Shining a light on poverty and heart disease

May 22, 2018 Providence Health Team

Throughout the world, poverty is both a cause and a symptom of poor health. Although the most sensational threats to public health typically get the most attention — infectious disease, natural disasters, starvation — cardiovascular disease remains the leading global cause of death, both in developing countries and in low-income populations in the “first world.”

In the US, death from cardiovascular disease is far more prevalent among the poor — especially the homeless — than among more affluent Americans.   

This raises an obvious question; “Is the prevalence of fatal cardiovascular disease among the poor due to unhealthy living or lack of access to adequate health care?

The answer, of course, is “yes.”

A landmark study from the mid-1980s sponsored by the American Heart Association showed that deaths from heart disease in Los Angeles county were higher overall in low-income neighborhoods and higher among poor versus affluent African-Americans. The study’s authors deduced that poor people were “less likely to get regular checkups, to have medical insurance and to be able to afford health care, and more likely to delay in getting treatment.”

Many similar studies found similarly heartbreaking results all across the United States.  

But then, an interesting thing started happening. Stimulated, at least in part, by massive, deliberate public health interventions like the CDC’s Behavioral Risk Factor Surveillance System, the incidence of cardiovascular disease in the US started to drop — but only among the affluent. 

We should expect this troubling trend to continue, especially as income disparity, chronic homelessness, and the cost of health care continue to grow.

Poverty is a risk factor for cardiovascular disease

Cardiovascular disease covers a wide range of conditions: arrhythmia, peripheral artery disease, heart attack, stroke, and everything in between.

The medical profession has a very clear understanding of the risk factors. A common factor across many cardiovascular diseases is atherosclerosis, build-up of plaque on arterial walls which impedes blood flow to the body’s tissue and organs. But socioeconomic factors also play a role.

The World Heart Federation (WHF) distinguishes between “modifiable” and “non-modifiable” risk factors:

Modifiable factors are all behavioral: physical inactivity, smoking, poor diet (including high cholesterol), chronically high blood pressure. and obesity.

Non-modifiable risk factors include family history, diabetes, and basic demographic factors like age, gender, and ethnicity. Interestingly, they also consider “socioeconomic status” a key, non-modifiable risk factor; “Being poor, no matter where in the globe, increase your risk of heart disease and stroke. A chronically stressful life, social isolation, anxiety and depression also increase the risk.”

This is really the crux of the matter. Obviously, stress, anxiety, social isolation, poor diet, and lack of exercise are not exclusively problems of the poor. However, the resources required to deal with such factors are far more available to the affluent.

In a world where half of our population could not raise $400 to cover an emergency, how do struggling Americans stand a chance?

It is exceedingly difficult for many low-income Americans to access even basic health care, which makes it nigh-on impossible to manage their health and wellness.

Eating healthy is not viable if you live in a food desert or don’t know where your next meal is coming from. And with no stable accommodations, let alone a safe place to exercise, even minimal, regular physical activity is difficult to maintain.

Providence St. Joseph Health believes everyone deserves access to high-quality, compassionate care as a basic human right. We serve seven western American states that include more than 20 million people who have Medicaid coverage. We stand by those for whom Medicaid has made a difference, and we give them a voice at The Many Faces of Medicaid, where those who are often very vulnerable share their stories of how the Medicaid safety net meets their health needs and supports the communities we serve. And we advocate on behalf of everyone we serve, especially the voiceless and marginalized, for public policies, laws and rules that can build health and restore our communities. Learn more about our advocacy agenda. Learn about our new statements of Mission and values.

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