Coronary heart disease, chronic inflammation, and pathogenic social hierarchy: a biological limit to possible reductions in morbidity and mortality

Details Coronary heart disease, chronic inflammation, and pathogenic social hierarchy: a biological limit to possible reductions in morbidity and mortality Coronary heart disease, chronic inflammation, and pathogenic social hierarchy: a biological limit to possible reductions in morbidity and mortality

2003-11-25

arxiv.org/abs/q-bio/0311034v1

Biology

Quantitative Biology

Neurons and Cognition

10 pages, 1 figure. In press, J. Nat. Med. Assn

Scientific paper

We suggest that a particular form of social hierarchy, which we characterize as 'pathogenic', can, from the earliest stages of life, exert a formal analog to evolutionary selection pressure, literally writing a permanent developmental image of itself upon immune function as chronic vascular inflammation and its consequences. The staged nature of resulting disease emerges 'naturally' as a rough analog to punctuated equilibrium in evolutionary theory, although selection pressure is a passive filter rather than an active agent like structured psychosocial stress. Exposure differs according to the social constructs of race, class, and ethnicity, accounting in large measure for observed population-level differences in rates of coronary heart disease across industrialized societies. American Apartheid, which enmeshes both majority and minority communities in a social construct of pathogenic hierarchy, appears to present a severe biological limit to continuing declines in coronary heart disease for powerful as well as subordinate subgroups: 'Culture', to use the words of the evolutionary anthropologist Robert Boyd, 'is as much a part of human biology as the enamel on our teeth'.

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