HYPERTENSION AND HEART FAILURE

Hypertension and Heart Failure

Case Study: Hypertension and Heart Failure

Introduction

Social causation of disease is defined as the origin of illness that results from social conditions and social interactions. This definition assumes that human biological factors are not the sole cause of disease. The definition further assumes that social factors such as socioeconomic status (SES), religion, and social networks have an effect on the level and severity of illness and mortality. The idea that social interaction and culture play parts in the causation of disease has been present in social thought since John Gaunt's discussion of the interaction between politics and mortality in 1662.

Social causes of disease can be divided into fundamental causes (Link & Phelan 1995) and proximate (or lifestyle) causes. Proximate causes of illness directly produce illness by affecting biological processes and are individually controlled. For example, diet, smoking, alcohol and drug use, seatbelt use, and exercise behaviors are lifestyle choices that directly affect disease prevalence.

Fundamental causes of disease can be defined as indirect causes of disease that act through specific proximate statuses and behaviors caused by variable access to resources (social capital) that may help people avoid disease, and the negative consequences of disease (Link & Phelan 1995: 81). Social capital is available to an individual through social networks, education, occupation, income and wealth, religious ties, and social power. The amount of social capital available to an individual, as well as other social factors, partially determines the severity and type of diseases the individual is afflicted with and may ultimately be more important as causes of disease than proximate causes (Link & Phelan 1995).

Case Analysis

Social Causation of Disease

The theoretical underpinnings of the social causation of illness are material, cultural, behavioral, psychosocial, sociopolitical, and longitudinal in nature. The common thread of all the theories is that differences in social factors lead to differences in illness levels and the ability to maintain and regain healthy status (Bartley 2004).

The material or socioeconomic status theory (Kitigawa & Hauser 1973; Kawachi & Kennedy 1997) links levels of illness to income. Income determines behaviors, diet, and type of work done, and is linked to housing quality and environmental determinants of illness as well as stress levels and work-related levels of self-identity and worth.

The cultural/behavioral theory states that socialized values and norms determine behavior and social identity, which in turn control health behaviors and levels of disease. A subset of behavioral/cultural theory, psychosocial theory (Wilkinson 1996; Elstad 1998), suggests that social status levels, social networks, and biochemical processes in the body are linked to behavior and thus to levels of illness.

Political economy theory (Lynch 2000) suggests that health and illness differentials are caused by differentials in social power controlled by external political and institutional hierarchies. Finally, life course theory states that events before and after birth affect physical health, the ability to maintain and repair health, and the level of illness through biological and social/behavioral pathways that change with age and the evolution of social ...