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Conceptualizing and Identifying Cumulative Adversity and Protective Resources: Implications for Understanding Health Inequalities

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Address correspondence to Stephani L. Hatch, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032. E-mail: slh2020{at}columbia.edu

Abstract

This article focuses on cumulative adversity and protective resources, both social and biological, that interrupt or deflect individuals from optimal life-course trajectories and contribute to widening gaps in health. Under the guiding framework of cumulative adversity and/or advantage, this narrative discusses the theoretical framework of cumulative adversity, presents identified sources of cumulative adversity and protective resources, and highlights the utilization of the life-course approach. Numerous social and biological adverse conditions are identified across multiple domains. Utilizing the life-course perspective in identifying early life determinants and the paucity of information regarding identified protective factors are discussed. Understanding health inequalities requires attention paid to heterogeneity in the impact of social statuses as well as sources of cumulative adversity and protective resources within diverging trajectories across the life course. Intervention implications are discussed, and suggestions for future research are made.