Health and Social Hierarchy: Preschool Edition

(c) Nurse Blog

As every teacher knows (and hates), people start forming social hierarchies in preschool. But the dominant children aren’t just steamrolling the subordinate kids into giving up their toys, they may also be sentencing them to a life time of poor health.

University of British Columbia Neurologist and Child Development Special, Dr. Thomas Boyce, spoke about the “biology of misfortune” at the Harvard School of Public Health yesterday afternoon. Dr. Boyce began studying social hierarchies in children to try and explain why some children have medical charts with just a few pages, while others have charts as thick as phone books.

Socioeconomic status is frequently singled out as the biggest predictor of future health. It’s more influential than age, height, social support, and even smoking habits.  On top of that, health isn’t just related to objective social status, but also subjective social status— where people places themselves in the hierarchy. Suspecting that perceived social status started in childhood, Dr. Boyce decided to dig a little deeper.

Playing short video clips of children playing with one another, Dr. Boyce described the different kinds of hierarchy-establishing behaviour he found, including imitation, displacement, directing behavior, and good old-fashion physical attack.

In one clip, two small children are shown digging, with a third child, a little brown haired girl, first attempting to displace one child digging next to a tree before successfully displacing the second from his digging spot. After she tires of digging and moves on to something else, the child she originally tried to displace, a boy with a head full of blond curls, chases after her, grabbing her around the waist and trying to drag her back to the tree.

Dr. Boyce described this as “another demonstration of nuanced male behavior,” to laughs from the audience. The boy eventually figured out he could get the little girl to keep digging with him if he just asked her.

These may seem like very typical childhood scenes, and they are, but Dr. Boyce also found that children on the low end of the social hierarchy— the ones who imitate and allow themselves to be directed and displaced— are often the ones with the highest activation of the stress response pathways.

To prove that extra stress results in poorer health outcomes, Dr. Boyce and his team turned their attention to teeth and dental caries (cavities). Knowing that excess cortisol (a stress hormone) effects mineralized tissue (like bone), they decided that the least invasive way to test children’s cumulative cortisol levels would be to wait for mineralized tissue to start dropping out of their mouths. In other words, they played tooth-fairy, paying children ten dollars per baby tooth. Using the teeth, Dr. Boyce’s team could then demonstrate that children with prolonged exposure to cortisol were more susceptible to dental caries and were more likely to be of low SES.

Early exposure to subordination and the accompanying stress, coupled with poverty, hunger and maternal injustices establishes the biology of misfortune.

The last finding he presented showed looked at variation within the groups— why some children of low SES thrive no matter what (dandelion children), while others are particularly sensitive and need very specific care (orchid children). Dr. Boyce presented findings that children whose parents were more stressed when they were still in the womb had a greater rate of epigenetic changes when tested later in life. Dr. Boyce was quick to say that research is still very preliminary, but his team is working to investigate further.

His team is also planning to publish on how different teaching styles affect hierarchies and health outcomes. Anecdotally, he believes that teachers that make a special effort to elevate the subordinate children in the eyes of their peers by pointing out their special talents make a positive impact on the children and their future health. How the research might impact teaching methods relates back to his overall take home message: it’s important to have an inter-disciplinary research approach to really see larger problems, and more importantly, to solve them.

Dr. Boyce’s work draws on pediatrics, genetics, sociology and economics to answer questions and he stressed that it is impossible to see the entire picture if you only looked at problems through the lens of a single discipline, and that people in all different fields would have to work together to end the biology of misfortune.

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