How to Prevent Heart Attacks

Researchers from across the world have launched the Human Early-Life Exposome Project. What they intend to study is “the totality of human environmental (i.e., nongenetic) exposures from conception onward, complementing the genome.”

This is obviously the right way to go about discovering what causes health and disease: begin before conception and identify how the child’s environment taken as a whole affects his or her biology and life. The Human Early-Life Exposome Project will have several thousand participants. But although it’s ambitious in conception, the Project focuses on chemical and physical exposures.

I regret to report at least one biologically active agent has been excluded: non-ionizing radiation. As part of their protocol, the researchers will use smartphones to monitor the study’s thousands of subjects. Equally disappointing is that they haven’t included anything but crude measures of the social and natural environments.

Don’t get me wrong. The science is a tremendous step forward for its approach in understanding the ecology of exposures but is still well within the boundaries of the dominant ideology of risk factor medicine: health is the absence of disease; to make people healthy, it’s the job of science to prevent disease or treat it by finding out what risk factors cause the disease and eliminate them or, more commonly, counteract them, typically with pharmaceuticals.

In this ideology, risk factors are biologically active agents narrowly defined.

The ideology is utterly blind to the social ecology that is not just the context in which risk factors emerge but are the active force behind the exposure itself and that is a biologically active agent in its own right.

Take the example of smoking.

A recent study asked why people with more education were dramatically less likely to smoke. The answer isn’t that educated people are smarter and better informed and so are better able to grasp the risks of smoking. The study found that the analytic skills of teens did not predict their being a smoker in adulthood. What did predict smoking as an adult was the teen’s school environment, peer status, and in particular life and health expectations.

The link the author of this study wants to make is that better educated families and the children who come from them will tend to have better school environments, better peers, and more positive expectations for life and health and so will be less inclined to fall victim to the lure of the smoking life. In fact, she goes so far as to say that smoking status at age 16 predicts the level of education attained as an adult—not the other way around.

That’s not to say that we should forget about the narrowly conceived idea that pollutants or food or personal care products or wireless technologies are risk factors that cause disease. It’s simply that this idea is very much in step with the reductionist approach taken by dominant institutional sciences and scientists. The chemical and other pathways certainly affect health. However, the health of the organism and the organism’s ecology are the landscape through which those pathways flow and which determine the course those pathways can and cannot take.

They’re all biologically active agents: pathway, organism, ecology.

In a recent article on what links social conditions and cardiovascular disease, public health researchers note that over the last fifty years deaths from cardiovascular disease (essentially heart attacks and strokes) have declined dramatically throughout the industrialized world. Two factors account for this decline. One is that medical practice has gotten better at keeping people alive. That doesn’t really count for our purposes since it hasn’t eliminated the disease and so by conventional standards health has not been restored.

The other factor is that an increasing number of people have avoided life-threatening events by reducing or eliminating the risk factors identified by the medical system as causing heart attacks and strokes. And sure enough there has been a general public health campaign to eliminate smoking, the single most powerful risk factor, along with medical campaigns to lower blood pressure and cholesterol.

Those last two have created medical problems of their own and what positive effect they’ve had on cardiovascular disease is an illusion. But I digress.

An interesting thing happens when you look at the statistics on cardiovascular disease by social class: the lower a person’s class standing, the more powerfully risk factors affect them. In other words, if you compare biologically similar people who smoke the same amount or have the same blood pressure or same cholesterol level, the one from the lower class will be more likely to have a heart attack. In fact, the effect of the difference in class status can be up to 25 times greater than the effect from conventional risk factors such as smoking, blood pressure, and cholesterol.

Want to prevent heart attacks? Prevent social stratification—that is, eliminate class society.

Could such a thing work for cancer, diabetes, Alzheimer’s disease, schizophrenia, or other plagues of our age? Almost certainly.