Nancy E. Adler, a health psychologist whose work helped change public understanding of the relationship between socioeconomic status and physical health, died Jan. 4 at her home in San Francisco. She is 77 years old.
Her husband, Arnold Milstein, said the cause was pancreatic cancer.
Dr. Adler was instrumental in documenting the powerful role that education, income, and self-perceived social status play in predicting health and longevity.
Today, the connection is well known—it’s a truism among public health experts that life expectancy depends more on your zip code than your genetic code. But just 30 years ago, this was a little-known concept.
“Thanks to Nancy’s decades of work and leadership, we now recognize that socioeconomic status is a factor in morbidity as we know it,” said Elissa Epel, a health psychologist at UC San Paul. and one of the largest and most consistent predictors of mortality.” Francisco, a disciple of Dr. Adler.
Since 1997, Dr. Adler has directed the MacArthur Foundation Research Network on Socioeconomic Status and Health, a network of health economists, epidemiologists, physicians, public health experts, psychologists, and sociologists. Study the relationship between socioeconomic status and health. The group is credited with mainstreaming the concept of social determinants of health and its implications for health and social policy.
“They looked at the question: ‘How does inequality, poverty or stress affect your life?’ How does it affect your life,” said Claire Brindis, a public health and policy researcher at the University of California, San Francisco. How many years can you live?”
Their work builds on the Whitehall Study, a survey of British civil servants begun in 1967, which showed a strong link between social class and mortality. This finding points to factors beyond access to health care or health insurance.
“What’s interesting to Nancy is that this relationship continues even at the top,” said Dr. Milstein, a prominent health policy researcher. “If you had an extra year of education, or if you were earning £200,000 instead of £190,000, the relationship would still hold.”
In 2000, Dr. Adler developed the MacArthur Ladder, a tool that asks people to mark their perceived income, education, and socioeconomic status on each of the 10 rungs of the ladder. It remains a reliable predictor of worsening health and early disease, suggesting that self-state perception is a meaningful marker in its own right.
In a 2007 MacArthur Foundation report, she wrote: “Middle-income Americans are more than twice as likely to die prematurely as those at the top of the income ladder, and those at the bottom are less likely to die prematurely than those at the bottom More than three times that.” Those at the top. “
“Once in a lifetime, a scientist changes the way we see what’s before us,” Dr. Brindis said of Dr. Adler.
Nancy Elinor Adler was born in Manhattan on July 26, 1946, to Alan Adler and Pauline Adler. Her mother was a teacher and her father was a clothing manufacturer and salesman. When Nancy was a young child, her family moved west, settling in Denver.
In middle school, she became obsessed with fictional teenage detective Nancy Drew, for whom she became a role model of sorts. “I think I was very impressed by Nancy Drew and very excited by the idea of solving the mystery,” Dr. Adler said in a 2015 lecture at UCSF.
She attended Wellesley College. During her sophomore year, she met Dr. Milstein, then a junior at nearby Harvard University, where his sister Ann also attended Wellesley College.
“Ann invited me to meet a sweet girl from Denver who lived across the street from her,” recalls Dr. Milstein, now a professor of medicine at Stanford University. “After she introduced us, my sister told me this was the girl I was going to marry.”
Dr. Adler graduated in 1968 with a degree in psychology. She married Dr. Milstein in 1975.
In addition to her husband, she is survived by two daughters, Julia Adler-Milstein and Sarah Adler-Milstein. her brother, Richard Adler; and three grandchildren.
Dr. Adler’s research challenged early mainstream thinking. At Harvard Graduate School, she earned her Ph.D. In 1973, for her doctoral thesis, she interviewed women before and after abortions.
“At the time, people were talking about abortion being nothing short of lifelong trauma for women,” said Dr. Harvey Feinberg, president of the Gordon and Betty Moore Foundation, a charity based in Palo Alto, California. He is an old friend of Dr. Adler. “But Nancy found just the opposite. She found that women saw this as an opportunity to reorient their lives.”
In 1972, Dr. Adler was hired as an assistant professor of psychology at the University of California, Santa Cruz. In 1977, she moved to the university’s San Francisco campus, where she became professor of medical psychology and vice chair of the Department of Psychiatry and Pediatrics. She retires in 2022.
At UCSF, she conducted a series of studies demonstrating the link between socioeconomic status and a range of conditions, including diabetes and cardiovascular disease. She coined the term in 1979 when she edited a book with two colleagues called Health Psychology. She founded the first graduate and postdoctoral programs in health psychology in the United States in the 1980s. Since then, similar plans have sprung up around the world.
A decade ago, amid growing concerns about health disparities, Dr. Adler recommended that large hospitals develop programs to measure and address the social factors of individual health. Today, hospitals and clinics regularly measure some of these problems, and many have programs designed to mitigate them.