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The Gerontologist The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America.

Vol. 49, No. 3, 333343 All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
doi:10.1093/geront/gnp034 Advance Access publication on April 17, 2009

Aging and Cumulative Inequality: How Does


Inequality Get Under the Skin?
Kenneth F. Ferraro, PhD,1,2 and Tetyana Pylypiv Shippee, PhD2

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Purpose: This article draws from cumulative dis- cumulative disadvantage, nancial accumulation,
advantage and life course theories to develop a and stress accumulation. Although the concept of
new theory for the social scientic study of aging. accumulationgradually collecting or amassing
Design and Methods: Five axioms of cumula- somethingis useful for many elds of study, ger-
tive inequality (CI) theory are articulated to identify ontologists appear to be elevating it from a latent,
how life course trajectories are inuenced by early almost silent, process into one which needs explic-
and accumulated inequalities but can be modied by it attention to better understand the aging process.
available resources, perceived trajectories, and hu- Indeed, a recent title search of PubMed for the
man agency. Results: Although the concept of words accumulation and aging identied
CI has attracted considerable attention among social 150 publications during the past 40 years. Half
scientists, it holds promise for integrating additional of them, however, were published in the past
disciplinary approaches to the study of aging includ- decade.
ing, but not limited to, biology, epidemiology, and In the social sciences, much interest has been
immunology. The applicability of CI theory to geron- shown in Dannefers (1987, 2003) prescient artic-
tology is illustrated in research on the early origins of ulation of cumulative advantage/disadvantage
adult health. Implications: Primary contribu- (CAD) theory. ORands (1996, 2003) exemplary
tions of the theory to gerontology include greater at- writings are parallel in many respects, but she pre-
tention to family lineage as a source of inequality; fers the phrase cumulative advantage theory. Many
genes, gestation, and childhood as critical to early scholars summarize CAD via the maxim advantage
and enduring inequalities; the onset, duration, and accumulates, but Dannefer (2003) denes CAD as
magnitude of exposures to risk and opportunity; and the systematic tendency for interindividual diver-
constraints on generalizations arising from cohort- gence in a given characteristic (e.g., money, health,
centric studies. status) with the passage of time (p. 327). Viewing
Key Words: Theory, Cumulative disadvantage, Life the life course perspective as too focused on mi-
course, Stress, Psychosomatic processes crolevel processeswhat Hagestad and Dannefer
(2001) call microcationDannefer sought to
privilege a set of social dynamics that operate on
The concept of accumulation has long interested a population, not individuals (Douthit & Dannefer,
gerontologists and, it appears, this interest has 2007, p. 224).
grown in recent years. Many biologists are study- Dannefers aim to apply CAD theory to popula-
ing how the aging process is altered by the accu- tion and cohort processes is excellent. We need
mulation of senescent cells, DNA damage, or more attention to age stratication and how mac-
oxidative damage. At the same time, social and be- rostructural forces inuence aging. Nevertheless,
havioral scientists are examining topics such as it is also valid to apply some of these concepts
to the analysis of micro- and mesolevel processes
that inuence the process of growing older (with-
1
Address correspondence to Kenneth F. Ferraro, PhD, Center on Ag-
out becoming lost in microed analyses). Perhaps
ing and the Life Course, Purdue University, Young Hall, West Lafayette, studying the accumulation of inequality will help
IN 47907-2108. E-mail: ferraro@purdue.edu
2
Center on Aging and the Life Course, Purdue University, West
us understand multiple levels of relationships be-
Lafayette, Indiana. tween individuals and their environments. Indeed,

Vol. 49, No. 3, 2009 333


when Ferraro (2007) incorporated a tenet for cu- and selected ndings and models of biologic pro-
mulative disadvantage into the gerontological cesses associated with aging. Social forces in every-
imagination, it spanned both individual and cohort day life can lead to psychological and biologic
phenomena: disadvantage accumulates over the changes in the body. Unlike the idiomatic use of
life course, thereby differentiating a cohort over under the skin, we hope to illustrate how CI
time (p. 336). leads to biologic changes in humans that are com-
Encapsulated in that tenet is a recognition that monly associated with the process of growing
cumulative disadvantage can be usefully linked older. In this sense, inequality may well lead to
with the life course perspective. Furthermore, an- the accumulation of biologic materials under the
other tenet of the gerontological imagination fo- skin that are markers of aging and predictive of
cuses on life course analyses: aging is a life-long senescence.
process, and using a life course perspective helps

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advance the scientic study of aging (Ferraro,
2007, p. 335). Studying the accumulation of in- Axioms of CI Theory
equality implies more than studying older people In this section, we summarize the ve axioms of
only; it is quite consistent with the life course or CI theory and identify their utility for gerontology
life span approach (Elder, 1994). (Ferraro et al., in press). Subsequently, we show
The purpose of this article was, therefore, to in- how they can be meaningfully linked to biomed-
tegrate core concepts and principles from cumula- ical and behavioral processes for the study of
tive disadvantage and life course theoriesas well aging.
as from other theoriesinto a new theory for
studying aging and the accumulation of inequality. Axiom 1: Social systems generate inequality, which
Cumulative inequality (CI) theory is specied as is manifested over the life course through demo-
graphic and developmental processes.
a middle-range theory that incorporates elements
of macro- and microsociological content in an at- Cumulative inequality theory draws on the so-
tempt to bridge both levels of analyses (Merton, ciological dictum that social structures shape hu-
1968b). man behavior and interpersonal relations. Heeding
Cumulative inequality theory species that so- the criticism of Hagestad and Dannefer (2001), CI
cial systems generate inequality, which is manifest- theory identies social systems as central to the
ed over the life course via demographic and generation of inequality. Inequality is not primar-
developmental processes, and that personal trajec- ily the result of individual choices and actions but
tories are shaped by the accumulation of risk, is structurally generated. Even before an individual
available resources, perceived trajectories, and hu- is born, social forces shape conception, fetal devel-
man agency. Recognizing that CI may lead to pre- opment, and birth. And evolutionary biologists
mature mortality, the theory also emphasizes the have long noted that adaptation and survival have
use of cohort-inclusive and longitudinal studies to a social component (Kirkwood, 1977); natural se-
discern how selection processes shape inequality. lection is, after all, a selection process (i.e., organ-
Ferraro, Shippee, and Schafer (in press) articu- isms mature to reproduce, thereby propagating
lated ve axioms of CI theory as they sought to traits favorable to survival).
apply it to the research on aging and the life course. What CI theory adds to the focus on the social
In the process, they also enumerated how CI is dis- antecedents of inequality, however, is a recog-
tinct from CAD theory and provided a rationale nition that inequality accumulates over the life
for preferring the term cumulative inequality the- course. Whether two infants (even twins) start with
ory for this emergent perspective. The present ar- the same genes and environment or vastly different
ticle is designed to extend the development of the ones, differentiation will occur. Thus, age is an in-
theory by focusing on its application to gerontol- dex of life changes and the accumulation of in-
ogy. The primary aims are twofold. equality. This is helpful for studying individual
First, we seek to explicate this new theory for lives as well as for studying cohort differentiation.
the social scientic study of aging, largely by inte- It also points to the importance of reproduction
grating several current theories, especially CAD and genetics in shaping cohorts and the life
and life course theory. Second, recognizing the course.
multidisciplinary nature of gerontology, we seek Cumulative inequality theory holds that child-
to develop meaningful links between CI theory hood conditions are important for explaining adult

334 The Gerontologist


functioning and well-being; thus, gerontology ben- Axiom 3: Life course trajectories are shaped by the
ets by systematically considering how early-life accumulation of risk, available resources, and hu-
events and experiences shape later life outcomes. If man agency.
childhood conditions are important for under- Although CI theory views social structure as an-
standing the accumulation of inequality, then it tecedent in the development of inequality, there is
stands to reason that family lineage is critical as no expectation that adverse experiences or events
well, both for genetic transmission and for shared have inexorable effects over the life course. The
living environments (and these topics have received accumulation of risks and opportunities is central
little attention in CAD theory). Whereas families to CI theory, but this does not mean that the indi-
are nested within communities, CI theory also pri- viduals life is determined by early exposure to
oritizes a multilevel approach for understanding adverse or favorable experiences. Rather, we view
how social systems inuence inequality over the trajectories as subject to change, a position consis-

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life course. tent with a large body of gerontological research
Axiom 2: Disadvantage increases exposure to risk, regarding the modiability of the aging process
but advantage increases exposure to opportunity. (Maddox, 1987). How, then, are trajectories
modied?
Many people think of advantage and disadvan-
Inequality accumulates over the life course, but
tage as opposites, but this may limit our under-
resource mobilization and human agency play crit-
standing of how inequality accumulates over the
ical roles in how trajectories are shaped. Resources
life course. Consider the difference between in- can blunt the potential impact of earlier disadvan-
come that is $50,000 and $50,000. The person tage, enabling the person to better function with or
with negative income does not just have less of the overcome the adversity (Ferraro & Kelley-Moore,
same units held by the person with positive income; 2003). Psychosocial resources are important, and
rather, the person with negative income will en- human agency plays a critical role in shaping how
counter different social processes to deal with this likely it is that social adversity can get under the
situation. Instead of thinking of positive and nega- skin. For example, being treated unfairly can pro-
tive income as simply the polar opposites of voke a number of psychosomatic processes that
advantage and disadvantage, it may be useful to can be harmful to health, but some persons seem
consider disadvantage as an exposure to risk (e.g., better able to deect or adapt to such unfair treat-
debt, bankruptcy) and advantage as an exposure ment without it damaging their health (Thoits,
to opportunity (e.g., investment, retirement secu- 2006). Others seem highly vulnerable to such
rity). Advantage and disadvantage refer to social treatment, even when they have resources that ap-
positions in a hierarchy, but one should not simply pear adequate given the magnitude of the unfair
assume that advantage is the opposite of disadvan- treatment.
tage (see also Willson, Shuey, & Elder, 2007). In The life course perspective gives priority to tim-
analytic terms, gerontologists need to consider ing in ones life, and it may be useful to think of
nonlinear relationships in how events and process- turning points as times during the life course when
es imprint the life course. major change occurs in how the person responds
Cumulative inequality theory also holds that to a risk or an opportunity (Elder & Shanahan,
there are multiple axes upon which inequality de- 2006). The point is that people respond to these
velops. Whereas inequality may diffuse across stimuli, and CI theory draws on the richness of life
outcomes, it is useful for gerontological research course theory to explicitly incorporate human
to monitor multiple domains (Kelley-Moore & agency into the process of trajectory modication.
Ferraro, 2005). To best capture how these domains
interactand how risk factors accumulatewe Axiom 4: The perception of life trajectories inu-
need greater attention to conceptualizing and mea- ences subsequent trajectories.
suring the magnitude, onset, and duration of expo- Another source of trajectory modication is
sures to advantage and disadvantage. Magnitude outlined in Axiom 4, thereby highlighting how CI
refers to the extent or dose of an advantage or theory is distinctive from previous theories regard-
disadvantage. Onset refers to when the exposure ing the accumulation of inequality. People have a
began, and duration is the length of time that an sense of how they are doing, and this sense inu-
individual experiences the condition (either risk or ences their subsequent actions (Carstensen, 2006).
opportunity). Drawing from symbolic interaction and social

Vol. 49, No. 3, 2009 335


comparison theories, CI recognizes that subjective nal studies is contingent on the ability to respond
views of positions and resources may be more im- (independent of availability in the population). As
portant than the actual positions and resources in such, gerontologists should give explicit attention
shaping subsequent trajectories. Following the to nonrandom selection in their studies as shown
Thomas theorem, actors seek meaning for their recently by Willson and associates (2007). More-
positions (Merton, 1995), and the interconnected- over, the utility of cohort-centric studies for assess-
ness of human lives may predispose them to view ing CI merits sober consideration. If the aim is to
their positions in the context of their associates show how inequality accumulates, it should be
(Elder & Shanahan, 2006). People view and evalu- clear that studying limited age ranges (e.g., 70+)
ate their trajectories in comparison to signicant will result in describing changes after considerable
others and reference groups. population truncation has occurred. Stated plainly,
The evaluation of trajectories is also part of the should gerontologists study older people only? If

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process whereby people select activities to opti- the aim is to identify mechanisms for the accumu-
mize. According to the theory of selective optimi- lation of risk factors and inequality, the limitations
zation with compensation, a person rst becomes of cohort-centric designs should be apparent.
aware of a decit in functioning; then he or she To supplement this brief overview of the theory,
selects an activity to optimize (Baltes, Staudinger, Table 1 lists the ve axioms as well as propositions
& Lindenberger, 1999). Compensation follows the for each as specied by Ferraro and associates (in
evaluation of a performance concern and a deci- press). The table is intended to formalize the theo-
sion to select an activity by which to restore a sense ry for developing hypotheses for future research,
of optimal functioning. and it may clarify some of the ways in which CI
Gerontologists have long been interested in how differs from CAD and life course theories. For in-
normative and nonnormative events inuence ad- stance, there is little attention to the role of family
aptation as well as whether the person feels he or lineage (Proposition 1c) in CAD theory. In addi-
she is on or off time when transitioning to new tion, neither CAD nor life course theory species
roles. Cumulative inequality theory holds that fa- propositions that focus on how perceived life tra-
vorable sentiments about being ahead of ones jectories shape self-efcacy and psychosomatic
peers likely lead to self-efcacy, and self-efcacy processes (4b and 4c). For the remainder of the
may alter the psychosomatic processes initiated by article, the table also permits concise reference to
adversity (Pearlin, Nguyen, Schieman, & Milkie, the theory as we articulate links to other disciplines
2007). By contrast, unfavorable sentiments about and to the eld of gerontology more generally.
a life transition, such as involuntary retirement due
to corporate downsizing, would challenge self- Interdisciplinary Linkages for Studying Aging and
efcacy and subsequent trajectories. Senescence
Axiom 5: Cumulative inequality may lead to pre- Although CI theory has strong connections to
mature mortality; therefore, nonrandom selection sociology, meaningful links may also be developed
may give the appearance of decreasing inequality to biologic and psychological concepts and theo-
in later life.
ries of aging and senescence. Others have re-
As noted earlier, selection processes are central marked on such potential connections, but we are
to the study of how inequality accumulates over unaware of any systematic endeavors to explicate
the life course. The practical signicance is that if the links. For instance, Alkema and Alley (2006,
CI operates on mortality, the composition of a p. 577) astutely asserted that accumulation pro-
population will change, perhaps resulting in what cesses are closely related to biological concepts
some refer to as cohort inversion. Removing such as stress theories of aging, allostatic load,
persons with the most health problems from a and physiological dysregulation. Thus, in this sec-
population will make the cohort that was initially tion, we articulate some of these interdisciplinary
disadvantaged appear better off than before the links and more directly address the question of
population truncation. The likely result is that how inequality gets under the skin. Two topics
mean scores may rise, giving the appearance of im- are considered to illuminate how CI theory can be
proving health and decreasing inequality. utilized, at least in part, to enhance our under-
This problem may be exacerbated for samples standing of the multidimensional phenomenon
because continued participation in most longitudi- known as aging.

336 The Gerontologist


Table 1. Axioms and Propositions of Cumulative Inequality Theory

Axioms Propositions
1. Social systems generate inequality, which is manifested a) Childhood conditions are important to adulthood, especially
over the life course through demographic and when differences in experience or status emerge early.
developmental processes. b) Reproduction is a fulcrum for dening life course
trajectories and population aging.
c) Inuenced by genes and environment, family lineage is
critical to status differentiation early in the life course.
d) Cohorts provide the context for development, structuring
risks, and opportunities.
e) Consider inter- and intra-individual processes and use
analytical techniques that explain variability on multiple

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levels or in multiple domains.
2. Disadvantage increases exposure to risk, but advantage a) Consequences of advantage may not be the inverse of
increases exposure to opportunity. disadvantage.
b) Inequality may diffuse across life domains (e.g., health
and wealth).
c) Trajectories are affected by the onset, duration, and
magnitude of exposures.
3. Life-course trajectories are shaped by the accumulation a) Human agency and resource mobilization may modify
of risk, available resources, and human agency. trajectories.
b) Turning points in the life course may alter the anticipated
consequences of a chain of risk.
c) The dialectic of human agency and social structure is
essential to cumulative inequality.
d) Unfavorable trajectories can be mitigated by the magnitude,
onset, and duration of resources; resources can also
accelerate favorable trajectories.
4. The perception of life trajectories inuences subsequent a) Social comparisons shape trajectories.
trajectories. b) Favorable life review linked to self-efcacy.
c) Perceived life course timing inuences psychosomatic
processes.
5. Cumulative inequality may lead to premature mortality; a) Cumulative inequality creates compositional change in a
therefore, nonrandom selection may give the appearance population.
of decreasing inequality in later life. b) Population truncation may give the appearance of
decreasing inequality.
c) Test for selection effects.
d) Interpret results in light of event censoring and cohort
inclusiveness.
Note: Adapted from Ferraro, Shippee, & Schafer (2009).

Early Origins of Adult Health quences on health, both during childhood and
As noted earlier, CI theory gives explicit atten- adulthood.
tion to the role of reproduction, family lineage, The work of Barker (2003) has been both en-
genes, and environmental context in shaping the lightening and controversial for providing insight
life course (i.e., Propositions 1a to 1c and 2c). into how fetal health may be related to adult health
Whereas CI focuses on the compounding of status outcomes. Beyond the obvious consequences that
hierarchies, it is important to understand the early risky maternal behaviors such as smoking may
origins of health. Are there inequalities in how have on fetal health, Godfrey and Baker (2000)
people start the race of life? Gerontologists fre- have shown that poor fetal nutrition raises the risk
quently think of aging as a life course process of low birth weight as well as adult health prob-
from birth to deathbut gestation may have a lems, including hypertension, coronary heart dis-
more vital role in gerontology than many of us ease, and stroke. The scientic innovation in this
would have previously imagined. From conception genre of research is to track the individuals from
to birth, evidence is mounting that the circum- conception to later life, even death, and to system-
stances of fetal growth may have long-term conse- atically document the associations. The outcomes

Vol. 49, No. 3, 2009 337


considered are diverse, extending also to diabetes ties develop over the life course (Propositions 1a to
and sarcopenia. 1c). Nevertheless, we disagree that the early inu-
As might be expected, this line of inquiry has ences are necessarily inexorable in their effects.
raised some controversy. Singhal and Lucas (2004) Many early imprints on the organism can be neu-
argue that it is not fetal programming per se but tralized or reversed, and a growing number of
the rate of growth after birth (accelerated develop- investigators are discovering that resources may
ment) that is the true causal agent. Severely mal- moderate the effects of adversities (Propositions
nourished fetuses may not survive, but most that 3a and 3d). The work of gerontology, therefore,
survive will experience rapid growth. Singhal and should include identifying how to modify what
Lucas contend that it is the rapid growth during may appear to be inexorable inuences on health.
infancy that raises the risk of obesity and insulin This can occur by prospective tracking of persons
resistance. Moreover, both the programming and over long periods of time or by interventional re-

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accelerated growth theses imply metabolic discon- search seeking to interrupt a presumed chain of
tinuity. It may be that the metabolic whiplash events. As Maddox (1987, p. 563) sagaciously
from poor nutrition during gestation to rich nutri- concluded decades ago:
tion during accelerated infant growth requires
We do not know the limits of modiability of aging
major homeostatic recalibration; perhaps this recali-
processes and the experience of aging. We do know
bration (or reprogramming) is the pathway to a that if we want to understand aging processes and the
series of metabolic and health problems. In adult- experience of aging, we can learn by trying to change
hood, there is evidence that weight cycling creates them when the observed outcomes are unacceptable.
metabolic problems often leading to weight gain
and insulin resistance. Perhaps this whole sequence Indeed, if the events and processes that compro-
starts much earlier in the life of the organism mise quality of life cannot be modied, what is
(Montani, Viecelli, Prvot, & Dulloo, 2006). the aim of biomedical research? Cumulative in-
The point is that gestation, infancy, and early equality theory holds that the imprint of early life
childhood are critical periods in the life course. is substantial but that there are many ways to
Gerontologists obviously consider later life as a modify the deleterious chain of events due to early
period of profound change and adaptation, but the inequalities.
seeds of many of these changes may have been It may be reasonable to accept the premise that
planted decades earlier. Although it may seem an- gestation and childhood shape health outcomes in
tithetical to gerontology as a eld of study, we as- adulthood, but how and why does this occur?
sert that gerontologists interested in health issues Some scholars feel that the fetal programming and
should be educated about and seek to integrate accelerated growth perspectives rely on an over-
what has been learned in recent decades on the simplied view of the link between early origins
early origins of health. A beginning point is the and health in later life. The two stages of life may
observation by Forrest and Riley (2004, p. 162) be linked, but why?
that childhood is an incubation period for First, some scholars argue that there may be a
many disorders that affect the health of the whole genetic basis for the link, a premise that is plausible
population. but insufcient for explaining the major social
Controversy has also arisen regarding whether changes in disease incidence and prevalence.
early origins have inexorable effects on adult Second, there may be complex etiological links
health. Some investigators hold that the effects of between early and later life, which we are only be-
selected early events are indeliblea scarring ef- ginning to understand. Although the links are
fect due to the early insult. Indeed, this viewpoint complex, CI theory is designed to help explicate
led Barker (2003) to propose a new approach to the accumulation processes that alter ones chances
thinking about disease causation. He is critical of to age optimally. Some social scientists have viewed
the widely held view that chronic diseases are the cumulative disadvantage primarily as the growing
result of health destructive actions on the part of gap in an outcome between status groupsearly
adults, seeking rather to improve adult health disadvantage amplies inequality over timebut
through better maternal and child health. Cumula- we think this misses a main point. Early inequali-
tive inequality theory concurs in some respects by ties lead to differences in how individuals and
identifying family lineage, genes, maternal health, groups are exposed to risk factors that typically
and childhood as critical to how health inequali- compromise health (Axiom 2; Propositions 2a and

338 The Gerontologist


2c). In short, CI is a life course process, not just the When people sense stress, common physiologi-
difference in outcomes due to early adversity. cal responses include activation of adrenal hor-
A research program that provides great insight mones, such as cortisol and catecholamines, and
into how inequality accumulates from childhood autonomic nervous system reactivity (Lundberg,
to adulthood is led by Felitti (2002). Using data 2005). Occasional arousal of these responses is
from managed care enrollees, Felitti and colleagues normal and probably conducive to healthy func-
(1998) found that childhood adversities (ranging tioning and adaptation. A growing body of re-
from parental divorce to sexual abuse) are more search, however, shows that chronic activation of
common than widely reported and consequential these responses may have adverse effects on the
to adult health 50 years later. In related articles, human body. The biologic arousal due to stressors
not cited herein, they also showed that a count of is increasingly seen as the intersection of many
adverse childhood experiences increased the likeli- processes ranging from social and behavioral de-

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hood of engaging in behaviors that compromise terminants of stress exposure and resource mobili-
health (smoking, obesity, and attempted suicide). zation to the endocrine responses that inuence
Thus, early adversities may have both direct and immune function.
indirect effects on physical health, with the indi- Recent ndings from stress research document
rect effects often manifested through high-risk how the accumulation of these stress responses can
lifestyles. accelerate the aging process, even among people
Children who are abused, for instance, may suf- who are asymptomatic of disease. For instance, a
fer immediate bodily harm as well as impaired psy- recent article by Epel and associates (2006) shows
chosocial development and an inclination toward that stress arousal is related to low leukocyte te-
risk takingand each is a mechanism by which lomerase, a precursor of telomere shortening. Te-
early adversity may lead to poor health (Irving & lomeres are DNAprotein complexes found at the
Ferraro, 2006). This illustration also claries that ends of chromosomes, which act as caps to keep
disadvantage in one domain (e.g., family life) may the sticky ends from fusing together. Telomeres are
spill over to other domains (e.g., mental and phys- essential to the stability of genetic information,
ical health) as specied in Proposition 2b. More- and it is widely known that telomeres are shorter
over, early adversity increases the likelihood of in older organisms. Moreover, the cellular enzyme,
exposure to additional risks, which may lead to telomerase, helps telomere stability and length,
additional adversity. Such a pernicious cycle is dif- thereby aiding genetic stability and cell function.
cult to overcome, especially when it is situated in Epel and associates (2006) administered a social
an environment and a family rife with problems stress test to a sample of 62 women and found that
(Propositions 1a to 1d). stress exposure was related to less telomerase and
shorter telomeres. Interestingly, they also found that
telomerase was positively correlated with educa-
Stress Accumulation
tion. In essence, they uncovered that social factors
The rst axiom of CI theory focuses on how and stressful exposures were related to biochemical
social arrangements shape inequality over the life responses that inuence genetic stability and cell
course. The primary antecedents of inequality are function. This nding suggests the utility of telom-
socially patternedeven genetic material is so- erase and telomere length as biomarkers of the ac-
cially transmittedand one of the major mecha- cumulated effects of stress over the life course.
nisms by which social forces get under the skin is Drawing from CI theory, people who had early-
through stress processes. We have, of course, al- onset and severe adversity (e.g., child abuse) would
luded to these mechanisms earlier, but it may be be more likely than their peers without such adver-
useful to focus more closely on biologic processes sity to be telomerase decient, resulting in shorter
associated with adversity. Social and environmen- telomeres (Propositions 1a and 1c). This hypothe-
tal stressors often precipitate biologic processes sized difference should exist long before the
that shape the survival and functioning of the or- development of heart disease or other diseases com-
ganism (Hayick, 1998). Cumulative inequality monly associated with stress processes (Proposition
theory may be helpful for identifying how these 2c). In addition to this hypothesis, it would also be
stressors accumulate, modify cohort inequality, fascinating to determine whether telomerase levels
and diffuse across life domains (Propositions 1d rise with adequate resource mobilization (Proposi-
and 2b). tion 3d). Whatever the case, biogerontologists have

Vol. 49, No. 3, 2009 339


expressed considerable interest in the process of te- ways in which accumulated inequality can get un-
lomere shortening, and Epel and associates (2006) der the skin. In this concluding section, we reect
provide an important insight into how accumulated on CI theorys utility for gerontology and offer
stress may lead to biologic changes that accelerate several observations regarding what might accel-
aging and senescence. erate theory development in social gerontology
A second illustration of how accumulation pro- and, more generally, paradigm development in
cesses are critical to understanding growing in- gerontology.
equality in populations and cohorts is through It should be noted that many elements of our
chronic inammation. A review by Finch and theory have been discussed in previous theories of
Crimmins (2004) reveals that infections during the aging, but the integration of these elements is nov-
early years of life increase the likelihood that the el. For instance, we merge concepts and expecta-
person will develop diseases as an adult, including tions from the following theories: CAD, life course,

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cancer, diabetes, and cardiovascular disease (see symbolic interactionism, stress process, and chron-
also Blackwell, Hayward, & Crimmins, 2001). ic inammation. The result is a new way of think-
From CI theory, we see that early disadvantage in- ing about how inequality accumulates over the life
creases the risk for additional disadvantage: Early course. In doing so, we also draw several concep-
infections increase the risk for chronic adult mor- tual distinctions such as differentiating between
bidity, creating a lifetime of chronic inammation. disadvantage and risk (Axiom 2) and noting
Advantaged children, who have less exposure to that disadvantage is not the inverse of advantage
infections, are less likely to become infected during (Proposition 2a). We also give priority to family
childhood, resulting in a lower risk for chronic dis- transmission of inequality (both genetic and envi-
ease during adulthood. They would still have bouts ronmental) and the role that actors play in inter-
of inammation, but these would be less chronic preting their life trajectories. Details of how we
over the life course, allowing greater time for re- constructed the theory and how it is distinct from
covery and optimal functioning. Disadvantaged other theories are presented elsewhere (Ferraro
children, however, such as those with an alcoholic et al., in press).
parent, may be more susceptible to infections due In this article, we drew from research on the
to poorer living conditions and the chronic stress early origins of health and stress processes to pro-
of potential abuse (Propositions 1a to 1d). vide examples of how CI can build some meaning-
Several biomarkers can be used to identify chron- ful links to other elds of study and theories of
ic inammation, including interleukin-6, brino- aging. The attempt was to build bridges. If success-
gen, and tumor necrosis factor-a, but the most ful, these are surely footbridges. Much work needs
widely used is C-reactive protein (CRP). C-reactive
to be done to more formally articulate how CI the-
protein is an acute-phase inammatory protein that
ory can be integrated with more biomedical nd-
signals a response to an exogenous or endogenous
ings and biologically based frameworks for
insult. For instance, CRP will be elevated from ex-
understanding aging and senescence.
ternal trauma or from internal tissue malfunction.
Several conclusions surfaced from this endeav-
C-reactive protein is functional for short-term ad-
or. First, gerontology needs greater and more sys-
aptation to inammation but can be maladaptive if
tematic attention to accumulation processes. For
chronically elevated. Monitoring CRP and other
instance, epidemiologists often refer to the accu-
biomarkers in the population may help identify
mulation of risk factors, but what does it mean?
how chronic inammation shapes aging and senes-
There are many ways to accumulate items
cence. According to CI theory, we anticipate that
continually, intermittently, in large or small quan-
accumulated disadvantage will generally be associ-
tities. And accumulation may infer dumping (e.g.,
ated with chronic inammation but that the char-
acteristics of the exposure and the mobilization of catastrophe theory) or systematic adaptation to
resources will also inuence the degree of chronic the accumulation of experiences. We need both
inammation (Propositions 2c and 3d). empirical research and theoretical explication about
how accumulation processes shape the aging pro-
cess. By analogy, we should not aim to study just
Implications of CI for Gerontology the contents of the accumulation process but the
Cumulative inequality is proposed here as a new processes by which the content was accumulated
social science theory of aging to help us explain the (Propositions 1d, 2c, 5a, and 5c).

340 The Gerontologist


Gerontologists would also be wise to study both studying accumulation processes during these early
the positive and negative content of accumulation periods (Propositions 1a, 1c, and 1d). We agree
processes. There is an understandable interest in with Finch and Crimmins (2004, p. 1739) that a
studying the accumulation of negative content such new theory of human health in life history could
as health decits (Kulminski et al., 2007) and dam- emerge from a fuller accounting of inammatory
age (Finkelstein, 2007). At the same time, we ap- exposures from gestation to old age (emphasis
plaud the growing interest in how positive attributes added). Although the promise of these early ori-
or characteristics inuence aging; examples include gins is profound, it could be argued that we are in
compensatory skill (Baltes et al., 1999), cognitive a scientic phase of health studies that might be
reserve (Richards & Sacker, 2003), and intellectual described as the black box of middle age. Cumula-
strategies (Roring & Charness, 2007). tive inequality theory holds that early origins are
Cumulative inequality theory provides a useful important but not just because indelible events

Downloaded from http://gerontologist.oxfordjournals.org/ at UNAM Direccion General de Bibliotecas on November 21, 2014
framework for studying accumulation processes, directly accelerate aging and senescence. Rather,
especially in the context of social stratication we view the early origins as precipitating different
(Merton, 1968a). As noted earlier, biologic pro- exposures for those who were disadvantaged early.
cesses are related to patterns of social interaction. In this sense, we also need to integrate adult adver-
Very telling in this regard is research by Cohen, sity in spheres such as work and family into the
Doyle, and Baum (2006) revealing that socioeco- study of CI. Our aim was to uncover the pathways
nomic status (SES) is inversely associated with by which early disadvantage leads to health prob-
stress hormones such as cortisol and catecholamines lems and early senescence. Cumulative inequality
(e.g., epinephrine and norepinephrine). This is an theory, therefore, examines the intertwined phases
important nding for stress researchers who want of the life course for the development of inequality.
to better understand how accumulated stress inu- We do not assume that certain periods of life initi-
ences biologic functioning. At the same time, it is ate changes that are universally experienced by
important for social gerontology. The inverse rela- a population. Instead, our interest is in studying
tionship between SES and stress hormones means how people experience events and processes at
that there are observable biomarkers of accumu- different timesin both biographical and histori-
lated stress that can be used to examine how peo- cal timeand how some people are able to reduce
ple respond to long-term disadvantage. Moreover, their exposure to noxious events and experiences.
it points to SES as an enduring exposure to risk or Third, Axiom 5 provides a lens for interpreting
opportunity (Propositions 2a and 2c)and one the processes of accumulation. This axiom recog-
that has been shown to have long-term effects. nizes how mortality changes the composition of a
Growing older entails accumulation. Cumulative population. In this sense, we must realize that peo-
inequality theory provides a frame of reference ple at advanced ages have survived the insults of
to consider the accumulation processes and the everyday life and some have overcome incredible
mechanisms that either exacerbate or reduce the odds. The intellectual consequences for gerontol-
risk for chronic stressors (Propositions 2c and 3d, ogy are twofold: (a) we need greater appreciation
respectively). for older people as survivors and (b) we need to
Second, it should be clear from this essay that recognize the limitations of cohort centrism and
CI theory is not an ontogenetic stage theory of ag- population truncation for studies of accumulation
ing, and life stages need not be tightly linked to processes. We also need more long-term life course
chronological age. Keeping with another tenet of studies of aging, especially if we intend to test how
the gerontological imagination, we need a healthy inequality accumulates (Propositions 5b to 5d).
skepticism for aging as a causal variable (Ferraro, Finally, gerontology as a eld of study has long
2007). Cumulative inequality theory uses basic life praised interdisciplinary collaboration, and it re-
stages as a frame for understanding accumulation mains one of the most exemplary elds of study to
processes involving structural disadvantage, expo- build bridges across disciplines. At times, however,
sure to risk, and mobilization of resources. the pace of gerontologys transformation from a
Cumulative inequality theory gives special at- multidisciplinary to an interdisciplinary eld of
tention to family lineage and, concomitantly, re- study almost seems dilatory (Achenbaum, 1995;
production, gestation, and childhood. The interest Bass & Ferraro, 2000). Many gerontologists es-
in fetal and childhood origins of health is strong, pouse the virtues of interdisciplinary research,
and we believe that gerontology will benet by but we suspect that relatively few of those who

Vol. 49, No. 3, 2009 341


claim to be gerontologists actually engage in such Carstensen, L. L. (2006). The inuence of a sense of time on human devel-
opment. Science, 312, 19131915.
research. Cohen, S., Doyle, W. J., & Baum, A. (2006). Socioeconomic status is
This slow pace of interdisciplinary integration, associated with stress hormones. Psychosomatic Medicine, 68,
414420.
moreover, is changing due to the intense scientic Dannefer, D. (1987). Aging as intracohort differentiation: Accentuation,
interest in biomarkers in population-based studies. the Matthew effect, and the life course. Sociological Forum, 2,
211236.
Although collecting biomarkers from clinical sam- Dannefer, D. (2003). Cumulative advantage/disadvantage and the life
ples has been done for centuries, we are now see- course: Cross-fertilizing age and the social science theory. Journal of
ing more systematic collection of biologic specimens Gerontology: Social Sciences, 58, S327S337.
Douthit, K. Z., & Dannefer, D. (2007). Social forces, life course conse-
in population-based surveys. With greater collec- quences: Cumulative disadvantage and getting Alzheimers. In J. M.
tion of biologic specimens in populations, we are Wilmoth & K. F. Ferraro (Eds.), Gerontology: Perspectives and issues
(pp. 223243). New York: Springer.
on the verge of exciting scientic developments for Elder, G. H., Jr. (1994). Time, human agency, and social change: Perspec-
studies not only of disease development but also tives on the life course. Social Psychology Quarterly, 57, 415.

Downloaded from http://gerontologist.oxfordjournals.org/ at UNAM Direccion General de Bibliotecas on November 21, 2014
Elder, G. H., Jr., & Shanahan, M. J. (2006). The life course and human
for normal aging. In addition, if biomarkers can be development. In R. E. Lerner (Ed.), Handbook of child psychology:
integrated into intervention studies or policy re- Theoretical models of human development (6th ed., pp. 665715).
New York: Wiley.
search, we will have a direct window on how social Epel, E. S., Lin, J., Wilhelm, F. H., Wolkowitz, O. M., Cawthon, R., Adler,
arrangements, whether planned or unintentional, N. E, et al. (2006). Cell aging in relation to stress arousal and cardiovas-
accelerate or retard senescence. cular disease risk factors. Psychoneuroendocrinology, 31, 277287.
Felitti, V. J. (2002). The relationship between adverse childhood experi-
Interdisciplinary collaboration in gerontology, ences and adult health: Turning gold into lead. Permanente Journal, 6,
moreover, is now growing at a much faster pace be- 4447.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M.,
cause of the availability of social survey data that Edwards, V., et al. (1998). The relationship of adult health status to
are coupled with biomarker data. Indeed, research childhood abuse and household dysfunction. American Journal of Pre-
ventive Medicine, 14, 245258.
questions about telomere shortening and chronic in- Ferraro, K. F. (2007). The gerontological imagination. In J. M. Wilmoth &
ammation are now being formulated by social sci- K. F. Ferraro (Eds.), Gerontology: Perspectives and issues (pp. 325
342). New York: Springer.
entists. Collaboration with more biologic scholars is Ferraro, K. F., & Kelley-Moore, J. A. (2003). Cumulative disadvantage
surely advisable, but the point is that few sociolo- and health: Long-term consequences of obesity? American Sociological
gists or psychologists a decade ago even considered Review, 68, 707729.
Ferraro, K. F., Shippee, T. P., & Schafer, M. H. (2009). Cumulative in-
the prospect that they might have a survey that also equality theory for research on aging and the life course. In V. L.
included telomerase or CRP as variables. This is a Bengtson, M. Silverstein, N. M. Putney, & D. Gans (Eds.), Handbook
of theories of aging. New York: Springer.
major shift in the science of aging and one that Finch, C. E., & Crimmins, E. M. (2004). Inammatory exposure and his-
points to our need for interdisciplinary studies of torical changes in human life-spans. Science, 305, 17361739.
Finkelstein, M. (2007). Aging: Damage accumulation versus increasing
accumulation processes over the life course. Cumu- mortality rate. Mathematical Biosciences, 207, 104112.
lative inequality theory is offered to aid such inter- Forrest, C. B., & Riley, A. W. (2004). Childhood origins of adult health:
disciplinary collaborations and guide empirical tests A basis for life-course health policy: A plea for policy attention to the
way child health problems affect a persons entire lifespan. Health
of how inequality gets under the skin. Affairs, 23, 155164.
Godfrey, K. M., & Barker, D. J. P. (2000). Fetal nutrition and adult dis-
ease. American Journal of Clinical Nutrition, 71, 1344s1352s.
Acknowledgments Hagestad, G. O., & Dannefer, D. (2001). Concepts and theories of aging:
An earlier version of this article received the Gerontological Society of Beyond microcation in social science approaches. In R. H. Binstock
Americas 2007 Award for Theoretical Developments in Social Gerontol- & L. K. George (Eds.), Handbook of aging and the social sciences (pp.
ogy. We appreciate Scott Bass encouragement of this work and the com- 321). San Diego, CA: Academic Press.
ments of Elizabeth Bozzelli, Margaret Favorite, Ann Howell, Shalon Hayick, L. (1998). How and why we age. Experimental Gerontology,
Irving, Laura Sands, Markus Schafer, and J. Jill Suitor on an earlier ver- 33, 639653.
sion of the manuscript. Irving, S. M., & Ferraro, K. F. (2006). Reports of abusive experiences dur-
ing childhood and adult health ratings: Personal control as a pathway?
Journal of Aging and Health, 18, 458485.
Kelley-Moore, J. A., & Ferraro, K. F. (2005). A 3-D model of health de-
References cline: Disease, disability, and depression among black and white older
Achenbaum, W. A. (1995). Crossing frontiers: Gerontology emerges as a adults. Journal of Health and Social Behavior, 46, 376391.
science. Cambridge, England: Cambridge University Press. Kirkwood, T. B. (1977). Evolution of ageing. Nature, 270, 301304.
Alkema, G. E., & Alley, D. E. (2006). Gerontologys future: An integrative Kulminski, A., Ukraintseva, S. V., Akushevich, I., Arbeev, K. G., Land,
model for disciplinary advancement. Gerontologist, 46, 574582. K., & Yashin, A. I. (2007). Accelerated accumulation of health
Baltes, P. B., Staudinger, U. M., & Lindenberger, U. (1999). Lifespan psy- decits as a characteristic of aging. Experimental Gerontology, 42,
chology: Theory and application to intellectual functioning. Annual 963970.
Review of Psychology, 50, 471507. Lundberg, U. (2005). Stress hormones in health and illness: The roles of
Barker, D. J. (2003). The best start in life. London: Century. work and gender. Psychoneuroendocrinology, 30, 10171021.
Bass, S. A., & Ferraro, K. F. (2000). Gerontology education in transition: Maddox, G. L. (1987). Aging differently. Gerontologist, 27, 557564.
Considering disciplinary and paradigmatic evolution. Gerontologist, Merton, R. K. (1968a). The Matthew effect in science: The reward and
40, 97106. communication systems of science are considered. Science, 159,
Blackwell, D. L., Hayward, M. D., & Crimmins, E. M. (2001). Does child- 5663.
hood health affect chronic morbidity in later life? Social Science and Merton, R. K. (1968b). Social theory and social structure. New York: Free
Medicine, 52, 12691284. Press.

342 The Gerontologist


Merton, R. K. (1995). The Thomas theorem and the Matthew effect. Richards, M., & Sacker, A. (2003). Lifetime antecedents of cognitive re-
Social Forces, 74, 379424. serve. Journal of Clinical and Experimental Neuropsychology, 25,
Montani, J.-P., Viecelli, A. K., Prvot, A., & Dulloo, A. G. (2006). Weight 614624.
cycling during growth and beyond as a risk factor for later cardiovas- Roring, R. W., & Charness, N. (2007). A multilevel model analysis of exper-
cular diseases: The repeated overshoot theory. International Journal tise in chess across the life span. Psychology and Aging, 22, 291299.
of Obesity, 30, S58S66. Singhal, A., & Lucas, A. (2004). Early origins of cardiovascular disease: Is
ORand, A. M. (1996). The precious and the precocious: Understanding there a unifying hypothesis? Lancet, 363, 16421645.
cumulative disadvantage and cumulative advantage over the life Thoits, P. A. (2006). Personal agency in the stress process. Journal of
course. Gerontologist, 36, 230238. Health and Social Behavior, 47, 309323.
ORand, A. M. (2003). Cumulative advantage theory in life course re- Willson, A. E., Shuey, K. M., & Elder, G. H., Jr. (2007). Cumulative ad-
search. In S. Crystal & D. F. Shea (Eds.), Annual review of gerontology vantage processes as mechanisms of inequality in life course health.
and geriatrics: Focus on economic outcomes in later life (pp. 1430). American Journal of Sociology, 112, 18861924.
New York: Springer.
Pearlin, L. I., Nguyen, K., Schieman, S., & Milkie, M. (2007). The life Received February 1, 2008
course origins of mastery among older people. Journal of Health and Accepted June 9, 2008
Social Behavior, 48, 164179. Decision Editor: William J. McAuley, PhD

Downloaded from http://gerontologist.oxfordjournals.org/ at UNAM Direccion General de Bibliotecas on November 21, 2014

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