Origins of heath inequalities: The case for allostatic load

In an opening paper Delpierre et al. explore the concept of allostatic load. The impact of the environment on our biological systems is summarised by the concept of embodiment. The biological embedding of social conditions could therefore be a relevant mechanism to partly explain the social gradient in health. A key issue is how to measure the ‘physiological reality’ – the biological expression of embodiment at individual and population levels. Allostatic load (AL) has been proposed as a measure of the overall cost of adapting to the environment and may be a relevant tool or concept for measuring the way we have embodied our environment. Social inequalities in health may be partly explained by the embodiment of social environments, and AL may allow us to measure and compare embodiment between socioeconomic groups. However, before operationalising AL, a number of issues deserve further exploration. Among these, the choice of biological systems, and variables within each system, that should be included to remain ‘loyal’ to the theory of biological multisystem wastage underlying AL and the most appropriate methodological approach to be used to build an AL score, are particularly important. Moreover, studies analysing the link between adverse environments (physical, chemical, nutritional, psychosocial) across the life course and AL remain rare. Such studies require cohorts with data on socioeconomic and psychosocial environments over the life course, with multiple biological measures, made at various stages across the life span. The development and maintenance of these cohorts is essential to continue exploring the promising results that could enhance our understanding of the genesis of the social gradient in health by measuring embodiment. These points are then debated in commentaries by Linn Getz and Margret Olafia Tomasdottir, Tony Robertson and Per Gustafson. The commentaries are followed by a response from the authors of the opening paper.