Physical Injury and Cardiovascular Disease

Abstract

Increasing evidence is accumulating that biomedical and lifestyle factors account for rather small proportions of population variance in incidence of cardiovascular disease (CVD). In North America, however, the medical and public health communities - reinforced by narrow media coverage focused on biomedical and lifestyle issues - remain wedded to these models of cause and prevention. Not surprisingly, public perceptions of the causes of CVD mirror these preoccupations. A review commissioned by a community heart health network brought together the evidence of how CVD results primarily from material deprivation, excessive psychosocial stress, and the adoption of unhealthy coping behaviors. The review has served to help shift thinking about CVD prevention in Canada and the USA.

Introduction and Background Theory

As with any area of medical or scientific research, the selection of “factors” to be studied cannot be immune from prevailing social values and ideologies … It is also evident that so-called lifestyle or behavioural factors (such as the holy trinity of risks - diet, smoking and exercise) receive a disproportionate amount of attention. As we have seen, the identification and confirmation of risk factors are often subject to controversy and the evidence about causal links is not unequivocal (Nettleton, 1997, p. 319).

Experimental Methods and Data

A series of studies in the UK document how those living on lower incomes are more likely to suffer from and die from CVD - and a number of other diseases - at every age (Black and Smith, 1992; Whiteside, 1992; Acheson, 1998). In the USA, lower-income Americans have a higher incidence of a range of diseases. Lower income Americans are much more likely - risk ratio of 2.52 - to die from CVD than highest income Americans (US Department of Health and Human Services, 1998).

In Canada, national examinations of the relationship between income and mortality from diseases use census tract of residence to estimate individuals' income. Canadians living within the poorest 20 percent of urban neighborhoods have much higher mortality rates for CVD, cancer, diabetes, and respiratory diseases than other income groups (Wilkins et al., 1989; Statistics Canada, 2001).

A recent study in the Canadian Journal of Public Health asked 601 residents of Hamilton, Ontario to identify “the major cause of heart disease” (Paisley and Midgett, 2001). Respondents were then provided with an additional six opportunities to identify “any other cause of heart disease”. In response to these open-ended questions, only one respondent out of 601 identified poverty as a cause of heart disease - out of 4,200 potential responses!

Results and Conclusion

One of the goals of the North York Heart Health Network in commissioning these reports was to counter these understandings and raise awareness of the role societal factors play in the incidence of CVD. In many ways this goal has been met. The report received international attention through numerous list-serves and bulletin boards. Its content has been quoted in numerous submissions to commissions reviewing health and social policy in Canada. It was featured in a United Church of Canada video entitled keeping the Vision Alive: ...