What are the main causes of illness and premature death? Cancer? Smoking? Obesity? One often-overlooked cause is lack of money. More precisely, being poor and/or having less than a high school education—what researchers call low socioeconomic status (SES)—is a health hazard, especially when it comes to heart health.
Why do the poor have worse health? Dozens of reasons: higher smoking rates and exposure to pollutants, higher rates of obesity, lack of prenatal care, the likelihood of holding dangerous jobs, to name a few. The gap in life expectancy in the U.S. between an unskilled laborer and highly paid professional is about 4.5 years and has widened in recent decades. Some experts believe that the main explanation is that poorer people have less access to health care and are thus less likely to be treated for problems such as smoking and high blood pressure.
Recently, a study in BMC Cardiovascular Disorders analyzed data from 12,000 people and found that those with low SES had a 53 percent greater risk of developing heart disease over a 10-year period. No surprise there. But even when the poorer people did improve their risk factors during this time—by quitting smoking, for instance, or lowering their blood pressure levels with medication—they were still at about 50 percent higher risk than comparable well-off people. This means that low SES increases the risk of heart disease independent of such risk factors.
Some research suggests that social disadvantage and adversity, starting in childhood, can result in lasting adaptations to stress that take a toll on health. That makes the cumulative effects of poverty—particularly the “wear and tear” on the cardiovascular system over a lifetime—hard to reverse, said the researchers from University of California, Davis.
What can be done, besides reducing the rising poverty levels and income inequality in the U.S.? One small practical step is that when poorer people do manage to get health care, their providers should consider their socioeconomic status itself as a major risk factor and adjust their treatment plans accordingly. Patients may need to be treated more aggressively to lower cholesterol or blood pressure, for instance.