Abstract

This study places social disparities in the major non-communicable chronic diseases within their global economic and historical contexts. Rapid economic transition outside the developed world provides a unique opportunity to re-examine the origins of, and biological mechanisms driving, social disparities. Gaps in prevailing theories focusing on material resources, civic infrastructure and social structure are identified. Using longstanding experimental evidence and epigenetic theories, it is suggested that exposure to economic development over generations (ie, improved living conditions over historical time) could by acting on different biological axes (somatotrophic and gonadotrophic) generate specific patterns of social disparities. Moreover, these same processes could initially generate a transient epidemic of diabetes as well as a permanent increase in male risk of premature ischaemic heart disease. As such, this study demonstrates the importance of context, and implies that current evidence from the developed world may be largely uninformative for preventing or mitigating social disparities in non-communicable chronic diseases elsewhere, suggesting research efforts should be focused on developing countries.