Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

From poverty to chronic diseases

Poverty and social exclusion increase the risks of developing a chronic disease, developing complications and dying. The resulting health inequalities have been widening over the past two decades. In some countries at an early stage of economic development, wealthy members of society report more chronic disease than poorer members - it is unclear, however, whether this is because they develop more chronic diseases, or because they survive with them longer owing to their ability to access health services.

In all countries, poor people are more likely to die after developing a chronic disease. In most countries, health inequalities have been widening over recent decades.

Why the poor are more vulnerable

The poor are more vulnerable to chronic diseases because of material deprivation and psychosocial stress, higher levels of risk behaviour, unhealthy living conditions and limited access to good-quality health care (see sidebar figure on the next page). Once disease is established, poor people are more likely to suffer adverse consequences than wealthier people. This is especially true of women, as they are often more vulnerable to the effects of social inequality and poverty, and less able to access resources.

Widening gaps in high income countries

The gap between rich and poor has been widening in many wealthy countries in recent years. In Denmark, England and Wales, Finland, Italy, Norway, and Sweden inequalities in mortality increased between the 1980s and the 1990s. These widening inequalities have been attributed to two important changes. The first is that cardiovascular disease death rates declined among wealthy members of these societies, explaining about half of the widening gap.

This might have been a result of faster changes in health behaviour in these groups and/or better access to health-care interventions. Second, widening inequalities in other causes of death (lung cancer, breast cancer, respiratory disease, gastrointestinal disease and injuries) resulted from increasing rates of mortality among poorer groups. Rising rates of lung cancer and deaths from chronic respiratory disease indicate the delayed effects of rising tobacco use among poorer members of society.