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Inequality in disease

This article discusses social inequality in the United States and its effects on individual health, and more specifically likelihood of developing diseases.

While rates of incidence for many diseases vary based on biological factors and inheritable characteristics, a larger disparity, which cannot be explained by biological factors, exists in disease rates among varying racial and socioeconomic groups in the United States (for example, lower-income African-Americans and upper-class Caucasians). This suggests that social and economic factors play a role in determining who acquires certain diseases in the United States. For example, heart disease is the most dangerous disease in America, followed closely by cancer, with the fifth most deadly being diabetes. The general risk factors associated with these three diseases include obesity and poor diet, tobacco and alcohol use, physical inactivity, and access to medical care and health information.[1] While some of these risk factors are individual health choices, all of them are also correlated with socioeconomic factors, such as gender, race, income, environment, and education, and consequently, a person’s likelihood for developing heart disease, cancer, or diabetes is in part correlated with these social factors. Men are more likely than women to die from heart disease. Likewise, African-Americans and other racial minorities have higher mortality rates from heart disease,[2] cancer,[3] and diabetes[4] than their white counterparts. Among all racial groups, individuals who are impoverished or low income, have lower levels of educational attainment, and live in lower-income neighborhoods are all more likely to develop heart disease,[2] cancer,[5] and diabetes.[6][2]


Gender as a defining characteristic of a social group has different effects for the different diseases. Men are 30% more likely to suffer a stroke than women.[citation needed] Women generally have a healthier diet, and tend to consume fewer fats and carbohydrates.[citation needed] Women are also more likely to engage in regular exercise and follow their doctor’s orders concerning healthy habits.[citation needed] Men are more inclined to hot tempers and emotional outbursts that can increase blood pressure.[citation needed] Men are also more likely to be smokers than women.[7][dead link] Both men and women battle cancer, but different forms of cancer pertain more or less to the different sexes. Breast cancer affects women more than men, and prostate cancer affects only men. Lung cancer, however, is the number one cancer-related killer for both men and women, but men are more likely to develop and die from it.[8] Diabetes, on the other hand, is more deadly for women.[citation needed] In recent years, the mortality rate for diabetes is higher for women than it is for men.[9]


Main article: Race and health

Race is a strong determinant of disease rates, mostly because racial minorities make up a large portion of the lowest social level.[citation needed] More African Americans are obese or overweight and are smokers.[2] Similarly, African Americans have the highest death rate and shortest survival rate of any racial and ethnic group for most cancers.[3] African Americans are more likely to smoke mentholated cigarettes with higher carbon monoxide concentrations, which put them at greater risk for developing lung cancer.[3] Obesity is more common in African Americans in part because they are less likely to engage in leisure-time physical activity.[3] The prevalence of Type 2 diabetes is four times higher among African Americans and other racial minorities due to both poorer diets and less physical activity.[4]


Income is highly correlated with the prevalence of heart disease because it is correlated with many other social factors, such as one’s neighborhood, education level, occupation, and overall social status. Income itself, as well as the distribution of income, affect the occurrence of heart disease. Populations with high levels of income inequality display higher rates of heart disease than populations with more evenly distributed income.[10][clarification needed] People living in poverty are less able to afford healthy food, spend time participating in physical activity, and pay for medical care that can reduce the risk of heart disease.[10] The lack of insurance for those in poverty is another cause of health disparities relating to heart disease.[10] Low-income individuals tend to face greater stress, and with low funds, many people turn to high levels of food consumption, smoking, and alcohol use as a way to cope.[10] People living in poverty are also more likely to die from cancer than their more affluent peers because they do not have access to high quality cancer prevention, early detection, and treatment services.[3] There is a close correlation between increased poverty and increased diabetes, as well.[6] The reasons for the diabetes discrepancy are probably the same as those for heart disease and cancer; low-income individuals cannot afford healthy food or medication, and tend to have more stress in their day-to-day lives.[6]


The neighborhoods and areas people live in, as well as their occupation, make up the environment in which they exist. People living in poverty stricken neighborhoods are at a greater risk for heart disease, possibly because the supermarkets in their area do not sell healthy foods and there is increased availability of stores selling alcohol and tobacco than in more affluent parts of town.[2][clarification needed] People living in rural areas are also more susceptible to heart disease, as well. An agriculturally based diet rich in fat and cholesterol, combined with an isolated environment in which there is limited access to health care and ways to distribute information probably creates a pattern in which people living in rural environments have higher levels of heart disease.[2] Occupational cancer is one way in which the environment one works in can increase their rate of disease. Employees exposed to smoke, asbestos, diesel fumes, paint, and chemicals in factories can develop cancer from their workplace.[11] All of these jobs tend to be low-paying and typically held by low-status individuals. The decreased amount of healthy food in stores located in low-income areas also contributes to the increased rates of diabetes for persons living in those neighborhoods.[6]


The lower a person’s level of education, the higher their chance of being diagnosed with heart disease.[12] People who have not graduated from high school have a 2.4% greater risk of dying than those who did graduate high school.[13] Education level is also related to smoking, overeating, and not exercising;[2] thus, education also affects rates of cancer and diabetes by influencing health behaviors. A lack of knowledge about the risk factors of these diseases, as well as the understanding of symptoms and when to go to the doctor, greatly affects both the development of disease as well as the prognosis of it.

See also


1.^ "Women, heart disease and stroke". American Heart Association. Retrieved April 7, 2008. 

2.^ ^2 a ^2 b ^2 c ^2 d ^2 e ^2 f Cort, Natalie A.; Stewart-Fahs, Pamela. "Heart disease: the hidden killer of rural black women". Retrieved April 5, 2008. 

3.^ ^3 a ^3 b ^3 c ^3 d "Cancer facts & figures for African Americans 2007-2008" (PDF). American Cancer Society, Inc. 2008. Archived from the original (PDF) on February 26, 2008. Retrieved April 13, 2008. 

4. ^ ^4 a "American Diabetes Association". Archived from the original on March 27, 2008. Retrieved April 13, 2008. 

5.^ "Cancer facts & figures for Hispanics 2006-2008" (PDF). American Cancer Society, Inc. 2008. Archived from the original (PDF) on June 2, 2008. Retrieved April 13, 2008. 

6.^ ^6 a ^6 b ^6 c Daniels, Peter (2006-01-30). "Diabetes in the US: a social epidemic". Retrieved April 13, 2008. 

7.^ Abel, Barbara (2005-05-27). "Men and heart disease: take lifestyle cues from women". Retrieved April 14, 2008. 

8.^ "Women catching up to men in lung cancer deaths". MediLexicon International Ltd. 11/12/2006. Retrieved April 6, 2008.  Check date values in: |date= (help)

9.^ Nelson, Nancy (2004-06-17). "The majority of cancers are linked to the environment". Retrieved April 6, 2008. 

10.^ ^10 a ^10 b ^10 c Income, income inequality, and cardiovascular disease mortality. Massing, Mark; Rosamond, Wayne; Wing, Steven; Suchindran, Chirayan; Kaplan, Berton; Tyroler, Herman

11.^ Rastegari, Esther C.; Odle, Teresa G. (2006). "Occupation exposures and cancer". The Gale Group, Inc. Retrieved April 6, 2008. 

12.^ Hitti, Miranda (10/5/2004). "Heart disease risk linked to low education: not finishing high school a risk factor for heart disease death". Retrieved April 6, 2008.  Check date values in: |date= (help)

13.^ Shi, Leiyu; Macinko, James; Starfield, Barbara; Politzer, Robert; Wulu, John; Xu, Jiahong (6/2/2004). "Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990". Retrieved April 6, 2008.  Check date values in: |date= (help)

14.^ Nelson, Nancy (2004-06-17). "The majority of cancers are linked to the environment". Retrieved April 6, 2008. 

15.^ Gregg, Edward W.; Gu, Qiuping; Cheng, Yiling J.; Narayan, Venkat; Cowie, Catherine C. (August 7, 2007). "Mortality trends in men and women with diabetes, 1971-2000". Retrieved April 7, 2008.