It’s now February and we all know what that means… it’s almost time for Valentine’s Day! Love and hearts, that’s what this whole month is all about, right? In some ways, perhaps yes. But, I’m not just talking about romance here.
So, what am I going on about?
February also marks heart month, a campaign that aims to raise awareness of heart disease and promote heart health. According to the World Health Organization (WHO), heart disease kills approximately 17.5 million people annually and accounts for 31% of all global deaths, making it the #1 killer of men and women around the world. In Canada, one person dies from heart disease every 7 minutes! This adds up to more than 48,000 deaths nation-wide (2012), costing our economy an estimated $20 billion every year in direct and indirect costs.
While most of the focus in raising awareness of heart disease is often placed on the triad of healthy eating, physical activity, and smoking cessation, a potentially more impactful risk factor is often neglected. Income, believe it or not, plays a vital role in shaping our health outcomes, including our risk of heart disease. Now, I’m sure you’re all wondering the same thing – how?
First, it’s important to understand that our health and well-being is not only determined by behavioural and lifestyle factors (i.e. diet, exercise, and smoking), rather it is also influenced by broader social, political, and economic factors (i.e. the quality of our everyday living conditions) that have come to be known as the social determinants of health (SDH).
Income is an important SDH that has an impact on our overall living conditions by determining our access to resources, goods, and services. For example, let’s take into consideration diet, a lifestyle factor that affects our risk of developing heart disease. Although a low-income earner may be aware of the impact that an unhealthy diet can have on their risk of heart disease, such awareness is of no use when they cannot afford to maintain a healthy diet. In this way, the prevalence of certain risk factors for heart disease is often higher among individuals/households (including children) with lower incomes, compared to higher incomes.
The association between income and heart disease has been documented for years, with findings showing that individuals from low-income households and neighborhoods (bottom 20%) have a higher risk of heart disease, compared to high-income households and neighborhoods (top 20%). A recent Canadian study from Saskatchewan found that “lower-income residents were… 52% more likely to have heart disease than higher-income residents”. Additionally, a report by Statistics Canada found that compared to the top 20% of households, the excess mortality rate for heart disease among the bottom 20% of households was 19% for men and 18% for women! So, as the risk of heart disease increases for the poor, the mortality rate inversely decreases for the rich.
Unfortunately, societal income inequality also affects our overall health outcomes – the risk for heart disease increases with growing income inequality. According to a US study, heart disease risk increases when one resides in a state with higher income inequality. In contrast, a more equal society often produces better health outcomes. For us in Canada, this hails bad news, as income inequality is growing and widening the gap between the rich and the poor.
Awareness and universal healthcare is not enough. To combat heart disease, we also need to combat poverty and income inequality, because wealth truly does equal health. Addressing this issue requires a broader focus on the part of health awareness campaigns. By raising awareness of the impact that income has on heart health, such campaigns could mitigate billions of dollars in health expenditure, where one study found that through an investment of $10 per person, towards the implementation of community-based disease prevention programs such as fitness, nutrition, and smoking cessation, the rate of heart disease could fall by 5% in 5 years.
Although many awareness campaigns fail to share this vital information with us, the medical and public health communities have recognized the impact that income can have on our health. A recent report by the Canadian Institute for Health Information (CIHI) further highlights this relationship in Trends in Income-Related Health Inequalities in Canada. Moreover, doctors in Canada are becoming increasingly concerned with screening for poverty among their patients, to provide well-rounded, quality care.