain control long-term memory, emotions, and deferred rewards. All these are signs of people coping better with their studies in their youth and reaching more in maturity [Xu, X., et al. A significant association between the BDNF promoter methylation and the risk of drug addiction. Gene 584, 54-59 (2016)] [Kheirouri, S., Noorazar, SG, Alizadeh, M., & Dana-Alamdari, L. Elevated brain-derived neurotrophic factor correlates negatively with severity and duration of major depressive episodes. Cognitive and Behavioral Neurology 29,24-31 (2016)]. Small doses of ketamine have an effect similar to fast antidepressants, and this is directly related to an increase in BDNF levels [Haile, CN, et al. Plasma brain derived neurotrophic factor (BDNF) and response to ketamine in treatment-resistant depression. International Journal of Neuropsychopharmacology 17, 331-336 (2014)].

I would try this treatment myself. But my main interest in the study of poverty is elsewhere. It stems from anxiety about the future.

We are on the edge of a cliff, and we urgently need to reconsider our understanding of poverty and inequality. Western neo-liberals tell us tales that if you work hard, then everything will be fine. And if nothing is formed, then the victim is blamed for everything, and they leave him no choice. Brexit, Le Pen and Hillary Clinton's defeat are examples of problems stemming from inequality and poverty. Already uncovered forks Piketty [ French economist who wrote a popular book about economic inequality in the US and Europe - approx. trans.], and the march of global turmoil can be stopped only by applying measures that oppose the speckled deck that everyone who is born in poverty, including me, receives and hates.

I am sure that the Italian party “Five Stars Movement” this year will launch a referendum on secession from the EU, and that Marine Le Pen has every chance of winning the French election [ not won, but is going to participate in the parliamentary elections - approx. trans. ].The EU can take the blame for the defeat of globalists and fall apart in two years.

Such trends are accelerated by the belief that the poor have failed to grasp the opportunities created by the globalized market. It is time to strangle this myth - and the emerging empirical scientific studies of poverty can help us in this if we give them the attention they deserve.