Being poor should be included as health risk factor

Doctors of all specialities can attest to the fact that low socioeconomic status is linked to a significant reduction in life expectancy. And the medical literature is full of evidence linking poverty and low social status with many illnesses, including the big killers – cancer and cardiovascular disease.

My own experiences illustrate this reality. The level of pathology I saw among patients living in poor circumstances was of an order of magnitude greater than that experienced by their more well-off peers.

Patients consulted with highly advanced cancers: I diagnosed one man in his 40s from the door of his bedroom – halted in my tracks by the huge tumour emerging from above his clavicle. He had an upper lobe lung cancer.

People just above the income threshold for a medical card see medical care as a luxury. I saw one man in his 50s who was reluctantly dragged to the surgery by his concerned wife; he had extensively disseminated tuberculosis and despite the best efforts of hospital colleagues he died three days later.

Literacy levels

The practicalities of preventive medicine proved a huge challenge. Despite a proactive contraception policy, young women from a lower socioeconomic background in my care continued to experience high pregnancy rates.

It took some time before I realised that this was because of low literacy levels. There is a lot of important written information contained in packs of the pill; however some of it relating to what to do when you miss a pill or develop gastroenteritis is relatively complex and not easily absorbed if you struggle with reading or writing.

Advice to eat more fresh fruit and vegetables was largely met with polite indifference. The relative cost of fresh food for a single mother with two children was such that fresh fruit could only ever be an indulgence.

The authors of a major new study of 1.7 million people, published last week in The Lancet – who include Dr Richard Layte of the Department of Sociology at TCD – have called for low socioeconomic status to be considered a major risk factor for ill health and early death in national and global health policies.

Using data from the UK, France, Switzerland, Portugal, Italy, the US and Australia, the study is the first to compare the impact of low socioeconomic status with other major risk factors on health such as physical inactivity, smoking, diabetes, high blood pressure, obesity and high alcohol intake.

According to the research, when compared with their wealthier counterparts, people with low socioeconomic status were almost 1.5 times more likely to die before they were 85.

Deprivation

Low socioeconomic status was associated with reduced life expectancy of 2.1 years. The comparison with other risk factors is interesting: greatest reductions were for smoking and diabetes (4.8 and 3.9 years); by comparison high blood pressure (1.6 years), obesity (0.7) and high alcohol consumption (0.5) were associated with smaller reductions in life expectancy than low socioeconomic status.

Commenting on the results, lead author Dr Silvia Stringhini of Lausanne University Hospital said: "Given the huge impact of socioeconomic status on health, it's vital that governments accept it as a major risk factor and stop excluding it from health policy.

“Reducing poverty, improving education and creating safe home, school and work environments are central to overcoming the impact of socioeconomic deprivation. By doing this, socioeconomic status could be targeted and improved,” she added.

"Socioeconomic status is important because it is a summary measure of lifetime exposures to hazardous circumstances and behaviours that goes beyond the risk factors for non-communicable diseases that policies usually address. Our study shows that it should be included alongside these conventional risk factors as a key risk factor for ill health." said Professor Paolo Vineis, Imperial College London.

There is really no excuse; socioeconomic adversity must now feature as a modifiable risk factor in local and global health strategies policies, and health-risk surveillance.