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

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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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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Correspondence to Peter Lloyd-Sherlock.

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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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Keywords

  • health
  • hypertension
  • equity
  • older people
  • policy