The question is being asked, Will Cardiovascular Disease Prevention Widen Health Inequalities? in a Policy Forum essay in the OpenAccess Journal PLoS Medicine.
Here is the executive summary from the article:
- The primary prevention of cardiovascular disease (CVD) is dependent on the effective reduction of the major risk factors for CVD, particularly tobacco control and a healthier diet.
- The high-risk approach to prevent CVD typically involves population screening. Those exceeding a risk threshold are then given lifestyle advice and/or tablets to reduce blood cholesterol and blood pressure.
- Evidence suggests this high-risk approach typically widens socioeconomic inequalities. Such inequalities have been reported in screening, healthy diet advice, smoking cessation, statin and anti-hypertensive prescribing, and adherence.
- The alternative approach is population-wide CVD prevention. For example, legislating for smoke-free public spaces, banning dietary transfats, or halving daily dietary salt intake. Such strategies are generally effective and cost-saving; there is also increasing evidence that they can reduce health inequalities.
- We conclude that screening and treating high-risk individuals represents a relatively ineffective CVD prevention approach that typically widens social inequalities.
Now, consider the following hypothetical sequence of events.
1) People presume that there are important genetic differences between races, say, pink/white people and brown/black people.
2) Health care disparities cause a significant gap in CVD preventative treatment so that people of higher SES get prevention, people of low SES get heart attacks. This correlates, because of pre-existing SES/Race correlations in wealth and opportunity, to a white/pink vs brown/black dichotomy in frequency of death due to heart attacks.
3) Epidemiological data, interpreted by people who really want to believe in point 1 above, and/or who are not aware of point 2 above, shows a difference in lifespan. Brown/black people tend to wear out and die of heart attacks sooner than pink/white people.
4) Shorter lifespan is associated with relative r-strategy life history parameters (compare, say, squids to whales) … more offspring, shorter gestation, shorter lifespan, having litters instead of singletons, being more aggressive and violent, less investment in costly traits such as intelligence, etc. etc. So, someone, probably someone who really wants to believe in Point 1 above, puts 1 and 1 together and ends up with 11. Brown/black people are more primitive than pink/white people, based on the life history differences combined with other equally bogus data.
Preposterous you say? Indeed.