One of the dilemmas in public health is about socioeconomic status.

Generally speaking, improvement in socioeconomic status are associated with benefits. People have better access to care, can afford healthy food choices and, in general, have better health choices.

On the other hand, these same improvements can send others to excess—eating more, eating poorly and, in general, losing the benefits that socioeconomic improvements should bring.

The bottom line is that health status is greatly influenced by individual’s choices when choices are available to them through social and economic gains.

In this study in Ontario, an 11-year study showed that the death rates from heart disease dropped by more than one-third and that the drop was “almost entirely attributable to improved treatment and better management of cardiovascular risk factors.”

• 48% of the total improvement resulted from improvements in lowering total cholesterol levels and systolic blood pressure.
• 43% of the total improvement resulted from advances in medical and surgical treatments in patients who had chronic stable coronary artery disease, heart failure and acute myocardial infarction (heart attack).
• During the same time period, an epidemic of obesity and diabetes occurred.

Over-consumption during the study period may partially explain increases in obesity and diabetes, the Medpage Story says.

Medpage Today

“Researchers say a 35% decline in death from coronary heart disease in Ontario was almost entirely attributable to improved treatment and better management of cardiovascular risk factors.

“From 1994 to 2005, the coronary mortality rate in Ontario dropped from 191 deaths per 100,000 to 125, according to Harindra Wijeysundera, MD, of Sunnybrook Health Sciences Center in Toronto, and colleagues.

“Nearly half (48%) of the decline was attributed to improvements in risk factors, particularly total cholesterol and systolic blood pressure, they reported in the May 12 Journal of the American Medical Association

“Another 43% of the slide was the result of advances in medical and surgical treatment, primarily in patients with chronic, stable coronary artery disease, heart failure, and acute myocardial infarction, according to a mathematical model.

“These trends may reflect the general improvement in socioeconomic status at the population level, which, in turn, may support healthier lifestyles and dietary habits,” Wijeysundera and his colleagues wrote.

“However, this may also lead to overconsumption, which may partially explain the recent epidemic of obesity and diabetes mellitus.”

Source: Medpage Today, May 12, 2010

Citation:Primary source: Journal of the American Medical Association, JAMA 2010; 303: 1841-47