Having control over your own health through access to medical appointments, healthy foods, clean air and water, among other resources indeed fosters better health. It’s equally understandable that when an individual doesn’t have these, they are at risk for worse health.
But simply believing that you don’t have control over your health could actually compound these problems, according to a recently published study from Drexel University researchers in the journal Psychology, Health & Medicine.
The team found that, among adult cancer survivors, external health locus of control — the belief that you don’t have control over your own health, or that your health comes down to luck or other outside forces beyond one’s own actions — acts as a pathway linking lower education level and higher levels of inflammation in the body.
“We found that cancer survivors with less formal education were more likely to perceive that their health was largely determined by factors out of their control,” said lead author Madeline Plummer, a student in the Dornsife School of Public Health. “This perceived lack of control is linked to higher inflammation, which we know is a reliable indicator of risk of age-related chronic disease.”
The Drexel News Blog checked in with the study’s senior author Agus Surachman, PhD, an assistant professor in the Dornsife School of Public Health, about how these findings should change how we look at health care, particularly for cancer patients.
What did you and your colleagues learn about health locus of control as a link between lower education, e.g., not having a bachelor’s degree or higher, and elevated C-Reactive protein (CRP), a protein created by the liver in response to inflammation?
In our study, we specifically tested whether health locus of control (HLoC) is an important psychosocial pathway that may explain how lower education is associated with elevated CRP, a robust marker of aging, and an increased risk of age-related chronic diseases.
We found that among cancer survivors, lower education was associated with higher levels of external HLoC, which in turn is linked to higher CRP. In our study, external HLoC was measured based on participants’ self-reports about the critical role of doctors in improving health and the difficulty of obtaining quality medical care. A higher external HLoC indicates greater reliance on external factors in determining health outcomes. We also examined the role of internal HLoC, or belief in one’s control over health outcomes, but did not observe a similar relationship.
Any thoughts on what is contributing to this link?
We think greater external HLoC among cancer survivors may be an individual reflection of social and structural inequality. In our data, this is reflected by the report of difficulty in accessing quality medical care and overall lack of belief in control over health. The belief that external factors control your health can lead to a lack of motivation in adhering to treatment, medication and health-promoting behaviors. In turn, this can contribute to accelerated aging phenotypes, such as elevated levels of inflammation.
Your team’s work showed that differences in educational attainment among cancer survivors were associated with differences in psychosocial resources, which can lead to disparities in inflammaging, or biological markers of aging. How is education important to feeling in control of your health?
From a sociological perspective, formal education has been posited as an important social context where a sense of control is developed. Sociological and psychological research have shown that higher levels of education are associated with greater belief in the ability to control life outcomes, including health outcomes.
On the other hand, lower education is usually characterized by higher attribution in external factors that determine life outcomes. Our study corroborated this, where we found that lower educational attainment among cancer survivors was associated with higher external HLoC and lower internal HLoC. More importantly, we see that it’s the higher external HLoC that plays an especially important role in explaining some of the relationships between lower education and higher inflammation.
Should these findings change the way we look at large-scale reforms or individual efforts to influence education and health care access, particularly for those with chronic illnesses and/or a history of cancer?
Reform in our health care system to provide access to quality health care for those with lower socioeconomic resources is the most important and needed systemic and structural change.
At the individual level, individuals process these structural barriers to health care psychologically and reflect on them in their psychosocial processes, which can influence their behavioral and health outcomes. We can leverage this knowledge to think about ways to promote adherence to treatment, medication and health-promoting behaviors, especially for those dealing with chronic illnesses and/or a history of cancer. Helping them to believe that what they do is improving their health, despite all the limitations and barriers, will make a difference in determining their overall health and well-being.
In addition to other funding, this research began as Plummer’s independent work as a Drexel Star Scholar and continued after she earned a Drexel Undergraduate Research & Enrichment Program Mini-Grant. How valuable is this institutional commitment to undergraduate research?
I really appreciate the infrastructure, resources and support available at Drexel to connect undergraduate students with faculty to provide them with independent research experience. This is especially helpful for junior faculty who have just started expanding their research lab and program. At the same time, this is valuable to our motivated and brilliant undergraduate students for building their knowledge and gaining independent research experience.
This research was also made possible through the pilot funding from the Drexel University/Sidney Kimmel Comprehensive Cancer Center Research Consortium. This funding allows me to expand my research program to look at the link between socioeconomic and psychosocial factors of aging among long-term cancer survivors.
Reporters interested in talking with Surachman should contact Greg Richter, assistant director of media relations at gdr33@drexel.edu or 215-895-2614.
