Abstract:

Having lower socioeconomic status is one of the most well-established social predictors of poor health. However, little is known about why some lower-class individuals maintain good physical health despite experiencing adversity. From a large number of empirical studies, researchers have found that psychological factors such as the “shift-and-persist” strategy can effectively protect the health of lower-class individuals in adversity and prevent them from developing certain diseases. The present study shows that in the midst of adversity, some individuals find role models who teach them to trust others, better regulate their emotions, and focus on their future. A role model is any individual who serves as an attachment figure and provides inspiration to a child and can be a parent, extended family member, or teacher. Over a lifetime, lower-class individuals with such role models develop an approach to coping with stress that helps them accept pressures and reappraisals (shift) while enduring adversity by maintaining a sense of meaning and optimism (persist). In contrast, among higher-class individuals, proactive efforts to cope aimed at eliminating stressors and the pursuit of future goals may be more effective, given such individuals' greater access to resources for engaging in preventive behaviors, resolving situations, and influencing outcomes.

The “shift-and-persist” model proposes that for lower-class individuals, developing a way of life that values changing oneself in coping with pressure while insisting on enduring adversity with strength and maintaining optimism and hope for the future can reduce the stress response, thereby protecting one's health. Why can the “shift-and-persist” strategy effectively protect the health of the lower class? Researchers have explained how a “shift-and-persist” strategy can affect the health of the lower class in reference to physiology and behavior. Specifically, the approach balances adaptation to stress and persistence at the same time, changes the physiological pathway of stress, and inhibits the physiological stress response of the lower-class in the face of adversity. In other words, the “shift-and-persist” strategy reduces responses to stress, thereby reducing the acute physiological activation of the hypothalamic-pituitary-adrenocortical (HPA) axis. Over time, this prevents the development of the pathogenic process and ultimately slows pathogenic disease processes over the long term among lower-class individuals. Specifically, first, a “shift-and-persist” strategy can effectively reduce the repeated activation of the HPA axis among lower-class individuals and then play a protective role in health. Cortisol, the end product of the HPA axis, is one of the most widely used physiological indicators of psychosocial stress, and researchers often use it as an indicator of HPA axis activity. Second, a “shift-and-persist” strategy can effectively regulate the inflammatory process of lower-class individuals to reduce the risk of developing chronic diseases. Low-grade inflammation has been implicated in the pathogenesis and expression of several chronic diseases associated with aging. Lower-class individuals are also more likely to engage in unhealthy behaviors, such as smoking, sedentary lifestyles and following a high-fat diet. These unhealthy behaviors increase the risk of developing cardiovascular disease and cancer and of early death. Preliminary evidence shows that different dimensions of the “shift-and-persist” strategy can reduce the health-threatening behavior of lower-class individuals to reduce the risk of disease.

In sum, the “shift-and-persist” strategy has drawn interest from researchers, its theoretical and practical value has been continuously examined, and it presents good development prospects. To address the problem of health poverty in a period of relative-poverty in China and better serve the health of lower-class individuals, future research can focus on the following aspects. First, research must be conducted in a longitudinal fashion to establish whether “shift-and-persist” strategies can predict health trajectories over time in children and adults. Second, from a multilevel and multipath perspective, studies must comprehensively investigate the mechanism by which a “shift-and-persist” strategy affects the health of lower-class individuals. Finally, future studies should vigorously develop intervention programs to promote a “shift-and-persist” strategy.

Key words: shift-and-persist, health, lower class, HPA axis