One of our readings for this week was Social Justice is Good for Our Hearts by Dennis Raphael. Raphael explains in the article that poverty and social exclusion cause cardiovascular disease (CVD). Raphael even goes so far as to say that lifestyle only plays a small role compared to poverty and social exclusion. The following is an excerpt from the article:
“Yet like so many other public discussions of the causes of CVD, the risk factors discussed in that document are limited to age, gender, family history, unhealthy behaviours such as tobacco use and physical inactivity, and biomedical indicators such as high blood pressure and blood cholesterol. This is surprising as numerous studies indicate that while these medical and lifestyle risk factors contribute to heart disease and stroke, they account for only a small proportion in the variation in their incidence.”
I understand that the social determinants of health have a great effect on our health but I'm struggling with Raphael’s notion that lifestyle factors only play a small role. My perception was that lifestyle choices such as poor eating habits, physical inactivity, and obesity or overweight were known to be risk factors for developing CVD. I thought this was common knowledge. In FNN 301 we were taught that the modifiable risk factors for CVD were hypertension, management of diabetes, inflammation, smoking, weight and waist circumference, a sedentary lifestyle and high cholesterol and the unmodifiable risk factors were family history, genetics, age, gender and having diabetes. I guess this is the other side of the coin- all medical and lifestyle risk factors and no mention of social determinants of health. I can’t help but think that the real answer in somewhere in the middle.
I decided to look into the articles that were given as supporting the above Raphael quote. Although he states that ‘numerous’ studies indicate that medical and lifestyle factors play only a small role in the incidence of CVD, he only references three. The three studies he referenced were published in 1978, 1998 and 1989. Since Social Justice is Good for Our Hearts was published in 2002, Raphael was citing articles that were 13 and 24 years old. In addition, the articles weren’t focused on whether lifestyle or the social determinants of health cause CVD. They were titled “Employment Grade and Coronary Heart Disease in British Civil Servants”, “Socioeconomic Factors, Health Behaviors, and Mortality”, and “National Trends in Educational Differentials in Mortality”. If there are numerous studies that show that medical and lifestyle factors only play a small role in the incidence of CVD, why did Raphael use out-dated research that didn’t focus on what he was trying to prove?