Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

Higher levels of risk behaviour

The immediate cause of inequalities in chronic diseases is the existence of higher levels of risk factors among the poor. The poor and people with less education are more likely to use tobacco products, consume energy-dense and high-fat food, be physically inactive, and be overweight or obese. This social and economic difference in risk factor prevalence is particularly striking in high income countries, but is also rapidly becoming a prominent feature of low and middle income countries.

Poor people and those with less education are more likely to maintain risk behaviour for several reasons. These include inequality of opportunities, such as general education; psychosocial stress; limited choice of consumption patterns; inadequate access to health care and health education; and vulnerability to the adverse effects of globalization. Aggressive marketing of harmful products, such as tobacco, sustain the demand for these products among those who have fewer opportunities to substitute unhealthy habits with healthier and often more expensive options.

In middle- and high-income countries, the poor tend to be more obese than the wealthy, which has been viewed as something of a paradox. It is likely that several factors contribute to this relationship, but one explanation is that "energy-dense" foods, such as fried or processed foods, tend to cost less on a per-calorie basis when compared with fresh fruit and vegetables.

From poverty to chronic diseases:
  • Material deprivation and physhosocial stress.
  • Constrained choices and and higher levels of risk behaviour.
  • Increased risk of disease.
  • Disease onset.
  • Reduced access to care.
  • Reduced opportunity to prevent complications.