International Journal of Epidemiology, Volume 33, Number 2, pp. 297-298
IJE vol.33 no.2 © International Epidemiological Association 2004; all rights reserved.
Commentary |
Commentary: Risk factors or social causes?
University College London, International Centre for Health & Society, 1–19 Torrington Place, London WC1E 6BT, UK. E-mail: m.marmot{at}ucl.ac.uk
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In many industrialized countries, there has been a welcome decline in coronary heart disease (CHD) mortality. In England and Wales, this has progressed for two decades.1 Many would like to take the credit for this decline, but the reasons for it are not entirely clear. Contributors to the decline are likely to include reductions in smoking, dietary change—but not the increase in obesity—and improvements in treatment, both of risk factors and the disease after it hits.
The shadow over this bright picture is cast by the uneven nature of the improvement. In general, the higher the socioeconomic position the greater has been the improvement.2 As a result, social inequalities in CHD have increased. It is useful
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