Social origins of cardiopulmonary disease: The need for population-focussed prevention studies

Abstract

Purpose: High-tech medical approaches have, no doubt, contributed some to the substantial decline in coronary heart disease (CHD) mortality, the principal fatal form of cardiopulmonary disease. These approaches have thereby gained much public attention. Methods: Thoughtful observers however, have emphasized the role of lifestyle changes in the CHD decline. Coronary heart disease has followed a unique epidemic course during the 20th century: it started among more affluent members of a society and then has descended down the social scale. Why has this pattern prevailed, not only in the United States, but in other countries, as well? Results: Evidence now shows that the major risk factors, in this epidemic as well as in others, are, for the main part, socially determined. Contrary to most epidemics, however, this one affects, first, more socially advantaged people. The risk factors—cigarette smoking, excessive fat consumption, physical inactivity, and high blood pressure—accompany advancing industrialization and commercialization. The first three categories appeal strongly to certain human propensities and, hence, are adopted by many people as soon as they become accessible. Thus, the more affluent are the first to suffer (and also to recover from) the consequences of indulging beyond the DNA-determined health capacity of our species; the population's poorer sections can afford exposure only in subsequent decades as they achieve access to the risk factors. Powerful social forces, including product marketing, reinforce the biological propensities. Conclusions: Coronary heart disease's epidemic course reflects these social origins, and social reinforcements. Hence, it should be viewed as a community phenomenon. As such, it must be attacked in the community. Trials of control strategies at the local community level should be continued. In addition, attention is due at state, national, and global community levels.