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The relentless stresses of poverty and ghetto life have also been associated with higher health risks. Studies of poor black neighborhoods in Detroit and Boston have correlated hypertension, which is twice as common among American blacks as among whites, with overcrowded housing and high levels of unemployment and crime. Research conducted in Massachusetts by Epidemiologist David Jenkins, now on the faculty of the University of Texas Medical Branch in Galveston, showed that the two areas with the highest mortality rates in the state were the Boston black ghetto of Roxbury and the working-class white enclave of South Boston, which had been locked in a bitter feud over school busing. Mortality rates in these two "death zones" are elevated not only for hypertension-related ailments like stroke, but for all causes of death. Even the rate of cancer among Roxbury men was 37% above the state average.
Whether or not daily stresses and hassles do more damage than life-change events may, in the final analysis, be a moot point. A single event can cause smaller changes that touch every aspect of existence. Divorce, for example, "is not an isolated event," observes U.C.S.F. Psychiatrist Leonard Pearlin. "It is accompanied by some social isolation, a reduction in income and sometimes the problems of being a single parent. These become the chronic strains of life."
Joblessness has a similar ripple effect. The greatest source of stress is not the actual loss of the job but rather the gradual domestic and psychological changes it imposes. These can be devastating, says Sociologist M. Harvey Brenner, professor of health services administration at Johns Hopkins. Brenner has found that over a period of about 25 years beginning in the late 1940s, for each 1% increase in the national unemployment rate, there were 1.9% more U.S. deaths from heart disease and cirrhosis, 4.1% more suicides, and an upturn in the number of first-time admissions to state mental health facilities (up 4.3% for men, 2.3% for women).
To be sure, not everyone falls to pieces because of the loss of a job or even a spouse. While surveying unemployed workers in the Detroit area, University of Michigan Researcher Louis Ferman found one hard-luck victim who had been successively laid off by the Studebaker Corp. in 1962 when it was about to fold, a truck manufacturer that went under in the 1970s, and more recently during cutbacks at a Chrysler plant. By all accounts, "he should have been a basket case," says Ferman, "yet he was one of the best-adjusted fellows I've run into." Asked his secret, the man replied, "I've got a loving wife and go to church every Sunday."
Such examples have convinced stress scholars that far more important than the trials and tribulations in one's life is how one deals with them. Consequently, much research into stress and preventive medicine has focused on what psychologists call "hardiness" or coping behavior. Certain population groups are known to enjoy remarkable good health and longevity: