. "15 A Neurovisceral Integration Model of Health Disparities in Aging." Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. Washington, DC: The National Academies Press, 2004.
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Critical Perspectives on Racial and Ethnic Differences in Health in Late Life
ment, which in turn leads to a plethora of negative affective states, such as fear, anxiety, anger and hostility, and depression. Both acutely and chronically, these affective states may lead to negative health outcomes (Kiecolt-Glaser, McGuire, Robles, and Glaser, 2002; Krantz and McCeney, 2002). That ethnic minorities might be differentially exposed to racism-related stress and negative affect has been proposed as a possible causal factor in the observed health disparities (Clark, Anderson, Clark, and Williams, 1999; Williams and Neighbors, 2001). However, any comprehensive model of emotions and health must account for the complex mix of cognitive, affective, behavioral, and physiological concomitants of normal and pathological affective states and dispositions, and how these might impact health. In addition, the concept of stress is often invoked to explain the impact of psychosocial factors on physiological processes and health. However, this concept is plagued by a lack of a precise and widely accepted definition, and by a lack of specificity in the organismic mechanisms by which stress produces its effects (Eriksen and Ursin, 2002). Despite recent attempts to reconceptualize stress effects in terms of allostatic load (McEwen, 1998), the situation has not substantially improved (Eriksen and Ursin, 2002; Kiecolt-Glaser et al., 2002).
The impact of multiple pathways on ethnic health disparities must be acknowledged, but this chapter focuses on psychosocial factors. Broadly defined in terms of stress, negative emotion, and perceived racism, the core question is how these psychosocial factors are instantiated in physiological processes that can lead to disease and death. With the added premise that ethnic minorities are differentially and excessively exposed to discrimination and racism, the underlying causes of the health disparities begin to be revealed.
Due to the scope of the issues involved, coverage of the literature will be more illustrative than comprehensive. However, wherever possible, references to more comprehensive reviews and key primary sources are provided. We begin in a broad context within which to view the observed health disparities in the elderly by presenting evidence for the role of autonomic imbalance in disease and negative affective states and dispositions. The notion of appropriate energy regulation as a factor in health and disease is emphasized. Next, a brief description of a neurovisceral model of emotion regulation and dysregulation is offered, in which heart rate variability (HRV) is used to index important aspects of autonomic, affective, and cognitive system regulation. This model may help to explicate the complex interrelationships that exist in the connection between psychosocial factors on the one hand and health and disease on the other. This model utilizes a dynamical systems approach, and stresses the role of inhibitory processes via parasympathetic mechanisms in maintaining optimal energy regulation. A discussion follows in which perseverative thinking is viewed