Blood Pressure Differences between Societies

Henry and Cassel (1969) noted that the observation that there are mean blood pressure differences between societies goes back at least to the 1930s. There are a number of papers appearing in the medical literature in the 1950s and 1960s that provide descriptive data on mean blood pressures and the distribution of blood pressure by age and sex in societies dramatically different from the industrial societies that were home to the researchers. Implicitly, and even sometimes explicitly, comparisons were uncritically made between, for example, foragers such as the Hadza of Africa and data from the United States and Europe. Typically, researchers were surprised by two results. First, mean blood pressures were usually found to be much lower in the "traditional" society than in a "modern" society like the United States. Second, rarely were blood pressures observed to increase with age or to differ between genders in the traditional societies, while in modern societies increasing blood pressure with age and differences between men and women (that change with age) were the norm.

With accumulating studies of this kind, in the late 1970s Ingrid Waldron and her associates (Waldron et al., 1982) were able to collate over 80 different studies of blood pressure, and to link characteristics of the communities studied with data from the Human Relations Area Files. A number of interesting results emerged from this exercise. First, community mean blood pressures increase along a continuum of sociocultural complexity, with societies arrayed according to the familiar sequence of foraging, pastoral, horticultural, agricultural, and industrial modes of adaptation. Second, the increase of community mean blood pressures is not smooth and linear along this continuum; rather, there is a sharp increase in mean blood pressure between horticultural and agricultural societies, which then stays high in industrial societies. And third, controlling for community average levels of obesity does not alter the pattern, which is consistent by age and sex as well. It is unlikely that these patterns are artifacts of differences between observers in the measurement of blood pressure, since such differences would be more likely to obscure patterns rather than produce them. Furthermore, these differences are not an artifact of treated cases, since measurements were carried out on (at least roughly) representative samples of the communities.

The work of Waldron and associates probably represents the most convincing evidence for societal differences in disease risk.

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