2007 Lewis A. Conner Memorial Lecture —Inequalities in Cardiovascular Disease: The Global Challenge
Cardiovascular disease contributes considerably to the burden of disease in all regions of the world. One of the continued dramatic findings on CHD is that it follows a social gradient: The lower the level in the social hierarchy, the higher the risk. As heart disease rates have declined in recent years, the social gap has actually widened.
Approaches to prevention of heart disease commonly emphasize individual risk factors for disease. There has been much concern with smoking and diet. Obesity has become a global concern, and the frequent response is to emphasize individual responsibility.
The question is how position in the social hierarchy can translate into increased risk of cardiovascular disease. There is a social gradient in smoking, aspects of diet, central adiposity, and sedentary lifestyle. There is also a social gradient in the metabolic syndrome, and these behaviors and the metabolic syndrome account for about two thirds of the social gradient in CHD in the Whitehall II Study of British civil servants.
A further question is why there should be these behavioral and biological differences according to the level in the hierarchy. A growing body of evidence implicates powerlessness, or lack of control, and social isolation, or lack of full engagement in society. A broader approach to prevention of heart disease needs to address its social determinants.
The Commission on Social Determinants of Health (chaired by Sir Michael Marmot) was set up by the World Health Organization to collate global evidence, raise societal debate, and recommend policies, with the goal of improving health and reducing health inequalities between groups. A major thrust of the Commission is turning public health knowledge into political action.
(Note: The lecture will present issues arising from the Interim Statement of the Commission on Social Determinants of Health released in July 2007. The Commission on Social Determinants of Health will report its conclusions and recommendations in May 2008.)