title: Coronary heart disease, chronic inflammation, and pathogenic social hierarchy: a biological limit to possible reductions in morbidity and mortality.
abstract: 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".
authors.affiliation: New York State Psychiatric Institute, USA. rdwall@ix.netcom.com
authors.forename: Rodrick
authors.initials: R
authors.lastname: Wallace
authors.forename: Deborah
authors.initials: D
authors.lastname: Wallace
authors.forename: Robert G
authors.initials: RG
authors.lastname: Wallace
mesh_terms: D000069:Acculturation; D001741:Black or African American / Q000208:ethnology / Q000235:genetics; D002490:Central Nervous System / Q000276:immunology; D002908:Chronic Disease; D003327:Coronary Disease / Q000208:ethnology* / Q000235:genetics / Q000276:immunology; D006608:Hierarchy, Social; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000208:ethnology* / Q000235:genetics / Q000276:immunology; D011287:Prejudice; D012641:Selection, Genetic; D035503:Sociobiology; D012962:Sociology, Medical