In 1961 the Framingham study investigators coined the term ‘risk factor’ and unwittingly ushered in a period in the history of medicine dominated by the advancement of risk modification as a strategy to prevent disease. Academic careers have succeeded and private enterprises have flourished on the promotion of this paradigm. Risk factor reversal is now an established surrogate for quality of care and the cornerstone of most ‘pay-for-performance’ schemes allegedly designed to improve health outcomes. One particular risk factor, however, stands out by virtue of the unusual treatment it receives from public health advocates.
Poverty, the condition of relative material destitution, is undoubtedly the foremost of all medical risk factors. Many of the common clinical risk factors for disease are more prevalent among the poor: diabetes, obesity, hypertension, tobacco and alcohol abuse, malnutrition, domestic violence, to name but a few. Lower levels of education may contribute to misinformed health decisions and lesser financial means restricts the availability of medical treatment. Other unidentifiable factors may also be at play. It scarcely requires demonstrating that compared to the better-off the poor stand a greater chance of getting sick or of dying prematurely.
Yet when it comes to public health proposals to address the effect of poverty, the reversal of this risk factor is rarely advocated. Instead the Center for Disease Control, World Health Organization, Institute of Medicine, and many other public health agencies are unwaveringly focused on “minimizing health care disparities.” This is a peculiar approach. It seems that anyone serious about addressing the effects of poverty should instead be supporting the promotion of prosperity. But few public policy specialists seem to be particularly concerned about or fluent in economics. Will the current financial turmoil prompt them to gain education on this matter? I suggest the following starting point.
Being economically ignorant is a risk factor to one’s financial health. And we know that financial illness is the mother of all risk factors.
Hello,
Nortin Hadler also makes this point in “the worried sick” among many others. Did you read him?
His book and also Penston’s have strengthened my contrarian skepticism.
I predict (first time in my life I predict something.) future generations will consider our medicine not too bad but polluted by a huge scale deceit.
Hello Alberto,
I did not read “worried sick” and I was not familiar with Nortin Hadler until you pointed him out. Looking at his blog posts, I agree with some of his viewpoints but not all. He has a soft spot for the RCT as a tool to direct policy… He still belongs among those who think they know the answers as to what constitutes “quality care” and overlook the part of medicine that is highly subjective.
Michel