sociology

The sociology essay below has been submitted to us by a student in order to help you with your studies.

Cardiovascular disease

How does socioeconomic status influence the risk of cardiovascular disease among middle-aged women living in the UK?

Objective:

This essay aims to examine whether socioeconomic status influences the risk of cardiovascular disease in women living in the UK. This will be achieved by conforming to the aims in the Module Action Plan (MAP) previously outlined. This will involve examining some of the most important factors in the aetiology of the disease and the socioeconomic trends associated with them. These trends will then be considered form a sociological viewpoint particularly with regards to the Marx and feminist theories. The classification of socio-economic status (SES), current trends and relevance to dietetic practise will also be discussed.

Methodology:

This is a library based literature review of material published since the 1990's on the topic of cardiovascular disease and socioeconomic status in the UK. It also encompasses material on the Marxist and Feminist theories relating to this topic.

Key Terms:

Socioeconomic status (SES); Women; Cardiovascular disease

Introduction:

Mortality rates from cardiovascular disease have been on the decline in recent decades due to improved primary prevention as well as improved diagnosis, treatment and secondary prevention (Kelly and Stanner 2003). There are geographical inconsistencies in this decline however as the incidence in the UK is decreasing at a slower rate than the rest of Europe and is still a serious problem among women in the UK. Particularly in relation to the British context, are the effects of socioeconomic status on the risk of developing cardiovascular disease. It has been suggested by Marmot et al. (1984) that coronary heart disease is the disorder in which the strongest socioeconomic inequalities are observed. It has been widely established that lower socioeconomic groups have a higher prevalence of cardiovascular disease when compared to those in high socioeconomic groups (Lyratzopoulos et al. 2006). Death rates have been on the decrease since the 1970's however rates have decreased more so in the higher socioeconomic groups causing the gap between those at the top and those at the bottom of society to be widened even further (Kelly and Stanner 2003).

Britain has some of the highest deaths rates from heart disease among women with only Hungary, Estonia and Slovakia having higher rates (Smith 2009). 103,000 British women suffer heart attacks each year. 22% of premature deaths in women were from CVD in 2006 (www.heartstats.org), while Ischemic heart disease remains the largest cause of death in Scotland (Davies et al. 2009). In general women have the attitude that they are not at risk of heart disease because they see it as disease more common in men (www.heratstats.org). However as can be seen from this sample of statistics from the UK, this is not the case. Smoking, diet occupation and health education contribute to cardiovascular disease and furthermore a social gradient has been illustrated in these factors. This literature review will aim to examine these factors and investigate the social reasons behind these socioeconomic trends as well as discussing the issue of classifying socioeconomic status.

Classification of socioeconomic status

It is difficult to categorize people according to their socioeconomic status as it is a term with many dimensions. Socioeconomic status was a concept first proposed by Marx. The term incorporates aspects such as income, education and housing. In contrast social class is usually classified according to occupation (Taylor and Field 2007). Socioeconomic status can be measured directly on an individual basis, in terms of the person's occupation or education or indirectly on a small population basis for example geographical regions (Graham 2000).

Most of Marx's works related to stratification and in particular social class however he did not categorize class in a systematic way (Giddens). According to Marx, class is a group of people who have a common means of production or livelihood. As the transition from production in land to production in industry occurred, the two main classes became the industrialists/capitalists and the working class which Marx sometimes referred to as the proletariat. Marx was very opinionated on the issue of capitalism and wrote of the inequalities of the capitalist system. Marx used the term pauperisation to describe the process by which the working class becomes poorer in relation to the capitalist class (Giddens 2006).

In relation to the investigations of health inequalities the two main measures of social position used in the UK are the Cambridge scale and the Erikson- Goldthorpe Schema (Graham 2000). Bartley et al. (1999) compared these two validated measures of social position. The study illustrates that the strength of the relationship between social position and cardiovascular disease risk factors varies depending on the definition of social position used. The Cambridge scale is based on social advantage and lifestyle while the E-G schema is based on employment relations and conditions. The E-G scale is based on employers versus employees, manual workers versus non manual workers, and the types of relationships between workers and employees (Graham 2000). The Cambridge scale incorporates life outside of the workplace as well as inside the workplace (Graham 2000).

Krieger et al. (1997) argue that that the term `socio-economic status', which is used widely in the US and UK literature to refer to social position is itself a hybrid of at least two terms: economic circumstances (income and wealth) and prestige (status). But it is occupation which is the major measure of socioeconomic position in the UK.

Smith et al. (1998) have shown in their study that both individual and area based measures of socioeconomic status may have independent effects on health. The author in this instance makes the point that using single socioeconomic indicators does not give a completely comprehensive description of the degree of health inequalities (Smith et al.1998). The author also recommends that both area based and individually-based socioeconomic data should be collected and considered when investigating health inequalities (Smith et al .1998).

Occupation is the predominant measure of socioeconomic status in the UK (Graham 2000).. The most commonly used individual socioeconomic indicator in British studies is Registrar General's occupational social class (smith et al. 1998). Class I is professional occupations which require educational attainment at University level, for example physicians, lawyers, etc.; Class II consists of intermediate professional and managerial occupations, such as bank managers and school teachers; Class III, consists of skilled workers, and is divided into two strands of skills namely skilled clerical and skilled manual workers; Class IV is semiskilled workers, such as bank clerks, farmers and labourers; and Class V is unskilled workers. (www.jrank.org).

It is important to acknowledge that various dimensions of social inequality for example social and material may contribute to health inequalities in women which in turn have subsequent affects on the risk factors relating to these aspects (Graham 2000).

Trends in the socioeconomic gradient of cardiovascular disease risk factors

Research illuminates a consistent relationship between social inequalities and ill health, to quote Marmot (2004) “Wherever we are in hierarchy our health is likely to be better than those below us and worse than those above us”.

There is a vast amount of evidence supporting the view that low SES women have a higher CVD risk. Steptoe and Marmot (2002) proposed six pathways which theoretically contribute to socioeconomic inequalities in cardiovascular disease risk. One such pathway was health behaviour. This pathway encompasses such factors as diet and smoking. According to various recent publications, women in lower income groups are associated with higher rates of cigarette smoking and lower levels of fruit and vegetables and non-starch polysaccharide fibre consumption, than women in higher income or social groups (Office for National Statistics (2006 & 2008). The link between CVD and obesity has been recognised especially in women in whom it has been estimated that the risk for fatal and non fatal CVD associated with obesity is between 25-28% (Seidell et al. 1996). Lyrathozopoulus et al. 2006 found in their study that the most deprived women had significantly higher levels of each of risk factors measured including blood pressure (both systolic and diastolic), total cholesterol and BMI.

As briefly mentioned previously not only is the decline in CVD death rates slower in the UK compared to other European countries, there also seems to be a widening of the gap in social inequalities between socioeconomic groups as regards CVD rates. O' Flaherty et al. (2002) observed a plateau effect in the decline of death rates from coronary heart disease particularly among young adults in the most deprived groups. The authors comment that this should be taken as an early warning sign. O'Flaherty et al. (2002) suggest that this decline is not due to deterioration of medical care but because of adverse trends in such risk factors as smoking and poor diet. These unhealthy lifestyle behaviours are correlated with low pay, unemployment and low social benefits according to the authors. Those who are most vulnerable to cardiovascular disease risk are those who cannot afford a healthy varied diet including the homeless, large families and single parents (O' Flaherty et al. 2002). These findings support the suggestion by Kelly and Stanner (2003) of the possibility that current prevention policies are not working among these groups. These findings show a clear socioeconomic gradient of cardiovascular disease risk among middle-aged women. Some of the factors which contribute to these inequalities such as occupation, diet and smoking shall now be discussed.

Education and Occupation.

Education or lack thereof has a huge impact on cardiovascular disease risk (Smith et al 1998). This impact may be caused directly through health education or indirectly by determining the type of occupation a person has. The difference in impact of health education on cardiovascular disease among different socioeconomic groups shall be discussed later. Education may influence risk by allowing better employment opportunities therefore consequently earning more income as well as more favourable living conditions (Smith et al. 1998). Occupation has been used as a determinant in cardiovascular risk factors in many areas of the literature for example Smith et al. (1998) found women in the manual social class had higher diastolic blood pressure and BMI, and more ECG ischemia than non-manual women. Cardiovascular disease risk was found by marmot et al. (1997) to be closely linked to employment ranking. This finding was based on the Whitehall II study, a dated yet fundamental piece of research on British Civil Servants in the 1980's.The first of the Whitehall studies in the 1960's showed an inverse social trend in CHD deaths. Those in low grade employment e.g. clerical officers had a mortality rate double that seen in those in high grade employment e.g. administrators. 20 years later the Whitehall II study found that the low grade employment category had an incidence 1.5 times higher than those in high grade employment. This observation is thought to be less to do with the narrowing of social inequalities and more to do with the differences between incidence and mortality rates (Marmot et al. 1997). Marx indicated in his writings that class is not attributed by economic position alone and that it has a social determinant (Gamble et al 1999). Marx believed that those who were in the dominant classes, those who were more educated had more power, exploited the lesser classes or the proletariat in order to gain surplus profit. Thus in other words, those who have lower income are dominated by the higher classes and thus have less quality of life because of the exploitation carried out by the ruling classes (Gamble et al. 1999). This divide in the classes leaves the proletariat earning less income which in turn can affect one's lifestyle choices and their exposure to risk factors of disease and thus can be attributed in part to the socioeconomic inequalities in health.

As discussed earlier, occupation is used to measure socioeconomic status in the UK (Smith et al. 1998). The issue of women's occupation is a topical issue in sociological research and can be discussed using concepts from feminist theories. Traditionally the partner's occupation has been used in classifying the socioeconomic status of women, however this is now changing (Bartley et al. 1999). This is the case due to the more traditional view of women as child bearers and primary caretakers, and the view of males as the workers outside of the home (Giddens 2006). Marxism would view this in terms of capitalism as this concept is the fundamental basis of the thoughts of Marx theory. The Marx view historically saw women as a back-up of labour providers in times when men were not available to work for example during both World Wars (Gamble et al. 1999) The idea of capitalism was based on the need for constantly replenished employees. This type of work, cooking and cleaning, was predominantly carried out by women (Gamble et al. 1999). The traditional Marx view was that this type of work was trivial in the capitalist system. Marxist feminists argue that this work was necessary for the successful operation of capitalism (Gamble et al.1999). The Feminist movement has caused a change in the view towards women in society, and in the methodology in sociology which has been criticised as being biased towards men. For example the Feminist Judith Butler believes that people should be categorized by what they do not by what they are (Giddens 2006).

Thus occupation is an important consideration when carrying out sociological research and has clear implications on the risk of cardiovascular disease as well as other health inequalities among the various socioeconomic groups. A second factor in the risk of cardiovascular disease is diet. This will be discussed in relation to middle ages women in the UK in the next section.

Cardiovascular disease and Diet

Having previously looked at the dietary trends among different SES groups briefly, the aspect of diet and cardiovascular disease in middle aged women will now be examined in more detail as well as a brief discussion as to why these socioeconomic differences exist.

There is a broad consensus that diet has an influence on cardiovascular health (Kelly&Stanner 2003). Dietary guidelines such as eating five or more fruit and vegetables, reducing intake of fat and salt and eating at least one portion of oily fish per week are in line with promoting good cardiovascular health (Kelly & Stanner 2003). It has been estimated that approximately one third of cardiovascular disease can be attributed to an unbalanced diet (Robertson 2001). While more research is needed to support this estimation there is quite a body of evidence on this issue already. Hamer et al. (2009) illuminated the relationship between dietary patterns associated with CVD and socioeconomic status. The authors found that a diet pattern consisting mainly of fast food was the most common in their representative sample of low-income UK adults. The author's reasoning for this finding was due to the much higher density of fast food restaurants in the most deprived areas as well as a lower availability of healthy foods (Hamer et al. 2009). The fast food diet which is high in saturated fat has been established as a factor in the aetiology of cardiovascular disease (Hamer et al 2009). However in this case there was no association found between the fast food dietary pattern and the markers used to assess cardiovascular disease risk. In this study factors measured were systolic blood pressure, Cholesterol and C-reactive protein. Contrastingly the ‘health aware' diet pattern was inversely associated with concentrations of CRP and homocysteine, and positively associated with HDL-cholesterol which is the good cholesterol in the diet (Hamer et al 2009).

A study by Shohaimi et al. (2004) examined the correlation between socioeconomic status and fruit and vegetable consumption. The authors measured socioeconomic status using both individual and area based measures. In this study, the socioeconomic status of women was based on the more traditional method of the partner's social class, rather than their own, which is gradually becoming the more acceptable method. The participants were categorized according to the registrar generals occupation based scheme of social class. The authors found that the consumption of fruit and vegetables showed a statistically significant socioeconomic gradient, with those in the lower social classes consuming less. Those with more education and living in more affluent areas consumed more fruit and vegetables (Shohaimi et al. 2004). Residential deprivation, which was measured using the Townsend deprivation index, was shown to be a strong predictor in those who were from the manual social classes and those without educational qualifications. The average daily intake of fruit and vegetables combined for this population (442 grams per day) was higher than the UK average of 310 grams per day. For women, educational level was the strongest socioeconomic measure independently predicting fruit and vegetable intake; those with no qualifications consuming as much as 30 g less fruit and vegetables per day than those which have achieved at least O levels. This finding is in line with other studies such as Pollard et al. (2001) who found that level of education can have an influence on ones intake of fruit and vegetables. Those classified as having no education in the Pollard et al. study (2001) were more likely to consume the least amount of these foods, which are associated with lowering the risk of cardiovascular disease. While contrastingly those with the highest level of education were more likely to consume more fruit and vegetables. Education level of course has a major influence on occupation as previously discussed and fruit and vegetable consumption categorised by occupation showed similar trends. Women who were classified as “professional” were more likely to consume more fruit and vegetables (Pollard et al. 2001). The author notes that the participants in this study were not a random sample but included vegetarians and vegans who consume larger amounts of fruit and vegetables, and therefore contributes to the high level of consumption found within this cohort. An interesting finding in this study was that smokers were more likely to be in the lowest tertile of fruit and vegetable intake. Clustering of cardiovascular disease risk factors such as smoking and poor diet is something which should be investigated further. Also those who were in the highest tertile of consumption had an overall healthier diet than those in the lowest tertile, with lower average intakes of saturated fat, and higher intakes of carbohydrates, fibre and polyunsaturated fats. It was also illustrated that those who ate quantitatively more fruit and vegetables also consumed the greatest variety (Pollard et al. 2001). The authors comment that this may be a gateway for health promotion strategies in relation to the promotion of alternative varieties of fruit and vegetables as well as teaching cooking methods and changing the way people shop. The authors also highlight that a new approach may be needed in tackling this problem, such as identifying what motivates high consumers of fruit and vegetables.

The results of a survey by the joint health survey's unit (2003) can be seen in table 2.

Women

Managerial&

professional

Intermediate

Small

employers

Lower

supervisory

Routine

None

4

6

6

8

8

Less than 1 portion

2

2

2

3

4

1 portion or more but less than 2

11

16

14

15

19

2 portions or more but less than 3

15

18

19

17

19

3 portions or more but less than 4

16

18

16

18

17

4 portions or more but less than 5

16

16

15

13

12

5 portions or more but less than 6

12

9

10

10

8

6 portions or more but less than 7

8

7

7

6

6

7 portions or more but less than 8

6

4

3

4

3

8 portions or more

9

5

6

6

3

All with 5 portions or more

35

25

27

26

21

Table 1. Fruit and vegetable consumption (Joint Health Surveys unit 2003)

The findings indicate that the socioeconomic group that one is categorized in (based on occupation), has an influence on one's consumption of fruit and vegetables. Patterns of consumption were graded, with a progressively higher proportion of the managerial and professional group eating five or more portions a day in comparison to the semi- routine and routine occupations group.

A recent American study is worth mentioning at this point which has provided interesting findings relating to diet particularly the energy density of the diet and socioeconomic status. It has been established that diets with low energy density are associated with higher dietary quality and are more in line with dietary recommendations for cardiovascular health (Monsivais & Drewnowski 2009). It was highlighted in this study that a low energy density diet is more expensive per 2000 kcal than the higher energy density counterparts Monsivais & Drewnowski (2009) show that socioeconomic status influenced the energy density of the diet with those in the lower socioeconomic groups having a higher energy density diet with higher intakes of total fat and saturated fat and lower intakes of fibre and vitamins A and C, while lower energy density diets in this study were associated with higher nutrient intakes. The mean energy cost of the lowest energy density diets was 41% more expensive than the highest tertile of energy density. The study also found that the energy density of the diet decreased with increasing levels of income. Similar patterns were also observed in educational level. This study did have limitations however as FFQ (food frequency questionnaires) were used which limits the strength of the findings. However using energy density as a means of classifying diet quality is in interesting aspect and more studies comparing the costs as well the trends in varying socioeconomic groups should clarify the association further. One interesting point illustrated by Kelly and Stanner (2003) which affects food intake is the ability of the public to understand healthy eating messages and applying them to their cooking and choices of foods.

Examining the social reasons behind these findings may lead to the development of community based approaches to increase fruit and vegetable intake (Shaoimi et al 2004). Statistics from a survey by the national consumer council (Dibbs et al. 2005) show that unhealthier foods high in fat and sugar have more price promotions in almost all of the supermarket chains analysed in a report by the national consumer council. Those on lower incomes therefore are more likely to buy the fatty sugary foods which are on offer more frequently.

On reflection of these findings, it is my opinion that this issue needs to be considered at a government level as this could have a huge impact on the public's food choices, especially those on lower incomes. The purchasing of cheaper, less healthy foods will have a direct effect on the dietary intakes of the public and therefore affect cardiovascular disease risk. This again can be related to the Marx theory in which there is a belief that the capitalists exploit the working classes. They therefore have less money than those above them in the socioeconomic ranks and cannot afford to buy the healthier more expensive foods, therefore they are once again exposed to more cardiovascular disease risk factors than the higher SES groups (Giddens 2006). It is clear from the above evidence that diet is a risk factor which has graded effects among groups of different socioeconomic status.

Price promotions by supermarket

Asda

Co-op

Iceland

Marks & Spencer

Morrisons

Sainsbury's

Somerfield

Tesco

Waitrose

Food categories

%

%

%

%

%

%

%

%

%

Fruit and vegetables

12

17

15

27

9

16

7

14

22

Fatty and sugary foods

27

37

35

27

29

33

31

35

32

Other foods

62

46

50

46

62

52

62

51

47

Table 1: Price promotions for fruit and vegetable, fatty and sugary foods and other foods at supermarkets in England (Dibbs 2005)

Pollard et al. (2001) found a correlation between fruit and vegetable intake and smoking as mentioned earlier. This is another independent risk factor for cardiovascular disease (Peto et al. 2003) and will the following discussion will examine this in more detail.

Cardiovascular disease and Smoking

Cigarette smoking is another factor which plays a large part in the aetiology of cardiovascular disease. Smoking along with BMI is a modifiable risk factor of cardiovascular disease and is responsible for socioeconomic differences in mortality Graham et al. (2006). It has been illustrated that women in disadvantaged areas make up a large proportion of the smoking population (McFadden et al. 2007). In the UK in the year 2000, 21% of all cardiovascular deaths in women between the ages of 35-69 were attributable to smoking (Peto et al. 2003). This was coincidentally one of the highest rates in Europe. It has been observed that the lower socioeconomic classes are less responsive to public health messages relating to the harms of smoking (Taylor and Field 2007). Taylor and Field (2007) highlight that research on women in low income families with pre-school children often use smoking as a means of managing stress.

*www.heartstats.org

It has been previously illustrated that many circumstances more commonly seen in women of low economic status such as early motherhood and single motherhood increase the chances of smoking thus leading to an increased risk in CVD (Graham et al. 2006). Early motherhood also decreases the odds of quitting more so than the effects of adult socioeconomic status and education (Graham et al. 2006). Graham highlights that working class women have less access to support networks in times of crisis compared to those of higher SES. This again highlights the inequality of the capitalist society as described by marx (Giddens 2006).

Inequalities in Healthcare and Health Education:

As discussed earlier the two most important modifiable risk factors are smoking and poor diet. However not all of the variation in CVD incidence is accounted for by these factors alone (Kelly & Stanner 2003).

Education may improve health related knowledge allowing people to choose healthier lifestyles Smith et al. (1998).

There has been evidence to show that there are inconsistencies in the prescription of lipid lowering medication, with those in the most deprived areas receiving fewer prescriptions for these medications (Livesey 2009). However improvements are occurring presently in this situation. Due to the long time span over which cardiovascular disease develops, it is thought that the issuing of inadequate prescriptions over a period of many years to those living in deprived areas may be one of the reasons why there has been an increase in severity of coronary heart disease in these deprived areas (Livesey et al. 2009). While there have been recent advances in healthcare which has improved cardiovascular disease mortality as mentioned previously, research has illustrated that there are indications that the rate of improvement in coronary artery disease among those living in the most deprived areas is not occurring as fast as in the most affluent areas. It has also been suggested that this discrepancy can also be applied to the aspect of cardiovascular advice as well as treatment. Research has highlighted that patients of different socioeconomic status respond differently to healthcare interventions. For example antismoking advice given to deprived groups resulted in lower rates of quitting when in comparison to the least deprived groups (Lyratzopolous et al. 2009). The inequalities in healthcare are currently being addressed by such strategies as the QOF Quality and Outcomes Framework which was introduced in 2004. This was implemented to reward practitioners for giving high quality care to cardiovascular disease patients (Livesey et al. 2009. It involves procedures such as recording the amount of patients with coronary heart disease who have had their blood pressure taken and how many patients which have controlled blood pressure among other records. This has had a major effect on cardiovascular disease mortality and the latest figures show a 32% reduction in the absolute gap (Livesey et al 2009). This is a very promising development and shows how much a difference sociological research can make in terms of public health. The identification of a problem causing health inequalities such as this has been made possible by investigations into the social reasons behind these inequalities. The implementation of services such as the FOQ shows how inequalities in health can be resolved successfully once the social reasons have been identified.

Relevance to Dietetic Practise

The subject of sociology has a significant role to play in the dietetic profession. Understanding the social reasons behind inequalities in health can help dietitians tailor advice for specific socioeconomic groups. Nutrition related diseases show a socioeconomic gradient and it is the function of sociological research to investigate the reasons behind this. Gaining a better understanding of why people choose the food they do through sociology can help us as dietitians to adapt the healthy eating guidelines into practical dietary advice to best suit the patient. It can also help us examine the effectiveness of current healthy eating advice or strategies currently in place among different socioeconomic groups. Sociological theories can help us explain many issues in society including dietary issues and health inequalities.

It is important to take into account socioeconomic differences when working as a dietitian as it can have a major affect on lifestyle choices including food purchases, cooking facilities, skills and healthy eating knowledge. Sociology can help highlight gaps in social policies and strategies and give guidance on how to implement these within population groups. The importance of health education cannot be underestimated as the public health message can empower the population to make informed choices about their health (Taylor and Field 2007). Sociology can help identify the socioeconomic barriers to health equality and provide a starting point to addressing these barriers in the community. As dietetics is a profession which requires reflective practise, the ability to reflect on public dietetic issues is necessary; the higher risk of CVD among low SES women is just one example of this. Reflective practise helps us achieve long-term solutions by helping us discover the fundamental reasons behind the health problems of the public.

Recommendations

As a result of the findings from the above discussion a number of recommendations have been highlighted. In practice, a clinician can rarely intervene to improve an individual's socioeconomic status in order to reduce their risk of cardiovascular disease (NHS). In light of this the question can be raised: should intervention be on a population based scale rather than an individual basis? A recent meeting of the Department for Environment, Food and Rural Affairs Council of food policy advisors (DEFRA 2009), acknowledged that changing consumer dietary patterns will not come from consumer choice alone. One possible solution suggested was the implementation of welfare measures such as extending fruit and vegetable vouchers to those receiving family tax credits. It was also highlighted that research on how other countries public advise may be beneficial.

Such population level interventions in healthcare as the FOQ have been shown to make huge improvements in CVD mortality rates, while more needs to be done at the prevention stage (Livesey 2009). The public need to be educated on cardiovascular disease and its associated risks. This is particularly true for those in lower SES groups. Another suggestion mentioned in the literature was to examine what motivates the public to buy the foods they do (Pollard et al. 2001). A final strategy suggested was the education of lower socioeconomic groups on cooking, and adding variety to the diet (Pollard et al. 2001 Kelly & Stanner 2003). All of these are reasonable suggestions for the improvement of cardiovascular health, particularly among lower socioeconomic groups. Once the gaps in intervention strategies such as these are identified, the next job is to implement changes within the public. This job must be undertaken by the Government and health professionals together.

Conclusion

Through this discussion the aims previously outlined in the MAP have been achieved. A review of the trends in cardiovascular disease rates has highlighted that the rates have decreased substantially over the last few decades. The improvements are not equal among all socioeconomic groups however with rates in the most deprived groups being 3 times higher than the least deprived groups (www.heartstats.co.uk). Understanding how specific socioeconomic factors might influence lifestyle may lead to more effective interventions to reduce social inequalities in health (Shohaimi et al. 2004). Some of these factors have been discussed here. The research of these lifestyle factors and implementation of intervention strategies will ultimately influence the work of dietitians thus the relevance of this research is substantial for the field of dietetics.


Request Removal

If you are the original writer of this essay and no longer wish to have the essay published on the UK Essays website then please click on the link below to request removal:

Request the removal of this essay


More from UK Essays