Poverty, not gluttony, major factor in incidence of heart disease

By Cathy Carlyle

Eat sensibly, don't smoke, don't drink too much alcohol, and exercise -- keys to
 a healthy heart. It is that simple. Right?

  Not right, according to Dennis Raphael, professor in the Atkinson School of
Health Policy and Management. At a recent Brownbag Research Seminar he said the
biggest contributor to heart disease is poverty. Yet the "It's your own fault"
message is still being given to the public "despite the rapidly?growing body of
research that finds
that economic and social conditions are the major factors in determining whether
 people fall prey to heart disease."

  In his talk entitled "Social Determinants of Health: The Case of Heart
Disease", he said to make matters worse, the number of Canadians lacking
adequate shelter, food,
and health and social services "is showing ominous increases."

  When Raphael reported on the determinants of heart disease at the request of
the community-based North York Heart Health Network, he was surprised at the
magnitude of the links between income and cardiovascular health. "When you
consider the studies that show what little effect lifestyle changes have in
reducing the risk of
heart disease, you have to seriously question the current approach toward
reducing it."

  Why would poverty be a major determinant of heart disease? According to
Raphael, low income leads to material deprivation, excessive psychosocial
stress, and
adoption of unhealthy behaviours --  all precursors of heart disease. Increasing
 poverty, coupled with the trend toward reduction of public services is a
prescription for poor
health, he said.

  He had some shocking statistics. The latest estimates are that in Canada 23
per cent of all years of life lost prior to age 75 can be attributed to
differences between
wealthy, middle class and poor people of this country, and the greatest
proportion of those years lost is caused by heart disease. To put it another
way, if all Canadians'
rates of death from heart disease were equal to the wealthiest 20 per cent of
Canadians, there would be 6,366 fewer annual deaths from cardiovascular disease.



  "In Ontario, the Institute for Clinical Evaluative Sciences tracked
hospitalization rates in the province for heart attack, congestive heart
failure, angina and chest pains
from 1992?1993 to 19961997," he said. The researchers ranked the patients'
neighbourhoods from highest to lowest in income. Although all the patients from
poorer areas
suffered significantly higher rates of heart disease than those from wealthier
sections, the most notable statistic was for chest pain. The rate was 121 per
cent higher for
those from low income neighbourhoods.

  Raphael mentioned that in 1991 Canadians had a lower incidence of heart
disease and total death rates than did people in the United States. At the same
time in
Canada, poverty rates were much lower and taxes allocated to the social safety
net were higher. However, since then the gap between the rich and poor has
increased in
Canada, and there has been a move toward reduced spending on social services.
While this has been happening, he said, many people



's incomes have been
shrinking.
Research from other nations has found these kinds of policies to be related to
greater incidence of heart disease.

   What really puzzles Raphael is why the media and health organizations
continue to focus on lifestyle and biomedical risk factors for this disease
when, according to his
 findings, they have relatively little to do with it. He suggests that the
government improve services offered to the public, raise the minimum wage and
introduce some form
 of guaranteed income.

   He closed his talk asking, "What will it take to shift attention to the
factors that either support heart health or lead to heart disease? Are we
prepared to live with the
 health consequences of subjecting so many of our neighbours to
heart-health-threatening living conditions?" Raphael's full report is available
at
 http://www.yorku.ca/wellness/heart.pdf.

The Brownbag Research Seminar is hosted by the Atkinson School of Analytical
Studies and Information Technology and co-sponsored by the York Centre for
Health
Studies.