Beyond medicine and lifestyle: addressing the societal determinants of cardiovascular disease in North America

Increasing evidence is accumulating that biomedical and lifestyle factors account for rather small proportions of population variance in incidence of cardiovascular disease (CVD). In North America, however, the medical and public health communities – reinforced by narrow media coverage focused on biomedical and lifestyle issues – remain wedded to these models of cause and prevention. Not surprisingly, public perceptions of the causes of CVD mirror these preoccupations. A review commissioned by a community heart health network brought together the evidence of how CVD results primarily from material deprivation, excessive psychosocial stress, and the adoption of unhealthy coping behaviors. The review has served to help shift thinking about CVD prevention in Canada and the USA.