The pressures of poverty, insecurity and psychological distress may be physically reshaping people’s hearts years before they develop any symptoms, according to a major new study.
Researchers led by the MRC Laboratory of Medical Sciences and Imperial College London analysed data from nearly 480,000 adults in the UK Biobank. The study, believed to be the largest of its kind, examined a blood marker of chronic inflammation alongside heart scans and genetic data.
People with the highest levels of inflammation had a 43 percent greater risk of suffering a heart attack or stroke than those with the lowest levels. This increased risk was found even among people with no previously diagnosed heart disease.
Heart scans also revealed signs of structural damage. People with greater inflammation were more likely to have thickened heart walls, smaller chambers and poorer filling of the heart. These changes can develop quietly for years before progressing into heart failure.
Professor Declan O’Regan, British Heart Foundation Chair of Cardiovascular AI at Imperial College London and Head of the Computational Cardiac Imaging Group at the LMS, said: “Our study, which is the largest of its kind, suggests that millions of people could be living with hidden inflammation, which is slowly changing their heart and causing long term damage – increasing the risk of heart attack and stroke. Chronic inflammation is complicated, but we know it’s tied to our health and driven by a range of lifestyle and economic factors – meaning people may be at more risk just because of their surroundings, their economic status, their family’s health and their lifestyle.”
Chronic inflammation is a prolonged, low-level activation of the immune system. It’s already been linked to conditions including cancer and diabetes, but is increasingly being recognised as one of the mechanisms through which social conditions damage cardiovascular health.
The researchers found particularly strong links between inflammation, socioeconomic disadvantage and psychological distress. Smoking, inactivity and excess body fat were also associated with higher inflammation.
These factors are often separated into “social” problems on one side and individual “lifestyle choices” on the other. In reality, the two can’t be pulled apart so neatly. A worker worrying about rent, debt, insecure hours or losing their job doesn’t experience economic insecurity as an abstract statistic. The strain is carried in the body.
Low wages also restrict access to good food, secure housing, warmth, rest and leisure. Long or irregular shifts leave less time for cooking and exercise. Smoking, alcohol and other forms of relief don’t emerge independently of stressful and alienating conditions. Capitalism first creates the circumstances in which unhealthy ways of coping become more likely, then lectures workers for failing to live healthier lives.
O’Regan said: “The surprising thing was how much social factors and mental health are linked to inflammation and damage to the heart – as well as more well-known risk factors like smoking and inactivity. There was also a strong genetic factor, with some people being naturally more resilient or susceptible to the inflammatory damage that comes from different lifestyles.”
Genetics may affect how susceptible an individual is, but it doesn’t explain why harmful conditions are distributed so unevenly between classes. The wealthy can purchase distance from many of the pressures that wear down the body. They can afford spacious homes, better food, time away from work and rapid access to care. Workers are expected to absorb economic shocks directly, while those who live from property and accumulated wealth are protected from them.
Under capitalism, a worker’s capacity to labour is treated as something to be purchased and consumed by an employer. The cost of restoring that capacity — food, sleep, healthcare, childcare and the work of maintaining a household — is pushed back on to workers and their families as far as possible. When wages and public services fail to meet those needs, the consequences appear as exhaustion, illness and premature death.
Economic insecurity also has a disciplinary purpose. The threat of unemployment, homelessness or destitution pressures workers into accepting worse conditions. The same insecurity that helps capital hold down wages may also be producing lasting inflammation and damage to the heart.
Engels described the predictable premature deaths created by such conditions as social murder. The point wasn’t that a single employer personally causes every illness. It was that the ruling class maintains a social order it knows exposes workers to conditions that shorten their lives. Modern medical imaging is now showing in extraordinary detail how that process can become embedded in the organs themselves.
The study identified inflammatory proteins belonging to the interleukin-1 and TNF families as possible drivers of the changes. Some are already being targeted by drugs in clinical trials. Researchers believe that combining inflammation tests with genetic risk scores could eventually help identify people who would benefit from treatment before symptoms appear.
Such treatments could save lives, but they can’t abolish the conditions producing the damage. An anti-inflammatory drug can’t make an insecure job secure, lower a person’s rent or give an exhausted worker more control over their time. Medicine can interrupt part of the biological process without touching the social relations that set it in motion.
The danger is that poverty is medicalised while its causes are left undisturbed. Individuals can be tested, classified and treated while the economic system responsible for their repeated exposure to stress disappears from view. Health inequality is then presented as a technical problem of identifying vulnerable bodies rather than a class relation between those protected by wealth and those forced to sell their labour to survive.
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: “Inflammation is part of the body’s healing process, but there is also a darker side to it. This large-scale study found people with higher levels of inflammation experienced silent changes to the structure of their hearts and had a higher risk of major cardiac events including heart attacks and strokes.”
The study doesn’t show that everyone exposed to poverty or psychological distress will develop heart disease. Nor does it mean that smoking, physical activity and other individual factors are irrelevant. It identifies a biological pathway through which social conditions may combine with those factors and with genetic susceptibility to produce lasting harm.
Britain is one of the richest countries at the centre of the imperialist world economy. Yet within it, millions may be living with hidden inflammation while enormous wealth is accumulated by a small owning class. The same social order that produces abundance for capital produces insecurity, distress and shortened lives for the workers whose labour sustains it.
Class inequality isn’t confined to differences in income or consumption. It can become a difference in the structure of the heart itself.
