{{Notability|date=November 2021}}

'''Biological inequity,''' also known as biological inequality, refers to the "systematic, unfair, and avoidable stress-related biological differences which increase risk of [[disease]], observed between social groups of a population".<ref name=":0">{{Cite medRxiv |last1=Camargo |first1=Araceli |last2=Hossain |first2=Elahi |last3=Aliko |first3=Sarah |last4=Akinola-Odusola |first4=Daniel |last5=Artus |first5=Josh |last6=Kelman |first6=Ilan |date=2021-01-25 |title=Using an Ecological and Biological Framing for an Anti-racist Covid-19 Approach |language=en |medrxiv=10.1101/2021.01.24.21250397v1}}</ref><ref>{{Citation|title=Questioning Identity and The Past - Encoding Inequalities in our Infrastructures M1S3| date=7 April 2021 |url=https://www.youtube.com/watch?v=mpC5uL_u9jw|language=en|access-date=2021-10-21}}</ref><ref>{{Cite web|title=Centric Lab — What is Health|url=https://www.thecentriclab.com/what-is-health|access-date=2021-10-21|website=Centric Lab|language=en-GB}}</ref><ref>{{Cite web|date=March 2020|title=Neuroscience, urban regeneration and urban health|url=https://www.researchgate.net/publication/342902782|website=Research Gate}}</ref> The term developed by Centric Lab<ref>{{Cite web|title=Centric Lab|url=https://www.thecentriclab.com/|access-date=2021-10-22|website=Centric Lab|language=en-GB}}</ref> aims to unify societal factors with the biological underpinnings of [[health inequities]] – the unfair and avoidable differences in health status and risks between social groups of a population — such that these inequalities can be investigated in a holistic manner.<ref>{{Cite web|title=Health inequities and their causes|url=https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes|access-date=2021-10-21|website=www.who.int|language=en}}</ref><ref>{{Cite journal|last=Braveman|first=Paula|date=2006|title=Health disparities and health equity: concepts and measurement|journal=Annual Review of Public Health|volume=27|issue=1 |pages=167–194|doi=10.1146/annurev.publhealth.27.021405.102103|issn=0163-7525|pmid=16533114 |bibcode=2006ARPH...27..167B }}</ref>

== Mechanism == Biological inequity posits that health inequity in urban populations is a result of structurally [[Structural racism|racist]] processes executed through the built environment. Specifically, particular social groups are disproportionately exposed to physical and psychosocial stressors in the urban environment. For example, studies show Black, Asian, and Minority Ethnic (BAME) groups inhabit more deprived<ref>{{Cite web|title=People living in deprived neighbourhoods|url=https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/people-living-in-deprived-neighbourhoods/latest#main-facts-and-figures|access-date=2021-10-21|website=www.ethnicity-facts-figures.service.gov.uk|date=16 June 2020 |language=en}}</ref> and environmentally polluted neighbourhoods.<ref>{{Cite journal|last1=Brulle|first1=Robert J.|last2=Pellow|first2=David N.|date=2006|title=Environmental justice: human health and environmental inequalities|journal=Annual Review of Public Health|volume=27|pages=103–124|doi=10.1146/annurev.publhealth.27.021405.102124|issn=0163-7525|pmid=16533111|doi-access=free}}</ref> Through this, these groups experience prolonged exposure to physical (e.g., air pollution<ref>{{Cite journal|last=Thomson|first=Errol M.|date=2019|title=Air Pollution, Stress, and Allostatic Load: Linking Systemic and Central Nervous System Impacts|journal=Journal of Alzheimer's Disease|volume=69|issue=3|pages=597–614|doi=10.3233/JAD-190015|issn=1875-8908|pmc=6598002|pmid=31127781}}</ref>) and psychosocial (e.g., discrimination<ref name="Egan 239">{{Cite journal|last1=Egan|first1=Matt|last2=Tannahill|first2=Carol|last3=Petticrew|first3=Mark|last4=Thomas|first4=Sian|date=2008-07-16|title=Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: a systematic meta-review|journal=BMC Public Health|volume=8|article-number=239|doi=10.1186/1471-2458-8-239|issn=1471-2458|pmc=2503975|pmid=18631374 |doi-access=free }}</ref>) stressors resulting in chronic stress.<ref name="Egan 239"/> Chronic stress increases the individuals '[[allostatic load]]' level – which refers to the wear and tear of stress-related biological systems e.g., [[Neuroendocrine System|neuroendocrine]], [[Metabolism|metabolic]], [[immune system]]s. In turn, these stress-related biological differences increase the risk of disease and poorer health outcomes.<ref>{{Cite journal|last1=McEwen|first1=Bruce S.|last2=Wingfield|first2=John C.|date=February 2010|title=What's in a name? Integrating homeostasis, allostasis and stress|journal=Hormones and Behavior|volume=57|issue=2|pages=105–111|doi=10.1016/j.yhbeh.2009.09.011|issn=0018-506X|pmc=2815096|pmid=19786032}}</ref><ref>{{Cite journal|last=McEwen|first=B. S.|date=February 2000|title=Allostasis and allostatic load: implications for neuropsychopharmacology|journal=Neuropsychopharmacology|volume=22|issue=2|pages=108–124|doi=10.1016/S0893-133X(99)00129-3|issn=0893-133X|pmid=10649824|s2cid=206088437|doi-access=free}}</ref>

== Measures and predictors of biological inequity == Measures have been developed to quantify biological inequity by combining physical (e.g., [[air pollution]], [[noise pollution]], [[light pollution]]) and [[psychosocial]] factors (e.g., deprivation) that define the phenomena, such as the 'Biological Inequity Index.<ref>{{Cite web|title=Centric Lab — Biological Inequities Index|url=https://www.thecentriclab.com/biological-inequities-index|access-date=2021-10-22|website=Centric Lab|language=en-GB}}</ref>

As a phenomenon, biological inequity is situated at the intersection between [[poverty]], structural racism, and place. As such, biological inequity as expressed through allostatic load is correlated with factors such as [[socioeconomic status]],<ref>{{Cite journal|last1=Seeman|first1=Teresa|last2=Epel|first2=Elissa|last3=Gruenewald|first3=Tara|last4=Karlamangla|first4=Arun|last5=McEwen|first5=Bruce S.|date=February 2010|title=Socio-economic differentials in peripheral biology: Cumulative allostatic load|journal=Annals of the New York Academy of Sciences|volume=1186|issue=1|pages=223–239|doi=10.1111/j.1749-6632.2009.05341.x|pmid=20201875|bibcode=2010NYASA1186..223S|s2cid=21391140|issn=0077-8923|doi-access=free}}</ref> ethnic and racial grouping,<ref>{{Cite journal|last1=Geronimus|first1=Arline T.|last2=Hicken|first2=Margaret|last3=Keene|first3=Danya|last4=Bound|first4=John|date=May 2006|title="Weathering" and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States|journal=American Journal of Public Health|volume=96|issue=5|pages=826–833|doi=10.2105/AJPH.2004.060749|issn=0090-0036|pmc=1470581|pmid=16380565}}</ref> and urban factors e.g., green space,<ref>{{Cite journal|last1=Egorov|first1=Andrey I.|last2=Griffin|first2=Shannon M.|last3=Converse|first3=Reagan R.|last4=Styles|first4=Jennifer N.|last5=Sams|first5=Elizabeth A.|last6=Wilson|first6=Anthony|last7=Jackson|first7=Laura E.|last8=Wade|first8=Timothy J.|date=October 2017|title=Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions|journal=Environmental Research|volume=158|pages=508–521|doi=10.1016/j.envres.2017.07.009|issn=1096-0953|pmc=5941947|pmid=28709033|bibcode=2017ER....158..508E}}</ref> and housing quality.<ref>{{Cite journal|last1=Riva|first1=Mylene|last2=Plusquellec|first2=Pierrich|last3=Juster|first3=Robert-Paul|last4=Laouan-Sidi|first4=Elhadji A.|last5=Abdous|first5=Belkacem|last6=Lucas|first6=Michel|last7=Dery|first7=Serge|last8=Dewailly|first8=Eric|date=April 2014|title=Household crowding is associated with higher allostatic load among the Inuit|journal=Journal of Epidemiology and Community Health|volume=68|issue=4|pages=363–369|doi=10.1136/jech-2013-203270|issn=1470-2738|pmid=24385548|s2cid=506997}}</ref><ref>{{Cite journal|last1=Jung|first1=Chien-Cheng|last2=Liang|first2=Hsiu-Hao|last3=Lee|first3=Hui-Ling|last4=Hsu|first4=Nai-Yun|last5=Su|first5=Huey-Jen|date=2014-04-23|title=Allostatic Load Model Associated with Indoor Environmental Quality and Sick Building Syndrome among Office Workers|journal=PLOS ONE|language=en|volume=9|issue=4|article-number=e95791|doi=10.1371/journal.pone.0095791|issn=1932-6203|pmc=3997416|pmid=24759685|bibcode=2014PLoSO...995791J|doi-access=free}}</ref>

== Health outcomes == Biological inequity increases the risk of disease and poor health outcomes for a social group through;

# disproportionate exposure to the cause(s) of the disease brought about by direct exposure to physical and/or psychosocial stressors, or # greater adverse effects of the cause(s) of a disease brought about from accumulated stress-related biological differences, i.e., higher levels of allostatic load.<ref name=":0" /><ref>{{Cite journal|last1=Gochfeld|first1=Michael|last2=Burger|first2=Joanna|date=December 2011|title=Disproportionate Exposures in Environmental Justice and Other Populations: The Importance of Outliers|journal=American Journal of Public Health|volume=101|issue=Suppl 1|pages=S53–S63|doi=10.2105/AJPH.2011.300121|issn=0090-0036|pmc=3222496|pmid=21551384}}</ref>

=== Non-communicable diseases === {{further|Non-communicable disease}} [[Obesity]] has been linked to biological inequity factors such as air pollution<ref>{{Cite journal|last1=Kim|first1=Jeniffer S.|last2=Chen|first2=Zhanghua|last3=Alderete|first3=Tanya L.|last4=Toledo-Corral|first4=Claudia|last5=Lurmann|first5=Fred|last6=Berhane|first6=Kiros|last7=Gilliland|first7=Frank D.|date=December 2019|title=Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study|journal=Environment International|volume=133|issue=Pt A|article-number=105180|doi=10.1016/j.envint.2019.105180|issn=1873-6750|pmc=6884139|pmid=31622905 |bibcode=2019EnInt.13305180K }}</ref><ref>{{Cite journal|last1=Parasin|first1=Nichapa|last2=Amnuaylojaroen|first2=Teerachai|last3=Saokaew|first3=Surasak|date=May 2021|title=Effect of Air Pollution on Obesity in Children: A Systematic Review and Meta-Analysis|journal=Children|language=en|volume=8|issue=5|page=327|doi=10.3390/children8050327|pmid=33922616|pmc=8146513|doi-access=free}}</ref> and psychosocial stress.<ref>{{Cite journal|last1=Cuevas|first1=Adolfo G.|last2=Chen|first2=Ruijia|last3=Thurber|first3=Katherine A.|last4=Slopen|first4=Natalie|last5=Williams|first5=David R.|date=2019-10-07|title=Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study|journal=Annals of Behavioral Medicine |volume=53|issue=11|pages=NP|doi=10.1093/abm/kaz008|issn=1532-4796|pmc=6779073|pmid=30917198}}</ref> Similar findings have shown [[diabetes]] to be associated with physical<ref>{{Cite journal|last1=Bowe|first1=Benjamin|last2=Xie|first2=Yan|last3=Li|first3=Tingting|last4=Yan|first4=Yan|last5=Xian|first5=Hong|last6=Al-Aly|first6=Ziyad|date=July 2018|title=The 2016 global and national burden of diabetes mellitus attributable to PM 2·5 air pollution|journal=The Lancet Planetary Health|volume=2|issue=7|pages=e301–e312|doi=10.1016/s2542-5196(18)30140-2|pmid=30074893|s2cid=51911901|issn=2542-5196|doi-access=free |bibcode=2018LanPH...2..301B }}</ref> and psychosocial<ref>{{Cite journal|last1=Steptoe|first1=A.|last2=Hackett|first2=R. A.|last3=Lazzarino|first3=A. I.|last4=Bostock|first4=S.|last5=La Marca|first5=R.|last6=Carvalho|first6=L. A.|last7=Hamer|first7=M.|date=2014-10-20|title=Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load|journal=Proceedings of the National Academy of Sciences|volume=111|issue=44|pages=15693–15698|doi=10.1073/pnas.1410401111|pmid=25331894|pmc=4226108|bibcode=2014PNAS..11115693S|issn=0027-8424|doi-access=free}}</ref><ref>{{Cite journal|last1=Hackett|first1=Ruth A.|last2=Steptoe|first2=Andrew|date=September 2017|title=Type 2 diabetes mellitus and psychological stress - a modifiable risk factor|journal=Nature Reviews. Endocrinology|volume=13|issue=9|pages=547–560|doi=10.1038/nrendo.2017.64|issn=1759-5037|pmid=28664919|s2cid=34925223 |url=https://discovery.ucl.ac.uk/id/eprint/1562662/ }}</ref> stressors.

=== Mental health === [[Mental health]] conditions such as [[Depression (mood)|depression]], [[anxiety]] have been linked to biological inequity factors such as air pollution,<ref>{{Cite journal|last1=Ali|first1=Naureen A.|last2=Khoja|first2=Adeel|date=2019|title=Growing Evidence for the Impact of Air Pollution on Depression|journal=The Ochsner Journal|volume=19|issue=1|page=4|doi=10.31486/toj.19.0011|issn=1524-5012|pmc=6447209|pmid=30983893}}</ref><ref>{{Cite journal|last1=Power|first1=Melinda C.|last2=Kioumourtzoglou|first2=Marianthi-Anna|last3=Hart|first3=Jaime E.|last4=Okereke|first4=Olivia I.|last5=Laden|first5=Francine|last6=Weisskopf|first6=Marc G.|date=2015-03-24|title=The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study|url=https://www.bmj.com/content/350/bmj.h1111|journal=BMJ|language=en|volume=350|article-number=h1111|doi=10.1136/bmj.h1111|issn=1756-1833|pmid=25810495|pmc=4373600}}</ref> noise pollution<ref>{{Cite journal|last1=Floud|first1=Sarah|last2=Vigna-Taglianti|first2=Federica|last3=Hansell|first3=Anna|last4=Blangiardo|first4=Marta|last5=Houthuijs|first5=Danny|last6=Breugelmans|first6=Oscar|last7=Cadum|first7=Ennio|last8=Babisch|first8=Wolfgang|last9=Selander|first9=Jenny|last10=Pershagen|first10=Göran|last11=Antoniotti|first11=Maria Chiara|date=July 2011|title=Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study|journal=Occupational and Environmental Medicine|volume=68|issue=7|pages=518–524|doi=10.1136/oem.2010.058586|issn=1470-7926|pmid=21084328|bibcode=2011OccEM..68..518F |s2cid=43114848|hdl=2318/79814|hdl-access=free}}</ref><ref>{{Cite journal|last1=Orban|first1=Ester|last2=McDonald|first2=Kelsey|last3=Sutcliffe|first3=Robynne|last4=Hoffmann|first4=Barbara|last5=Fuks|first5=Kateryna B.|last6=Dragano|first6=Nico|last7=Viehmann|first7=Anja|last8=Erbel|first8=Raimund|last9=Jöckel|first9=Karl-Heinz|last10=Pundt|first10=Noreen|last11=Moebus|first11=Susanne|date=May 2016|title=Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study|journal=Environmental Health Perspectives|volume=124|issue=5|pages=578–585|doi=10.1289/ehp.1409400|doi-broken-date=6 April 2026 |issn=1552-9924|pmc=4858388|pmid=26606640 |bibcode=2016EnvHP.124..578O }}</ref> and area deprivation<ref>{{Cite journal|date=May 2005|title=Local area deprivation and urban- rural differences in anxiety and depression among people older than 75 years in britain|journal=Primary Health Care|volume=15|issue=4|page=8|doi=10.7748/phc.15.4.8.s11|issn=0264-5033}}</ref><ref>{{Cite journal|last1=Chiavegatto Filho|first1=Alexandre Dias Porto|last2=Kawachi|first2=Ichiro|last3=Wang|first3=Yuan Pang|last4=Viana|first4=Maria Carmen|last5=Andrade|first5=Laura Helena Silveira Guerra|date=2013-11-01|title=Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil|journal=Journal of Epidemiology and Community Health|volume=67|issue=11|pages=966–972|doi=10.1136/jech-2013-202626|issn=1470-2738|pmid=23908459|s2cid=45759310}}</ref>

=== Infectious disease === Measures of Biological inequity such as psychosocial stress and environmental stress have been shown to correlate with [[COVID-19]] mortality rates, suggesting possible increased exposure to COVID-19 or increased vulnerability to the virus.<ref name=":0" />

== References ==

{{reflist}}

===Further reading === # Camargo, A. et al. Using an Ecological and Biological Framing for an Anti-racist COVID-19 Approach. medRxiv 2021.01.24.21250397 (2021) {{doi|10.1101/2021.01.24.21250397}} # UNDP Eurasia. Questioning Identity and The Past - Encoding Inequalities in our Infrastructures M1S3. (2021). # Centric Lab — What is Health. Centric Lab <nowiki>https://www.thecentriclab.com/what-is-health</nowiki>. # Aliko, S., Camargo, A., Artus, J., Akinola-Odusola, D. & Hossain, E. Neuroscience, urban regeneration and urban health. J. Urban Regen. Renew. 13, 280–289 (2020). # www.thecentriclab.com # WHO. Health inequities and their causes. <nowiki>https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes</nowiki>. # Braveman, P. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health 27, 167–194 (2006). # People living in deprived neighbourhoods. <nowiki>https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/people-living-in-deprived-neighbourhoods/latest#main-facts-and-figures</nowiki>. # Brulle, R. J. & Pellow, D. N. ENVIRONMENTAL JUSTICE: Human Health and Environmental Inequalities. Annu. Rev. Public Health 27, 103–124 (2006). # Thomson, E. M. Air Pollution, Stress, and Allostatic Load: Linking Systemic and Central Nervous System Impacts. J. Alzheimers Dis. 69, 597–614. # Egan, M., Tannahill, C., Petticrew, M. & Thomas, S. Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: A systematic meta-review. BMC Public Health 8, 1–13 (2008). # Schulz, A. J. et al. Associations Between Socioeconomic Status and Allostatic Load: Effects of Neighborhood Poverty and Tests of Mediating Pathways. Am. J. Public Health 102, 1706–1714 (2012). # McEwen, B. S. & Wingfield, J. C. What's in a name? Integrating homeostasis, allostasis and stress. Horm. Behav. 57, 105 (2010). # McEwen, B. S. Allostasis and Allostatic Load: Implications for Neuropsychopharmacology. Neuropsychopharmacology 22, 108–124 (2000). # Centric Lab. Biological Inequities Index. Centric Lab <nowiki>https://www.thecentriclab.com/biological-inequities-index</nowiki> (2021). # Seeman, T., Epel, E., Gruenewald, T., Karlamangla, A. & McEwen, B. S. Socio-economic differentials in peripheral biology: Cumulative allostatic load: SES peripheral biology. Ann. N. Y. Acad. Sci. 1186, 223–239 (2010). # Geronimus, A. T., Hicken, M., Keene, D. & Bound, J. "Weathering" and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States. Am. J. Public Health 96, 826–833 (2006). # Egorov, A. I. et al. Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions. Environ. Res. 158, 508–521 (2017). # Riva, M. et al. Household crowding is associated with higher allostatic load among the Inuit. J. Epidemiol. Community Health 68, 363–369 (2014). # Jung, C.-C., Liang, H.-H., Lee, H.-L., Hsu, N.-Y. & Su, H.-J. Allostatic load model associated with indoor environmental quality and sick building syndrome among office workers. PLOS ONE 9, e95791 (2014). # Gochfeld, M. & Burger, J. Disproportionate Exposures in Environmental Justice and Other Populations: The Importance of Outliers. Am. J. Public Health 101, S53–S63 (2011). # Kim, J. S. et al. Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study. Environ. Int. 133, 105180 (2019). # An, R., Ji, M., Yan, H. & Guan, C. Impact of ambient air pollution on obesity: a systematic review. Int. J. Obes. 42, 1112–1126 (2018). # Cuevas, A. G., Chen, R., Thurber, K. A., Slopen, N. & Williams, D. R. Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study. Ann. Behav. Med. 53, NP (2019). # Bowe, B. et al. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. Lancet Planet. Health 2, e301–e312 (2018). # Steptoe, A. et al. Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load. Proc. Natl. Acad. Sci. U. S. A. 111, 15693–15698 (2014). # Hackett, R. A. & Steptoe, A. Type 2 diabetes mellitus and psychological stress — a modifiable risk factor. Nat. Rev. Endocrinol. 13, 547–560 (2017). # Ali, N. A. & Khoja, A. Growing Evidence for the Impact of Air Pollution on Depression. Ochsner J. 19, 4 (2019). # Power, M. C. et al. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ 350, h1111 (2015). # Floud, S. et al. Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study. Occup. Environ. Med. 68, 518–524 (2011). # Orban, E. et al. Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study. Environ. Health Perspect. 124, 578–585 (2016). # Walters, K. et al. Local Area Deprivation and Urban–Rural Differences in Anxiety and Depression Among People Older Than 75 Years in Britain. Am. J. Public Health 94, 1768–1774 (2004). # Filho, A. D. P. C., Kawachi, I., Wang, Y. P., Viana, M. C. & Andrade, L. H. S. G. Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in São Paulo, Brazil. J Epidemiol Community Health 67, 966–972 (2013).

[[Category:Determinants of health]]