Conner Lecturer: Social inequality

Conner Lecturer: Social inequalityboosts heart diseasePoverty is widely recognized as a risk factor for poor health and lower life expectancy, but lack of income is not the main determinant of health. Where you stand in the social pecking order is critically important. Social inequality is the leading risk factor for higher incidences of cardiovascular disease and increased mortality.“The issue of inequality is key to all of our activities,” said Professor Sir Michael Marmot, M.D., Ph.D., director of the International Institute for Society and Health, London, and head of the World Health Organization Commission on Social Determinants of Health.Cardiovascular disease has already emerged as the No. 1 cause of mortality in all but the poorest countries, Dr. Marmot said during the Lewis A. Conner Memorial Lecture on Sunday afternoon. That puts reducing cardiovascular risk at the top of the disease prevention list, and the No. 1 risk for CVD is social inequality.Psychosocial factors, such as empowerment, can affect health. The life expectancy for Oscar winners, for example, is four years longer than Oscar nominees who have not won.“Winning an Oscar is like reducing your risk of dying from heart attack from population normal to zero,” Dr. Marmot said. “That is a tremendous improvement.”Population studies around the world show that social inequality affects control over one’s own life and work, he explained. In the United States, United Kingdom, Sweden, South Korea and other countries, the key factors are education and social status in the workplace. Better-educated individuals and those with more authority at work have lower rates of cardiovascular disease and longer life expectancy.Education and status even trump access to health care, he noted. In the United States, for example, education and workplace status are positively associated with longer life expectancy, even in populations with similar access to health insurance and medical care.“Health equity, putting inequality right, is a matter of social justice,” he said. “The medical profession should take the lead.”