Poverty shortens life more than obesity, alcohol and hypertension

Source: Javier Salas, El País.

The scientific evidence is strong: poverty and social inequality seriously harm your health. However, health officials do not give these social factors the same attention they devote to others when they try to improve the health of citizens. A study about 1.7 million people, published by the medical journal The Lancet, brings back this neglected issue: poverty shortens life almost as much as having a sedentary life and more than obesity, high blood pressure and excessive alcohol consumption. The study is a critique of the policies of the World Health Organization (WHO), which did not include in its agenda this determining factor of health — as important or more than others that are part of its goals and recommendations.

“The low socioeconomic level is one of the strongest indicators of morbidity and premature mortality around the world. However, global health strategies do not consider the poor socio-economic circumstances as modifiable risk factors”, say the authors of a study published by The Lancet, about thirty experts from prestigious institutions such as Columbia University,  King’s College of Londres, Harvard School of Public Health and the Imperial College of Londres.

Its work focused on data from 1.7 million people to examine how socioeconomic status affects health and mortality in comparison with other more conventional factors, such as smoking or obesity. The result is in line with previous studies: poverty is an agent that affects health in a way as solid and consistent as tobacco, alcohol, physical inactivity, hypertension, obesity and diabetes. In addition, the ability to shorten life is bigger than several of these factors. The low socioeconomic level reduces life expectancy by more than 2 years (2.1) in adults between 40 and 85 years; the high consumption of alcohol reduces in half a year; obesity shortens 0.7 year; diabetes reduces life expectancy in 3.9 years; hypertension in 1.6 year; sedentariness, 2.4 years; and worse, reducing the average of 4.8 years life, the habit of smoking.

The choice of these factors is not casual: they are those taken by WHO to combat contagious diseases in its plan to reduce its impact on 25% by 2025, the so-called 25×25 goal. “Our findings suggest that strategies and global actions defined in the WHO health plan excludes from its agenda an important determinant of health”, criticize the researchers, led by Silvia Stringhini, of the University Hospital of Lausanne. And they add: “the economic adversity should be included as a modifiable risk factor in the strategies of local and global health policies and monitoring of the risk to health”.

In the same way that you can promote the abandonment of smoking or sport among the population, the article argues that the economic factor can also be modified at all levels with interventions such as the promotion of early childhood development, poverty reduction policies or the improvement in access to education. Therefore, prevention strategies for chronic diseases are mistaken not to approach “powerful structural solutions”.

Not ideology, but science

“The strength of the evidence of the social effect on mortality, as shown the study of Stringhini and her colleagues, is now impossible to ignore,” says one comment in The Lancet by Martin Tobias, an expert from the Ministry of Health of New Zeland. He adds: “they base their argument not on political ideology, but on rigorous science”. According to the epidemiologist, having a low socioeconomic status “means being unable to determine your own destiny, deprived of material resources and with limited opportunities, which determine both the lifestyle and the opportunities of life”.

The Spanish researcher Manuel Franco, who did not participate in the study, believes that “it is important that the authors show that socio-economic factors matter, and matter as much as the appointed by WHO”. “The evidence says that inequality kills. Are we interested in the health of the country, both in the poor and the rich health? This factor is not attacked because it doesn’t matter”, says Franco, an epidemiologist at the University of Alcalá de Henares, an expert on the effects of social and environmental factors on health.

Franco explains how in rich countries (the study was centered in data from United Kingdom, France, Switzerland, Portugal, Italy, United States and Australia) there are “unbearable” differences in life expectancy within the same city, such as Barcelona, Madrid, Glasgow or Baltimore. “And the difference does not stop growing: the life expectancy of the poor does not grow as the rich”, he denounces. And he concludes: “we do research to improve something. We know that there are structural factors that affect health, but the authorities don’t want to attack them, they prefer to speak only of individual factors: practice sport, don’t smoke. “