Sunday reading: The greatest health risk factor

Economic health is rarely considered a health index, but, as Dr. Michel Accad, M.D., writes at Alert and Oriented, it is the most important one.

Years ago, the history of medicine departed from clinical evidence-based medical care when it adopted a new paradigm: treating risk factors. It all started when the Framingham Heart Study authors invented the term “risk factor,” he explained:

In 1961 the Framingham study investigators coined the term ‘risk factor’ and unwittingly ushered a period in the history of medicine dominated by the advancement of risk modification as a strategy to prevent disease. Academic careers have succeeded and private enterprises have flourished on the promotion of this paradigm. Risk factor reversal is now an established surrogate for quality of care and the cornerstone of most ‘pay-for-performance’ schemes allegedly designed to improve health outcomes. One particular risk factor, however, stands out by virtue of the unusual treatment it receives from public health advocates. Poverty…

This paradigm, he noted quickly became popular and is built for profit. As we’ve examined, it led to the creation of the Framingham Risk Score, a simplified assessment tool based on select risk factors commonly believed to predict our chances of dying from heart disease. While it has been adopted by the government and embraced by the insurance industry, these risk factors continue to fail to predict heart disease or premature death for most people. Correlations do not make for causations and, hence, very good targets for preventive health. Especially untenable links.

More importantly, today’s preventive health movement continues to ignore the most significant, "health risk factor": poverty. Public health proposals rarely advocate reversing this risk factor, Dr. Accad pointed out. “Instead, we are offered plans to ‘minimize health inequalities.’” This is a peculiar approach to medicine, he said. Equalizing cholesterol levels, blood pressures or smoking behaviors among a population doesn’t change health disparities. Observant readers of his article who follow the links to the history of Nazi economic policy and understand Germany’s preventive health movement, which similarly sought to address “health disparities,” will get his larger message.

We’ve examined the troubling and growing movement here, said to address what is termed “health disparities” — that’s working to make race/ethnicity, genetics (including obesity), and lifestyles, markers for biological weakness and risk factors for diseases such as cancers and heart disease. When, in fact, the most significant risk factor for health disparities and premature mortality is social status and poverty.

The best health outcomes for adults and children and saving the lives of babies, don’t come with most of today's preventive wellness programs or weight loss or insurance coverage, but with improving economic status and eliminating discrimination.

But there is no simple pill for poverty. Addressing poverty and classism doesn’t enable pay-for-performance schemes, as Dr. Accad noted, that make money for stakeholders and give the government a reason to monitor and dictate what we eat and how we live, what lab tests and screenings we get, what medications we take, and if doctors are complying with the P4P measures written by stakeholders.

While the strongest evidence from every country on earth and throughout human history has shown prosperity to be the single most important factor for health outcomes, he says that, rather than pursue today’s misguided paradigm:

It seems that anyone serious about addressing the effects of poverty should instead be advocating the promotion of prosperity. But for most doctors, this is a foreign concept. That is because most doctors, like most politicians, know very little about economics. Economics, though not an intuitive field of knowledge, is not necessarily rocket science... Don’t let the failure of the majority of mainstream economists to predict the current turmoil fool you into likening economics to astrology. The enormous involvement of the state into economic life has unavoidably turned most economists into political pawns and has introduced dangerous bias and errors in the science…

“Financial illness is the mother of all risk factors,” he emphasized.