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Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

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Abstract

This paper identifies a general perception among development policymakers that health conditions such as hypertension and other non-communicable diseases (NCDs) disproportionately affect privileged socioeconomic groups. The paper argues that this framing of the issue is derived more from established discourses and institutional dynamics than from evidence. The paper then assesses the validity of this view, with reference to the social patterning of hypertension in China, Ghana, India, Mexico, the Russian Federation and South Africa. Using data for adults aged 50+ from the WHO Survey of Ageing and Adult Health, it finds the social patterning of hypertension prevalence varies markedly between the study countries, but that hypertension awareness and control rates are generally lower for less-advantaged groups. This reveals a need to challenge misleading representations of NCD pandemics and for interventions that specifically target the poor.

Cet étude adresse une perception diffusé parmi les décideurs de politiques de développement, c’est-à-dire que les maladies chroniques – telles que l’hypertension et d’autres maladies non contagieuses (en anglais : NCD) – affectent surtout les groups socio-économiques les plus privilégiés. Cette étude affirme que la façon dans laquelle on envisage cette problématique est dictée par des discours établis et des dynamiques institutionnelles, plutôt que par une évidence concrète. Cet étude évalue la validité de cet point de vue, à travers d’une étude de la modélisation sociale de l’hypertension dans plusieurs pays : Chine, Ghana, Inde, Mexique, Fédération Russe, et Afrique du Sud. On utilise les données de l’Enquête sur le Vieillissement et la Sante des Adultes, menée par l’OMS ; on trouve que la modélisation sociale de la prévalence de l’hypertension varie parmi les pays, mais que la prise de conscience de l’hypertension et le niveau de contrôle de cette maladie sont en général plus faibles chez les groupes les moins avantagés. Ceci révèle la nécessite de contester les représentations acquises et trompeuses des pandémiques NCD, et la nécessité d’interventions qui ciblent les plus pauvres.

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References

  • Alleyne, G., Binagwaho, A., Haines, A., Jahan, S., Nugent, R., Rojhani, A., Stuckler, D. and Lancet NCD Action Group (2013) Embedding non-communicable diseases in the post-2015 development agenda. Lancet 381(9866): 566–574.

  • Banerjee, A. (2012) Tracking global funding for the prevention and control of noncommunicable diseases. Bulletin of the World Health Organisation 90: 479–479A.

    Article  Google Scholar 

  • Beaglehole, R., Bonita, R., Alleyne, G., Horton, R., Li, L., Lincoln, P., Mbanya, J.C., McKee, M., Moodie, R., Nishtar, S., Piot, P., Reddy, K.S., Stuckler, D. and Lancet NCD Action Group (2011) UN high-level meeting on non-communicable diseases: Addressing four questions Lancet 378(9789): 449–455.

  • Chan, C., Marmot, M., Farley, T. and Poulter, N. (2002) The influence of economic development on the association between education and the risk of acute myocardial infarction and stroke. Journal of Clinical Epidemiology 55: 741–747.

    Article  Google Scholar 

  • Chiolero, A., Cachat, F., Burnier, M., Paccaud, F. and Bovet P. (2007) Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. Journal of Hypertension 25(11): 2209–2217.

    Article  Google Scholar 

  • Crane, H., Van Rompaey, S. and Kitahata, M. (2007) Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy. AIDS 20(7): 1019–1026.

    Article  Google Scholar 

  • De Maeseneer, J., Roberts, R.G., Demarzo, M., Heath, I., Sewankambo, N., Kidd, M.R., van Weel, C., Egilman, D., Boelen, C. and Willems, S. (2012) Tackling NCDs: A different approach is needed. Lancet 379(9829): 1860–1861.

    Article  Google Scholar 

  • Di Cesare, M., Khang, Y.H., Asaria, P., Blakely, T., Cowan, M.J., Farzadfar, F., Guerrero, R., Ikeda, N., Kyobutungi, C., Msyamboza, K.P., Oum, S., Lynch, J.W., Marmot, M.G., Ezzati, M. and Lancet NCD Action Group (2013) Inequalities in non-communicable diseases and effective responses. Lancet 381(9866): 585–597.

  • Egan, B.M., Zhao, Y. and Axon, R.N. (2010) US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 303(20): 2043–2050.

    Article  Google Scholar 

  • Ferdinand, K.C. and Townsend, R.R. (2012) Hypertension in the US Black population: risk factors, complications, and potential impact of central aortic pressure on effective treatment. Cardiovascular Drugs and Therapy 26(2): 157–165.

    Article  Google Scholar 

  • Ferguson, B., Murray, C.L., Tandon, A. and Gakidou, E. (2003) Estimating permanent income using asset and indicator variables. In: C.L. Murray and D.B. Evans (eds.) Health Systems Performance Assessment Debates, Methods and Empiricism. Geneva: World Health Organization.

    Google Scholar 

  • Ferri, C.P., Schoenborn, C., Kalra, L., Acosta, D., Guerra, M., Huang, Y., Jacob, K.S., Llibre Rodriguez, J.J., Salas, A., Sosa, A.L., Williams, J.D., Liu, Z., Moriyama, T., Valhuerdi, A. and Prince, M.J. (2011) Prevalence of stroke and related burden among older people living in Latin America, India and China. Journal of Neurology, Neurosurgery and Psychiatry 82(10): 1074–1082.

    Article  Google Scholar 

  • Gakidou, E., Oza, S., Fuetes, C.V., Li, A.Y., Lee, D.K., Sousa, A. et al (2007) Improving child survival through environmental and nutritional interventions. The importance of targeting interventions towards the poor. JAMA, 298: 1876–1887.

    Article  Google Scholar 

  • Gwatkin, D. (2013) Metrics matter: The case of assessing the importance of non-communicable diseases for the poor. International Journal of Epidemiology 42:1211–1214.

    Article  Google Scholar 

  • Hosseinpoor, A.R., Mohammad, K., Majdzadeh, R., Naghavi, M., Abolhassani, F., Sousa, A. et al (2005) Socioeconomic inequality in infant mortality in Iran and across its provinces. Bull World Health Organ 83: 837–844.

    Google Scholar 

  • Hotchkiss, J.W., Davies, C., Gray, L., Bromley, C., Capewell, S. and Leyland, A.H. (2011) Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: Cross-sectional surveys. British Medical Journal Open Access 1(1): e00017

    Google Scholar 

  • Johnston, D.W., Propper, C. and Shields, M.A. (2009) Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient. Journal of Health Economics 28(3): 540–552.

    Article  Google Scholar 

  • Jones, N. and Young, J. (2007) Setting the Scene: Situating DFID’s Research Funding Policy and Practice in an International Comparative Perspective. London: Overseas Development Institute.

    Google Scholar 

  • Joshi, R., Cardona, M., Iyengar, S., Sukumar, A., Ravi Raju, C., Rama Raju, K., Raju, K., Srinath Reddy, K., Lopez, A. and Neal, B. (2006) Chronic diseases now a leading cause of death in rural India – mortality data from the Andhra Pradesh Rural Health Initiative. International Journal of Epidemiology 35: 1522–1529.

    Article  Google Scholar 

  • Kahn, K., Tollman, S., Thorogood, M., Connor, M., Garenne, M., Collinson, M. and Hundt, G. (2006) Older adults and the health transition in Agincourt, rural South Africa: new understanding, growing complexity. In: B. Cohen and J. Menken (eds.) Aging in Sub-Saharan Africa: Recommendations for Furthering Research. Washington, DC: National Research Council.

    Google Scholar 

  • Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K., and He, J. (2005) Global burden of hypertension: Analysis of worldwide data. Lancet 365(9455): 217–223.

    Article  Google Scholar 

  • Kowal, P., Chatterji, S., Naidoo, N., Biritwum, R., Fan, W., Riadura, R. L., and SAGE Collaborators et al (2012). Data resource profile: The World Health Organisation Study of global AGEing and adult health. International Journal of Epidemiology 41: 1639–1649.

  • Lloyd-Sherlock, P., Minicuci, N., Beard, J., Ebrahim, S. and Chatterji, S. (2014) Hypertension among older adults in low and middle income countries: Prevalence, awareness and control. International Journal of Epidemiology 14(1): 116–128.

    Article  Google Scholar 

  • Lloyd-Sherlock, P. et al (2015) A premature mortality target for the SDG for health is ageist. Lancet 385(9983): 2147–2148.

    Article  Google Scholar 

  • Moodie, R., Stuckler, D., Monteiro, C., Sheron, N., Neal, B., Thamarangsi, T., Lincoln, P., Casswell, S. and Lancet NCD Action Group (2013) Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 381(9867): 670–679.

  • Murphy, G., Asiki, G., Ekoru, K., Nsubuga, R.N., Nakiyingi-Miiro, J., Young, E., Seeley, J., Sandhu, M. and Kamali, A. (2014) Sociodemographic distribution of non-communicable disease risk factors in rural Uganda: A cross-sectional study. International Journal of Epidemiology 42(6): 1740–1753.

    Article  Google Scholar 

  • NCD Alliance (2012) Who we are. http://www.ncdalliance.org/who-we-are

  • Neuman, M., Finlay, J.E., Davey Smith, G. and Subramanian, S. (2011) The poor stay thinner: stable socioeconomic gradients in BMI among women in lower- and middle-income countries. The American Journal of Clinical Nutrition 94: 1348–1357.

    Article  Google Scholar 

  • Nugent, R. and Feigl, A. (2010) Where have all the donors gone? Scarce donor funding for non-communicable diseases. Centre for Global Development Working Paper 228, Washington, DC.

  • Omran, A. (2005) The epidemiologic transition: A theory of the epidemiology of population change. Millbank Quarterly 83(4): 731–757.

    Article  Google Scholar 

  • Ordunez, P., Munoz, J.L., Espinosa-Brito, A., Silva, L.C. and Cooper, R.S. (2005) Ethnicity, education, and blood pressure in Cuba. American Journal of Epidemiology 162(1): 49–56.

    Article  Google Scholar 

  • Reddy, K.S. et al. (2007) Educational status and cardiovascular risk profile in Indians. Proceedings of the National Academy of Science 104:16263–16268.

    Article  Google Scholar 

  • Prentice, A. (2006) The emerging epidemic of obesity in developing countries. International Journal of Epidemiology 35(1): 93–99.

    Article  Google Scholar 

  • Shiffman, J. (2009) A social explanation for the rise and fall of global health issues. Bulletin of the World Health Organisation 87: 608–13.

    Article  Google Scholar 

  • Singh-Manoux, A., Nabi, H., Shipley, M., Guéguen, A., Sabia, S., Dugravot, A., Marmot, M. and Kivimaki, M. (2008) The role of conventional risk factors in explaining social inequalities in coronary heart disease: The relative and absolute approaches to risk. Epidemiology 19(4): 599–605.

    Article  Google Scholar 

  • Steyne, K., Sliwa, K., Hawken, S., Commerford, P., Onen, C., Damasceno, A., Ounpuu, S. and Yusuf, S. (2005) Risk factors associated with myocardial infarction in Africa. The INTERHEART Africa Study. Circulation 112: 3554–3561.

    Article  Google Scholar 

  • Subramanian, S., Corsi, D., Subramanyamn, M. and Davey-Smith, G. (2013) Jumping the gun: The problematic discourse on socioeconomic status and cardiovascular health in India. International Journal of Epidemiology 42: 1410–1426.

    Article  Google Scholar 

  • Suhrcke, M., Nugent, R., Stuckler, D. and Rocco, L. (2006) Chronic Disease: An Economic Perspective. London: Oxford Health Alliance.

    Google Scholar 

  • WHO (2004a) Diseases of Poverty and the 10/90 Gap. Geneva: WHO.

    Google Scholar 

  • WHO (2004b) Why are chronic conditions increasing? www.who.int.

  • World Health Organisation (WHO) (2010) Global status report on noncommunicable diseases 2010. Geneva: WHO.

    Google Scholar 

  • Yach, D., Hawkes, C., Gould, C. and Hofman, K. (2004) The global burden of chronic diseases. Overcoming impediments to prevention and control. JAMA 291(21): 2616–2622.

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Acknowledgments

We would like to acknowledge the principal investigators at the SAGE sites: P. Arokiasamy (India), R. Biritwum (Ghana), Wu Fan (China), R. Lopez Riadura (Mexico), T. Maximova (Russian Federation) and N. Phaswanamafuya (South Africa). The views expressed in this paper are those of the author(s) and do not necessarily represent the views or policies of the World Health Organization. This work was supported by the National Institute of Health (grants OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-0 (R01-AG034479), which funded the WHO Study on global AGEing and adult health (SAGE) on which this analysis is based. The analysis was funded by the Economic and Social Research Council (Grant ES/K003526/1).

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Lloyd-Sherlock, P., Minicuci, N., Corso, B. et al. Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries. Eur J Dev Res 29, 827–842 (2017). https://doi.org/10.1057/s41287-016-0063-2

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