Issue 24 / 4 July 2011

IT has long been known that poverty has a negative impact on health.

In the latest issue of the MJA, researchers show that people living in socioeconomically deprived areas in Australia and New Zealand experience higher rates of stroke. They tend to be younger, more likely to have hypertension and diabetes and, not surprisingly, are more likely to smoke.

The magnitude of the difference was startling.

When comparing the most deprived with the least deprived groups, the age-standardised incidence rate for stroke per 100 000 person-years was 70% higher. After adjusting for age, they found that almost one in five strokes could be attributed to living in the most socioeconomically deprived areas compared with the least deprived areas.

In developed countries, stroke is the second most common cause of death after heart disease, and it is predicted that by 2020 this will be the case worldwide.

Stroke is a leading cause of disability and results in the loss of at least 49 million disability-adjusted life-years annually throughout the world. Stroke in later life has been linked to socioeconomic deprivation in early life, and even to prenatal factors that have socioeconomic determinants, such as low birthweight and short birth length.

The effect of socioeconomic status on health is multifactorial. Income, environment, education level and social support are important, as are lifestyle factors such as diet, exercise and smoking.

Service provision and access also matter. The Marmot Review was undertaken to put forward evidence-based strategies for reducing health inequalities in England from 2010.

Its key message was that health inequalities result from social inequalities and that the reduction of inequality is a matter of fairness and social justice.

The review also identified a “social gradient” for health in England — people living in the poorest neighbourhoods have a life expectancy that is 7 years less than those living in the richest neighbourhoods.

In addition to the health benefits for an individual, the Marmot Review also points out the economic benefits of alleviating health inequalities. These include reduced productivity losses and forgone tax revenue, and reduced treatment costs and welfare payments — all especially relevant to stroke.

In Australia, belatedly, we are aware of the survival difference between Indigenous and non-Indigenous people and there are now calls to “close the gap”. There is less awareness of the difference in survival rates across socioeconomic groups.

As a profession, we have a responsibility to the community as well as our individual patients to ensure that the treatments we employ are cost-effective. By extrapolating the message of the researchers in the MJA and Marmot, it’s also part of our role to promote health by advocating for policy that diminishes socioeconomic inequality.

The “debate” of the moment is about plain packaging of cigarettes. Smoking has a strong inverse relationship with socioeconomic status and is a major risk factor for stroke.

We should continue to advocate for any measure that will reduce it — not nanny state, but Nanny knows best.

Dr Annette Katelaris is the editor of the MJA.

This article is reproduced from the MJA with permission.

Posted 4 July 2011

4 thoughts on “Annette Katelaris: Stroke — for richer or poorer

  1. Bruni Brewin says:

    Greg, I couldn’t agree with you more and couldn’t have put it better myself. We have had inequality since time began. Yet some of those from rock-bottom situations have sky-rocketed and become a ‘victor’ in their own survival, whilst others become the ‘victim’ and expect hand-outs from those that have laboured to get a few steps up the rung of their ladders. I do not fix people’s problems, I motivate them to fix their own problems. Isn’t it a case of “Give a man a fish and you feed him for a day, verses Teach a man to fish and he can feed his family every day?” I am reminded of Dr. Spock who persuaded millions of mums to bring up their children without ever spanking them when they did things wrong. Dr. Spock’s son committed suicide, he also admitted that he had been wrong. There is a whole difference between chastising a child when it is warranted, than being a physical abuser that hits out of anger, alcohol and drugs.

  2. Greg Hockings says:

    Annette, I strongly disagree with your point of view and truly hope that it does not represent AMA ploicy on this matter.
    In our free society, people have the right to do themselves harm by not exercising, not losing weight, not getting enough sleep, leading very stressful lives, drinking alcohol (sometimes to excess) and even smoking cigarettes. However, they should not expect the community to carry the expense of medical treatments for lifestyle-related morbidity resulting from these choices. An individual should take responsibility for their own lifestyle-related health.
    If the government is so strongly opposed to cigarettes, it could legislate to make nicotine a banned substance, as is the case with cannabis. It can certainly run educational programs aiming at the young and the financially and educationaly disadvantaged.
    However, plain packaging could just as well be applied to alcohol, fast food burgers, etc.
    You are in fact advocating precisely a nanny state. How about self-responsibility and accepting consequences for one’s actions.
    As for Bevmidwife (I at least am prepared to put my name to my opinion), no country without a strong economy can afford to finance a decent health system, so let’s close the coal mines, put unemployment and power prices through the roof and see what happens to the health of the more vulnerable members of our society then.

  3. Bevmidwife says:

    So smoking is a link. Politicians representing the rich oppose blank cigarette packages, oppose taxes for the billionaire mining conglomerates, promote more fossil fuel for electricity, sell off our food basins for more fossil fuel production. This research tells us what we already know – we only have to examine the life span of our first nation – the Aboriginal original inhabitants – and the state of their health to have the answers to these questions!

  4. Dianna Kenny says:

    Ah! But what Nanny knows, Nanny does not always tell. The Whitehall studies conducted by Michael Marmot began in 1967. We have known about social inequalities in health for over 40 years. These inequalities cannot be solved in the GP’s office – that constitutes too little, too late.

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