Social Class and Cardiovascular Disease
S. Leonard Syme University of California-Berkeley
We are at a crisis stage in the study of psychosocial factors and cardiovascular disease (CVD). Over the last 40 years, researchers in this field have generated a large and impressive body of data on many psychosocial risk factors. Unfortunately, the field operates in a theoretical vacuum. No agreed-on conceptual model or theory exists in epidemiology to guide either our research or the interpretation of findings that have been generated. As a result, the field of psychosocial epidemiology consists of a series of seemingly unrelated findings on a variety of seemingly unrelated topics.
One explanation for this problem is that we have never agreed on the central focus of our work in this field. Is the purpose of our research to explain why some groups have higher rates of disease than other groups? Or is it to explain why one person gets sick while another does not? Or is it to explain why one person gets sick with one disease while another succumbs to another disease? Each of these questions is important, but the research to answer them all involves different training, research instruments, technology, and language. Anyone who has attended an interdisciplinary meeting knows how difficult it is to communicate with people who are asking fundamentally different questions and who do not explicitly recognize this difference. These interdisciplinary meetings tend to become multidisciplinary meetings. We seem to be talking about the same things, but we are not. In nursery school children, we call this parallel play. Like nursery school children, we often meet in the same room and talk about the same topics, but, essentially, we each do our own thing. My task in this chapter is to discuss findings regarding social class. I do this in a way that is amenable