Health psychology: what is an unhealthy environment and how does it get under the skin?

Annu Rev Psychol. 1997;48:411-47. doi: 10.1146/annurev.psych.48.1.411.


This review explores the role of environments in creating chronic and acute health disorders. A general framework for studying the nesting of social environments and the multiple pathways by which environmental factors may adversely affect health is offered. Treating socioeconomic status (SES) and race as contextual factors, we examine characteristics of the environments of community, work, family, and peer interaction for predictors of positive and adverse health outcomes across the lifespan. We consider chronic stress/allostatic load, mental distress, coping skills and resources, and health habits and behaviors as classes of mechanisms that address how unhealthy environments get "under the skin," to create health disorders. Across multiple environments, unhealthy environments are those that threaten safety, that undermine the creation of social ties, and that are conflictual, abusive, or violent. A healthy environment, in contrast, provides safety, opportunities for social integration, and the ability to predict and/or control aspects of that environment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Behavioral Medicine*
  • Health Behavior
  • Humans
  • Internal-External Control
  • Psychophysiologic Disorders / psychology*
  • Risk Factors
  • Social Environment*
  • Social Support
  • Somatoform Disorders / psychology*