The Foreclosure Crisis and Cardiovascular Disease
Cardiovascular disease (CVD) epidemiology is often presented as the paradigm for an approach to prevention that focuses on identifying individual-level risk factors and intervening on them through behavioral change (eg, diet and physical activity interventions) or through the early detection and treatment of biomedical risk factors (such as high blood pressure or dyslipidemias). At times, this approach has been criticized for failing to consider the more distal causes of these individual-level risk factors (many times of a social or economic nature) that drive the distributions of the proximal risks factors, shape population-level differences in cardiovascular risk, and present large potential opportunities for CVD prevention.
Article see p 2262
In parallel to the risk factor approach, a long tradition in CVD epidemiology has documented the social patterning of CVD and the impact of a number of distal factors, including social class, work environments, and neighborhood environments, on cardiovascular events and risk factors. The article by Arcaya et al1 in this issue of Circulation on the links between foreclosures and blood pressure falls squarely within the latter tradition that aims to place CVD within social and economic contexts.
Spurred perhaps in part by recent economic circumstances in the United States and worldwide, a growing body of work has attempted to document the health consequences of economic recessions or exposures to specific conditions (such as job loss, financial stress, or experiences of losing a home) that may be more common during recessions. As in other areas of health research, clearly specifying the causal question of interest is key. Precisely specifying the causal question is particularly important in investigating the health effects of distal economic processes because the total population health impact of economic recessions (which may involve unfavorable effects for those experiencing unemployment counterbalanced or even exceeded by favorable effects associated with …