Evolution and Inequality

Some scientists remain wary of evolutionary theory because of its supposed genetic determinism and insensitivity to the inequalities often associated with gender, race and class. The document aim is to show that such fears are outdated and to foster a role for evolutionary theory in public health. It use complex adaptive systems theory and the concept of a tradeoff between current and future reproduction to argue that when the future is objectively risky and uncertain the optimal reproductive strategy will often be to reproduce at a young age and/or high rate. Because reproducing early and/or often can lead to ill health and shortened lives, and because inequality is a major source of environmental risk and uncertainty, is argue that any attempt to use evolutionary theory to understand human reproduction, health or wellbeing must include considerations of inequality and social capital.(Sign-in/subscription is necessary for full-text)

Socioeconomic Differentials in Health - Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985-1987 and 1995-1997

Socioeconomic inequalities in mortality have been repeatedly observed in Britain, the United States, and Europe, and in some countries there is evidence that the differentials are widening. This study describes trends in socioeconomic mortality inequality in Australia for males and females aged 0-14, 15-24 and 25-64 years over the period 1985-1987 to 1995-1997. For both periods, and for each sex/age subgroup, death rates were highest in the most disadvantaged areas. The extent and nature of socioeconomic mortality inequality differed for males and females and for each age group: both increases and decreases in mortality inequality were observed, and for some causes, the degree of inequality remained unchanged. If it were possible to reduce death rates among the SES areas to a level equivalent to that of the least disadvantaged area, premature all-cause mortality for males in each age group would be lower by 22%, 28% and 26% respectively, and for females, 35%, 70% and 56%. (Au)(Sign-in/subscription is necessary for full-text)

Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?

Cause-specific information on socioeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making. Methods Mortality data of the under 65 age group in The Hague were analyzed (1982-1991) at residential area level. Causes of death with a high socioeconomic gradient among males were: homicide, chronic liver disease, 'other' external causes of injury, diabetes, bronchitis, emphysema and asthma, and motor vehicle accidents; and among females: diabetes, ischaemic heart disease, 'other' diseases of the circulatory system, signs, symptoms and ill-defined conditions, malignant neoplasm of cervix, and 'other' diseases.(Sign-in/subscription is necessary for full-text))

Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen Male Study

The predictive value of some risk factors may diminish with increasing duration of follow-up. This study was performed to elucidate the role of socioeconomic status as a risk factor for ischaemic heart disease (IHD) mortality in middle-aged men, testing the hypothesis that the role of mediators of the association of socioeconomic status with risk of IHD would diminish with increasing length of follow-up. Methods A cohort of 5249 men aged 40-59 was established in 1971. Baseline data on social class and other confounded variables were collected, and the cohort was followed through registers for 8, 15, and 22 years. In all, 5028 without a history of myocardial infarction or angina pectoris were included in the follow-up. Four factors associated with either occupation or lifestyle were strong mediators of the association found between social class and risk of fatal IHD, and were more common in the lower social classes (classes IV and V): occasional demand for vigorous activity at work, low leisure time physical activity level, high alcohol consumption, and smoking. (Au)(Sign-in/subscription is necessary for full-text)

Childhood socioeconomic position and cognitive function in adulthood

Risk of dementia and Alzheimer's disease is higher among adults with limited education, and the less educated perform poorer on cognitive function tests. This study determines whether the socioeconomic environment experienced during childhood has an impact on cognitive functioning in middle age. Those from more disadvantaged backgrounds exhibited the poorest performance. (Sign-in/subscription is necessary for full-text)

Educational differences in lung cancer mortality in male smokers

To assess the extent of lung cancer mortality differentials by education while adjusting for exposure to tobacco smoke and asbestos based on survey questions. Lung cancer mortality of basic-educated men was 32% higher than that of better-educated men in the ATBC Study. The excess is practically unchanged when additional adjustment was made for age at initiation, duration of smoking, current smoking at baseline and at first follow-up, smoke inhalation, occupational exposure to asbestos and interactions between asbestos exposure and all smoking variables. This excess mortality was about 40% of the similar excess observed in the general population of men of similar age. Educational differences in lung cancer mortality in the total Finnish population are likely to be mainly caused by differences in exposure, particularly to active smoking. Further understanding of the determinants and consequences of socioeconomic differences in smoking behavior are of major scientific and public health importance. (Au)(Sign-in/subscription is necessary for full-text)

Social class differences in lung cancer mortality: risk factor explanations using two Scottish cohort studies

The study investigated differences in lung cancer mortality risk between social classes. Methods Twenty years of mortality follow-up were analyzed in 7052 men and 8354 women from the Renfrew/Paisley general population study and 4021 working men from the Collaborative study. There is a difference in lung cancer risk between social classes, in addition to the effect of smoking. This can be explained by poor lung health, deprivation and poor socioeconomic conditions throughout life. As well as anti-smoking measures, reducing socioeconomic inequalities and targeting individuals with poor lung function for help with smoking cessation could help reduce future lung cancer incidence and mortality.(Sign-in/subscription is necessary for full-text)

Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm Female Coronary Risk StudY

Measures of low socioeconomic position have been associated with increased risk for coronary heart disease (CHD) among women. A more complete understanding of this association is gained when socioeconomic position is conceptualized from a life course perspective where socioeconomic position is measured both in early and later life. Their were examined various life course socioeconomic indicators in relation to CHD risk among women. Both early and later exposures to socioeconomic disadvantage were associated with increased CHD risk in women. Later life exposure seems to be more harmful for women's cardiovascular health than early life exposure to socioeconomic disadvantage. However, being exposed to socioeconomic disadvantage in both early and later life magnified the risk for CHD in women.(Au)(Sign-in/subscription is necessary for full-text)

Time trends of major coronary risk factors in a northern Italian population (1986-1994). How remarkable are socioeconomic differences in an industrialized low CHD incidence country?

The goals are to estimate time trends (1986-1994) of major coronary risk factors in an industrialized low CHD incidence population and to assess education class (EC) differences in risk factor prevalence and in time trends. Three population surveys were conducted in 1986-1987, 1989-1990 and 1993- 1994 on independent and two-stage age- and gender-stratified random samples (1906 men and 1941 women) of 35-64 year old residents of Brianza, an affluent region of northern Italy. The protocol for data collection, clinical measurements and biochemical determinations adhered to the WHO MONICA manual and underwent repeated quality control assessments. EC were identified according to gender-and 5-year birth-cohort specific tertiles. Favorable changes of the risk factor profile in the low socio-economic classes may have contributed to reduce CHD rates in this population. Specific policies oriented to lowest socio-economic classes are needed to continue to combat the smoking epidemic. (Sign-in/subscription is necessary for full-text)

Commentary: Socioeconomic health differentials

The present issues of the International Journal of Epidemiology (IJE) contain eight reports of socioeconomic differences in health. These articles illustrate a number of traditional themes and point to new directions. There is a growing consensus that health inequalities need to be explained, as well as described, and that a life course perspective is required to explain them as biologically plausible phenomena. Significant incremental gains in knowledge can be achieved by studies that eliminate possible explanations of earlier findings. The work reported in the present issue demonstrates that a similar process is under way internationally. Second, efforts to reduce health inequalities should benefit from an appropriate knowledge base on which to form policy; for example, should early life be prioritized, or instead, critical transitions during the whole life course? The way we answer such questions may influence policy in the coming decades. (Au)(Sign-in/subscription is necessary for full-text)

Commentary: Social inequalities in health, social epidemiology and social value

Despite this limitation, the frameworks are helpful in emphasizing the complex ways the range of health determinants 'operate' in the production of health, illness and recovery in populations. But, application of the frameworks in research studies and policy discussions has often ignored these complexities in favor of simple research questions based on individual elements of the broader framework. The underlying assumption is that elements of the complex system of health production can be studied in isolation of the other parts of the system and that the results produced by these more focused enquiry's represent 'truths' that are free of influence from other elements of the system. (Au) (Sign-in/subscription is necessary for full-text)

Commentary: General or cause-specific factors in explanations of class inequalities in health

Findings in these papers are particularly relevant to our understanding of the causes of class inequalities in health. The first of these concerns the extent to which controlling for the known higher risk behaviors in the most economically disadvantaged reduces the association between class and mortality. They find that controlling for current and past cigarette consumption reduces but does not eliminate the association between class and lung cancer mortality, suggesting other factors (e.g. diet) account for the residual association. The second finding extends the search for an account of the residual associations (between class and mortality after control for known risk factors) in another direction. This involves examining the extent to which the health of a current generation may be influenced by factors in early childhood or the health of the previous generation.(Sign-in/subscription is necessary for full-text)