Abstract
Chronic stress is coming into focus as a cause of excess weight and cardiovascular disease risk among African-American women (Albert, 2019). Pickett, McCoy, et al. (2020), in the study The influence of chronic stress and emotions on eating behavior patterns and weight among young African American women, show that higher chronic stress was associated with emotional eating. which is characterized as consuming palatable foods such as snacking on sweets as a result of negative emotions. Higher emotional eating was associated with higher waist circumference measurements representing increased visceral fat accumulation, which represents a pre-diabetic state. These findings show how chronic stress may result in unhealthy behaviors leading to health risk.
Findings from our study and many others suggest that it is reasonable to develop weight-management interventions that focus on individual behavior change to increase healthy eating behaviors and regular physical activity. However, behavioral-focused interventions even with culturally specific strategies such as a culturally specific diet, cultural-based sensitivity training, race concordant staff, individual and group counseling, and religious, spiritual, and community considerations fail to produce clinically meaningful weight loss and maintenance (Pickett, Burchenal, et al., 2020). This reality must prompt us to look at factors beyond behavior to address issues that create chronic stress leading to behavioral responses that adversely impact weight management and overall health.
African-American women may experience life stressors that may be persistent and pervasive (Albert, 2019). These life stressors are largely subsumed within societal structures. These societal structures are “macrolevel systems, social forces, institutions, ideologies and processes that interact.” which generate and reinforce social inequities leading to health equities (Gee & Ford 2011; Powell, 2007). These societal structures include structural racism that influences distribution of resources and impacts coping strategies and behavioral responses (Bailey et al., 2017).
Societal structures like structural racism inform the social determinants of health, which are the conditions in which people live, learn, work, and recreate (Marmot et al., 2008). These conditions impact health and health equity (Bailey et al., 2017; Marmot & Bel, 2019). Societal structures that instill social inequity leading to health inequity must be addressed through public policy. The Universal Basic Income (UBI) is a public policy that shows promise.
UBI is unconditional income granted to each citizen of a country, irrespective of work criteria or need (Basic Income Earth Network [BIEN], 2016). Empirical studies have examined the benefit of UBI. Pilot studies in various countries including various places in the Unites States show that UBI was associated with improved neonatal and childhood development, reduction in childhood obesity, improved literacy scores, and reduced student dropout rates with improved grades. Higher levels of educational attainment have been associated with better health outcomes (Ruckert et al., 2018). UBI has allowed recipients to obtain better housing, which was associated with improved physical and mental health, and family safety. UBI has also been associated with more efficient health care utilization (Ruckert et al., 2018; Watson et al., 2019).
Although studies with UBI have demonstrated very positive results, one of the primary criticisms of the UBI policy is the belief that UBI reduces the motivation to work. Empirical evidence indicates that work effort does not significantly decrease among recipients receiving UBI (Ruckert et al. 2018). The intention of UBI policy is to provide a foundational level of economic security that would reduce chronic stress levels associated with obtaining the basic necessities for life. UBI is not meant to replace or compete with earner wages. The discourse about UBI is increasing in the United States as solutions are sought for social and health inequities. Nurses should be a part of this discussion in support of UBI policy.