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Center Stage


“Adopting healthy practices [at midlife] sets the stage for more robust later years.”

AS A HEALTH DEMOGRAPHER devoted to better understanding and promoting women’s health over the life course, Dr. Dawn Upchurch concluded that a pivotal phase was being largely ignored by researchers.

“The social and behavioral aspects of women’s health at midlife have been vastly understudied,” says Upchurch, professor in the Fielding School’s Department of Community Health Sciences. “The research has mostly focused on physiological changes with menopause, and while that is important, much more is going on in women’s lives that affect their health.”


Dr. Dawn Upchurch has studied the use of complementary and alternative medicine for wellness and health promotion

Lifestyle changes at any phase can pay off in better health. But Upchurch sees middle age as a critical window of opportunity to embrace habits that go a long way toward determining longevity and quality of life in older age. “Midlife is a time when risk factors accelerate and chronic diseases become increasingly prevalent,” she says. “Adopting healthy practices – in particular, engaging in appropriate levels of physical activity, making changes in weight and diet, maintaining good social and familial relationships, and developing ways to cope with life’s stresses – sets the stage for more robust later years.”

After studying factors associated with poorer health at midlife, Upchurch concluded that more attention needed to be paid to identifying and promoting factors associated with better health. That led to her interest in complementary and alternative medicine (CAM). In 2004, Upchurch received a prestigious career development award from the National Institutes of Health to support her research on the use of CAM for wellness and health promotion in the U.S., and for the last decade-plus she has published extensively on the topic. Among other things, the funding allowed Upchurch to go to school at night, while continuing in her FSPH faculty position, so that she could train to become a licensed acupuncturist.

“There is a growing body of scientific studies demonstrating the positive health benefits of certain types of CAM,” Upchurch says. “For example, practicing tai chi has been shown to reduce general inflammation, a risk factor for many health problems; to increase flexibility; and to reduce risk of falling. There is strong evidence that acupuncture can be used to treat and manage pain, especially chronic pain. There are also a number of yoga studies among midlife and older adults showing improvements in a variety of outcomes, including lower levels of stress.”

Early CAM research had focused on how people were using it for treating health ailments, but Upchurch was among the first in the field to highlight the importance of these strategies for prevention and health promotion, finding that nearly nine out of 10 CAM users reported wellness, or wellness in combination with disease management, as their reason for use. Upchurch notes that chiropractic is an example of a common therapeutic CAM modality; those used for wellness include yoga, meditation, tai chi and nutritional supplements, while practices such as acupuncture and massage are employed for both purposes. “What I have discovered in a number of studies using national data is that people who use these modalities are really not any different from those who use conventional care,” Upchurch says. “They’re using CAM in addition to conventional care, not instead of it – hence the growth of ‘integrative medicine,’ which incorporates CAM into conventional medical practices.”

Overall, Upchurch has found public attitudes toward CAM are highly positive, and these approaches are embraced widely among midlife women in the United States. Using data from the National Health Interview Survey, she reported in a 2010 study that 46 percent of women ages 40-59 had used CAM in the past 12 months.

Upchurch believes that given the growing popularity and evidence of certain CAM approaches in enhancing wellness, public health professionals should do more to incorporate information about proven practices into health promotion campaigns while also educating consumers about untested and potentially risky services and products – over-the-counter supplements, for example, are not well regulated by the U.S. Food and Drug Administration.

“In the past, CAM has been viewed through the biomedical treatment paradigm, but so many of these modalities align with the public health perspective of prevention,” Upchurch explains. “Most importantly, this is about empowering people to engage in practices that can benefit them.”

Whether it’s through CAM or other strategies, reducing stress appears to be critical to the healthy aging process, Upchurch notes. Over the last two decades, researchers have developed a measure of the “wear and tear” on the body resulting from chronic stress, known as allostatic load, that can serve as an early warning sign for greater susceptibility to chronic conditions. “When individuals are exposed to chronic or unremitting stress, the body becomes maladaptive, leading to small changes in biological markers across multiple systems,” Upchurch says.“Allostatic load serves as an index to these changes that seems to be a strong indicator for subsequent disease. We know that higher allostatic load at midlife, for example, is associated with poorer health at older ages.”

In recent studies, Upchurch and her colleagues have found that midlife women who report more discrimination tend to have a higher allostatic load, and that women who report higher levels of perceived stress over time experience a faster rate of allostatic load increase – in effect, more rapid aging. In a related study, Upchurch’s group found that higher levels of physical activity were associated with lower levels of allostatic load in midlife women, and that physical activity might lower some of the cumulative biological risk associated with aging. Upchurch is now looking at other factors that may help to reduce allostatic load and thus contribute to healthier aging, including regular sleep and healthy diets.

As with other aspects of women’s health, Upchurch says, early investments can go a long way toward healthy aging. “We’re finding that these differences in allostatic load emerge very early in the life course,” she says. “If we can use that warning sign to successfully intervene at younger ages through both individual-level and community-level changes, the impact on people’s health in middle and older ages could be profound.”