Glaucoma, Health Inequities, and Chronic Stress

Jordan Mitchell

Dr. Alyssa Grant [MPH]

Jordan Mitchell

So, glaucoma. It's the leading cause of irreversible blindness worldwide, right? But here's something that’s, uh, kind of shocking—Black patients are like twice as likely to have it compared to White patients. And not just that, their disease tends to progress faster and more severely.

Dr. Alyssa Grant

Exactly. The disparities with glaucoma are striking. And it isn't because of biology or genetics alone. There’s a much more complex interplay at work—rooted in social determinants, like access to healthcare or even chronic exposures to stress.

Jordan Mitchell

Right, and I think this whole angle is what really caught my attention about the capstone project we’re going to dive into today. Alyssa, for those who don’t know, what is a capstone project in an MPH program?

Dr. Alyssa Grant

It’s essentially the culmination of an MPH student’s academic journey. It’s hands-on research—or what I like to call a practical deep dive—where students identify real-world public health issues and propose evidence-based solutions. It’s a chance for them to contribute something meaningful to the field.

Jordan Mitchell

And what makes this specific project so relevant is that it takes this, you know, all-too-common topic of racial disparities—but then it links the issue to something reflective of life stressors. I mean, they’re not just looking at glaucoma through a medical lens.

Dr. Alyssa Grant

Mm-hmm. Exactly. Young Sheng's project tackles this racial gap using a concept called allostatic load score, or ALS. This is a measure of the physical impact stress has on the body. And—

Jordan Mitchell

Wait, hold up. What’s—allostatic load again?

Dr. Alyssa Grant

Sure. So allostatic load essentially measures what chronic stress does to your body over time. For example, when you're constantly dealing with stressors—like racism or poverty—it takes a toll on your organs, your immune system, even your blood pressure. It’s like wearing down the body's defenses bit by bit.

Jordan Mitchell

Okay. And then, what Sheng’s saying is that this stress load could—

Dr. Alyssa Grant

Could actually explain some of the differences we see in glaucoma cases. People with high allostatic load scores—specifically those from marginalized backgrounds—had way higher odds of developing glaucoma. About twice as high, in fact.

Jordan Mitchell

That’s wild. Twice as high. And the numbers just emphasize it. In their study, Black participants had a significantly higher allostatic load score on average compared to White participants, right?

Dr. Alyssa Grant

Yes. And what's even more significant is that, through mediation analysis, Sheng’s findings suggest that about 13.7% of the racial disparity in glaucoma prevalence could be attributed to these allostatic load differences.

Jordan Mitchell

Wow. That's—the findings are... I mean, this isn't just research for research's sake, either. This has real implications for health equity.

Dr. Alyssa Grant

Absolutely. For me, it’s especially compelling because ALS is quantifiable. It gives public health professionals a concrete way to measure the damage caused by systemic stressors, and maybe even target interventions that could mitigate those effects going forward. It’s a small but critical piece of a much larger puzzle.

Jordan Mitchell

And it sounds like this capstone project really sets the stage for something deeper—like looking at stress not just as, you know, a feeling, but as something impacting the body on a cellular level. This is where the conversation about "weathering" comes in, isn’t it?

Dr. Alyssa Grant

Exactly, Jordan. The weathering hypothesis really captures that idea—the notion that chronic exposure to stressors like racism and poverty doesn’t just affect feelings but actually breaks the body down over time, even at a cellular level, like wind and water steadily eroding a rock.

Jordan Mitchell

Oh wow, okay. So, stress literally, not just figuratively, breaks us down?

Dr. Alyssa Grant

That’s right. It’s not just psychological. Over time, the body's physiological systems—like the cardiovascular, immune, and nervous systems—get overworked trying to cope with these constant stressors. And that’s where allostatic load comes in.

Jordan Mitchell

So, allostatic load is kinda like... a stress tracker for your body?

Dr. Alyssa Grant

Exactly, but more than just tracking. It’s a measure of the cumulative damage. Think blood pressure, stress hormones, cholesterol levels. When those biomarkers go haywire because you’re constantly stuck in high-stress situations, that’s high allostatic load.

Jordan Mitchell

And this connects back to glaucoma how?

Dr. Alyssa Grant

Well, the NHANES study showed a very clear linkage. Individuals with high allostatic load scores are more than twice as likely—

Jordan Mitchell

Twice as likely?

Dr. Alyssa Grant

Yes, twice as likely to develop glaucoma compared to those with lower scores. That’s a staggering correlation. Add to that the fact that Black participants had significantly higher allostatic load scores on average, and it starts to explain part of the racial disparities in glaucoma prevalence.

Jordan Mitchell

Makes sense. If you're constantly under systemic stress, it’s bound to show up in your health, right?

Dr. Alyssa Grant

Absolutely. And what's remarkable is the mediation analysis Sheng performed. About 13.7% of the disparity in glaucoma between Black and White participants could be attributed to differences in allostatic load scores.

Jordan Mitchell

That’s just wild. So, beyond just saying racism and poverty impact health, here's hard data proving how it affects something as specific as glaucoma.

Dr. Alyssa Grant

Exactly. What this study gives us is a quantifiable piece of the puzzle. And with measures like allostatic load, we can start to design targeted interventions—programs that aim to reduce that stress burden and, ideally, lower these risks in vulnerable populations.

Jordan Mitchell

So, it’s not just about treating glaucoma once it’s there; it’s about intervening way earlier in the chain reaction?

Dr. Alyssa Grant

Exactly. By addressing the social determinants of health—those upstream stressors—we might reduce the physiological damage before it even manifests as disease. That’s why the weathering hypothesis is so compelling. It gives us a framework to unravel these complex, layered issues.

Jordan Mitchell

It’s honestly amazing—and kind of overwhelming—how interconnected everything is. And I think it really sets the stage for what comes next: digging deeper into how this research all came together, step by step.

Jordan Mitchell

Right, so as we dive deeper, let’s break this down further. If allostatic load is essentially mapping out how chronic stress wears the body down over time—

Dr. Alyssa Grant

Yes.

Jordan Mitchell

Then how exactly do we gauge that? Like, how do you measure wear and tear?

Dr. Alyssa Grant

Great question. Allostatic load scores are built from biomarkers—things like blood pressure, cholesterol, and levels of stress hormones, such as cortisol. Essentially, it’s a composite score that captures disruptions across multiple systems in your body.

Jordan Mitchell

Right, and if those numbers are out of whack...

Dr. Alyssa Grant

...It’s a signal that your body’s been under chronic stress for too long, and it's struggling to maintain balance. When that happens, it can lead to higher risks for various health issues—including, as this study found, glaucoma.

Jordan Mitchell

Twice as high, right?

Dr. Alyssa Grant

Exactly. Sheng’s study showed that participants with high allostatic load scores were more than twice as likely to have glaucoma compared to those with lower scores. What’s crucial here is not just the overall risk, but how this ties into systemic inequities.

Jordan Mitchell

You're talking about the differences in allostatic load between Black and White participants?

Dr. Alyssa Grant

Exactly. On average, Black participants in the study had markedly higher allostatic load scores compared to White participants. And here’s where things get really interesting. Sheng used something called mediation analysis to quantify how much of the racial disparity in glaucoma prevalence can be explained by those stress-induced physiological impacts. It turned out to be about 13.7%.

Jordan Mitchell

Okay, hold on. Just to recap, that means 13.7% of the gap in glaucoma cases between Black and White participants could basically be pinned on these stress loads?

Dr. Alyssa Grant

Exactly. It shows that systemic stressors—captured through allostatic load—contribute significantly to these disparities. And while it’s not the full picture, it’s a measurable step toward understanding the root causes.

Jordan Mitchell

Wow. And the fact that it’s measurable changes everything—it gives us something real to address.

Dr. Alyssa Grant

It does. By quantifying these effects, we’re not just saying that systemic inequities affect health. We’re showing how, and that opens up possibilities for targeted interventions. For instance, if we could develop community-level programs to reduce these stressors, we might be able to lower these allostatic loads—and by extension, reduce glaucoma risk.

Jordan Mitchell

Right, like tackling the problem at its source rather than just treating the outcome.

Dr. Alyssa Grant

Exactly. And while there’s still much to uncover, studies like this pave the way for what public health can achieve by focusing on prevention and systemic change.

Jordan Mitchell

Honestly, it feels like a whole new perspective on tackling disparities. But, I’m curious—how did Sheng's team even begin to pull all this data together? Like, how do you connect the dots between stress scores, racial disparities, and glaucoma?

Jordan Mitchell

Right, so we ended with the question of how Sheng's team managed to connect those dots—the stress scores, racial disparities, and glaucoma. But beyond that, what does all of this mean for public health and reducing these disparities in practical, day-to-day terms?

Dr. Alyssa Grant

Great question. And this is where it gets really exciting. See, allostatic load doesn’t just tell us how stress influences health outcomes—it gives us a target for intervention. If we can design policies and programs that lower these stress loads, we might actually reduce the risk of developing conditions like glaucoma in the first place.

Jordan Mitchell

Okay, so what does that look like? Like—what kind of policies or interventions could help bring those stress levels down?

Dr. Alyssa Grant

For starters, addressing systemic stress means tackling the root causes—things like racism, income inequality, and lack of access to healthcare. But it’s not just about policy-level changes. Community-level initiatives can make a huge difference too. Programs to increase access to mental health resources, improve financial literacy, or even create safe spaces for social support—they all build resilience and buffer against these stressors.

Jordan Mitchell

Right. And I guess this isn’t a one-size-fits-all thing, huh? Like, you’d need tailored interventions for different communities, based on what they’re facing?

Dr. Alyssa Grant

Exactly. Public health is inherently community-driven. And that’s one reason why programs like Jefferson’s MPH are so vital. They equip students to not only identify these complex issues but also design solutions that address specific community needs. You learn how to connect the dots between research, practice, and actual policy change.

Jordan Mitchell

And what I like about that is—it’s not just about diagnosing a problem. You’re being trained to be part of the solution. Like with Sheng's project, for instance. This wasn’t just a theoretical dive into data. It's something that could shape real interventions in the future, right?

Dr. Alyssa Grant

Exactly. The study bridges research and action, showing the tangible ways health equity work can, well, change health outcomes. Whether it’s advocating for more community health centers or funding programs to reduce financial stress, there’s a clear path from data to impact. And that’s what Jefferson’s MPH emphasizes—equipping professionals to walk that path.

Jordan Mitchell

Yeah, and honestly, I think that’s what makes this field so exciting. Every dataset, every study—like this one—it all points us towards making a real difference in people’s lives. It’s not just numbers; it’s action, right?

Dr. Alyssa Grant

Absolutely. And with every small step—like understanding allostatic load—we get a little closer to addressing health disparities at their roots. It’s complex work, yes, but it’s also deeply rewarding because it touches on something fundamental: the ability to create healthier, more equitable communities.

Jordan Mitchell

Well, Alyssa, this has been such an eye-opening conversation. From systemic stress to physiology to public health, it’s like—all these pieces connecting. And I think it sends a clear message to anyone listening who’s passionate about making a difference in health equity—there’s a place for you in this work.

Dr. Alyssa Grant

Exactly. And whether you’re diving into research like Sheng, advocating for policy change, or building programs on the ground, there’s so much room for creativity and impact in public health.

Jordan Mitchell

On that note, that’s all for today. Thanks for breaking down some pretty heavy concepts with me, Alyssa. And hey—for anyone out there considering a career in public health, programs like Jefferson’s offer the tools to connect knowledge with action.

Jordan Mitchell

Jordan Mitchell

So, uh, don’t hesitate to check it out. Until next time, listeners, take care and keep those conversations going.