The scientific literature contains many examples of socioeconomic factors such as income, education and ethnicity directly contributing to the development of disease.
Recently, the journal Ethnicity and Disease (Winter 2011) found that increased obesity was linked to income below poverty level, receipt of food stamps, and lower income in general. The researchers concluded that lower income levels equated to poorer food quality and less consumption of healthy foods like fruits and vegetables.
A May 2011 study featured in the journal Sleep Medicine found that people with the least amount of education had the most sleep complaints. In addition, those who were unemployed or making less than $75,000 a year also had significantly more sleep complaints than those who were gainfully employed and making at least $75,000 annually.
Of course, we now know that lack of sleep can weaken the immune system, increase obesity, and put us at risk of developing diabetes and heart disease. A 2011 study in the journal Clinical Endocrinology & Metabolism demonstrated that even just one night of sleeping four or fewer hours creates a state of insulin resistance-which is associated with increased obesity and diabetes-in study participants.
The journal BMC Cardiovascular Disorders reported in November 2011 that low socioeconomic status, defined as less than a high school education and earning less than $12,000 annually, is an independent risk factor for the development of heart disease. This conclusion is similar to those of other published studies regarding income and education as it relates to heart disease. The researchers concluded, "Ignoring [socioeconomic status (SES)] in coronary heart disease risk assessment under-estimates the risk in lower SES persons, and may, in turn, through relative undertreatment, contribute to widening SES disparities in coronary heart disease." The researchers contend that in addition to the Framingham risk score, socioeconomic factors should be considered in assessing a person's risk of coronary heart disease.
The "duh" factor
Perhaps it's obvious that if people can't afford to buy organic foods or fresh fruits and vegetables, they often will opt for cheaper fast food that will make them fatter and sicker. Maybe it's even obvious that lower-income workers or blue-collar laborers are destined to get stuck with night shifts or swing shifts that will likely impair their sleep quality.
Let's face it, if you have the means, in addition to getting enough sleep, you can get a massage for added stress reduction, see your doctor every year for proper preventive care, and even afford to take vitamins for dietary "insurance."
Yes, some of this is obvious, so it is surprising that socioeconomic factors such as income and education are not being more widely considered in research as independent risk factors for cardiovascular and other diseases. Certainly research results will vary dramatically if we evaluate relaxed spa patrons versus exhausted night-shift workers.
But what's a country to do?
In the past, we have worked on the assumption that if we spend more money on health technology, including high-tech treatments and sophisticated new drugs, we can improve health. There is the belief that a better health care "system" results in better health. Though this is true to some extent, it does not address the glaring gap between those with a lower socioeconomic status who don't have access to these high-tech treatments and fancy new drugs and those who do. This may, in fact, increase health care costs.
My focus is clearly in the information realm, specifically on enhancing education regarding disease prevention and living life with vitality. This, after all, is the message of a book that I recently wrote with Dr. Lise Alschuler, Five to Thrive: Your Cutting-Edge Cancer Prevention Plan (www.Five2Thrive.com).
The hope is that if we give people the benefit of the doubt and educate them about why it's important to eat organic, avoid fast food, exercise more, and find healthy ways to relax, they will, in fact, try to do those things as much as possible. Everybody—not just those with a higher education and income—wants to prevent illness.
I feel strongly that we need to spend more money not only on educating all individuals about the ways in which diet and lifestyle can impact our health, but also on improving access to higher-quality foods for those with a lower socioeconomic status. A solid health foundation is built on awareness, information and then action.