Why Do The Poor Get Heart Attacks?

Lack of healthy lifestyle choices compound over time and affect the underprivileged more adversely

- Dr (Prof) K. Srinath Reddy

CONTRARY TO POPULAR BELIEF, heart attacks are not confined to the affluent, who have the riches to revel in indulgent lifestyles. Indeed, in many high- and middle-income countries it is the poor who have heart attacks more frequently than the rich. In India, heart attacks have become more common among the impoverished and less-educated in recent years.

The main reason for this phenomenon is that the risk factors of heart disease have become more common among the poor, as social change tends to accompany economic development in evolving societies. Global experience vividly demonstrates these health and nutrition transitions. Initially, the epidemic of coronary disease, which causes a spate of heart attacks, manifested most prominently in the wealthier sections of high-income countries. But, over time, it evolved into a major threat to the poor among countries and the poor within countries. This followed changes over a period in the pattern of risk factor exposures in different population groups.

Most of the risk factors of heart attack are related to external elements that alter our physiology. Tobacco and diet are prime examples—even the levels of physical activity and stress are influenced by our environment. As societies develop economically, the social gradient of risk factor exposure reverses with time, with the rich purchasing protection and the poor becoming increasingly vulnerable.