by Nancy E. Adler, a health psychologist whose work helped transform public understanding of the relationship between socioeconomic status and physical health, died Jan. 4 at her home in San Francisco. She was 77 years old.
The cause was pancreatic cancer, said her husband, Arnold Milstein.
Dr. Adler was instrumental in documenting the powerful role that education, income, and self-perceived status in society play in predicting health and longevity.
Today, the connection is well known: A truism among public health experts is that life expectancy is determined more by ZIP code than genetic code. But just 30 years ago it was an obscure notion.
“Thanks to Nancy’s decades of work and leadership, we now recognize socioeconomic status as one of the largest and most consistent predictors of morbidity and mortality that we know of,” said Elissa Epel, a health psychologist at the University of California, San Francisco. Francisco, and apprentice of Dr. Adler.
Beginning in 1997, Dr. Adler directed the MacArthur Foundation Research Network on Socioeconomic Status and Health, a group of health economists, epidemiologists, physicians, public health experts, psychologists, and sociologists who studied the relationship between socioeconomic status and health. The group is credited with incorporating the concept of social determinants of health, along with its implications for social and health policy.
“They asked the question: ‘How does inequity, poverty or stress affect you?’” said Claire Brindis, a public health and policy researcher at UCSF. “How does it affect your life? How many years are you going to live?
His work was based on Whitehall Study, a survey of British civil servants begun in 1967, which showed a strong link between social class and mortality. This finding pointed to factors beyond access to health care or health insurance.
“What intrigued Nancy was that the relationship persisted even at the highest levels,” said Dr. Milstein, a prominent health policy researcher. “If you had an extra year of education, or earned £200,000 instead of £190,000, the relationship still existed.”
In 2000, Dr. Adler developed the MacArthur Staircase, a tool that asks people to mark their perceived income, education, and socioeconomic status on the rungs of a 10-step ladder. It remains a reliable predictor of worsening health and early illness, indicating that self-perceived status is a significant marker in itself.
In a 2007 report for the MacArthur Foundationwrote, “premature death is more than twice as likely for middle-income Americans as for those at the top of the income scale, and more than three times as likely for those at the bottom than for those at the bottom.” those who are at the top.”
Dr. Brindis said of Dr. Adler: “Once in a lifetime, along comes a scientist who changes the way we see what’s in front of us.”
Nancy Elinor Adler was born on July 26, 1946 in Manhattan, daughter of Alan and Pauline (Bloomgarden) Adler. Her mother was a teacher and her father was a clothing manufacturer and seller. When Nancy was a little girl, her family moved west and settled in Denver.
In high school, she became captivated by Nancy Drew, the fictional teenage detective, who became something of a role model. “I think I was really impressed with Nancy Drew and got really excited about the idea of solving mysteries,” Dr. Adler said in a talk at UCSF in 2015.
He attended Wellesley College. In her sophomore year, she met Dr. Milstein, then a junior at nearby Harvard, whose sister, Ann, also attended Wellesley.
“Ann invited me to meet a lovely girl from Denver who lived across the street from her,” recalled Dr. Milstein, now a professor of medicine at Stanford University. “After she introduced us, my sister told me that this was the girl she would marry me.”
Dr. Adler graduated with a degree in psychology in 1968. 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 prevailing thinking from the beginning. In graduate school at Harvard, where he earned a Ph.D. In 1973, he interviewed women before and after abortions for his doctoral thesis.
“At the time, there was a lot of talk that abortion amounted to lifelong trauma for a woman,” said Dr. Harvey Fineberg, president of the Gordon and Betty Moore Foundation, a philanthropic organization based in Palo Alto, California, and which was a long-time friend of Dr. Adler. “But Nancy discovered the opposite. She found that women saw it as an opportunity to reposition their lives.”
In 1972, Dr. Adler was hired as an assistant professor of psychology at the University of California, Santa Cruz. She moved to the university’s San Francisco branch in 1977, where she became professor of medical psychology and vice chair of the departments of psychiatry and pediatrics. She retired in 2022.
At UCSF, he embarked on a series of studies demonstrating the link between socioeconomic status and a spectrum of diseases, including diabetes and cardiovascular disease. In 1979, together with two colleagues there, he edited a book titled “Health Psychology,” thus coining the term. He started the first graduate and postdoctoral programs in health psychology in the United States in the 1980s. Since then, similar programs have emerged around the world.
A decade ago, encouraged by growing attention to health disparities, Dr. Adler recommended large hospitals create programs to measure and address the social factors of personal health. Today, hospitals and clinics routinely measure some of them and many have programs aimed at mitigating them.
