Fatalism and short‐termism as cultural barriers to cardiac rehabilitation among underprivileged men

Abstract

Cardiovascular diseases are a leading cause of death and disability in Canada, and individuals of low socioeconomic status appear particularly vulnerable to such disorders. Although many health-related institutions have promoted cardiovascular health and have created cardiac rehabilitation programmes, they have not attained their desired outcomes, especially amongst socioeconomically deprived men. Drawing on Pierre Bourdieu's sociocultural theory, this qualitative study aims to understand the social mechanisms underpinning the lifestyles and health practices of men who had suffered a cardiovascular incident requiring hospitalisation. In all, 20 interviews were conducted with francophone men aged 40 to 65 years living in the province of Qu ebec, Canada. The analysis strongly suggests that the respondents' living conditions and disease were significant obstacles to their adoption of a healthy lifestyle. Their despair and pessimism, apparently originating in the harshness of their financial realities, physical limitations and social networks, led them to believe that they could do little to control their lives, thereby limiting the fulfillment of any long-term ambitions. Therefore, the adoption of a habitus characterised by fatalistic and short-term perceptions of health influenced their lifestyle choices, leading them to maintain lives that were in stark contrast with the recommendations made by health promotion experts.Keywords: Bourdieu, lifestyle, rehabilitation, men, social class Many studies have documented the link between social inequality and health. While research on this subject is abundant, many specific questions remain on the connection between socioeconomic conditions and lifestyles. Drawing chiefly on Pierre Bourdieu's social cultural theory of practice, this qualitative study focuses on fatalism and short-termism as key considerations involved in the adoption of 'unhealthy lifestyles' by underprivileged francophone men who had suffered a cardiovascular incident requiring hospitalisation. While these attitudes have a bearing on health, they have yet to be applied together in an empirical study on lifestyle dispositions. It is argued here that social and material deprivation do not provide individuals with many incentives to adopt recommended forms of cardiac rehabilitation; through a combination of increased concern for short-term necessities and reduced perceptions of self-control over health, low socioeconomic status appears to compromise an individual's personal investments in future health and wellbeing.

Lifestyle as a choice of necessity: Young women, health and obesity

“…For instance, socioeconomically disadvantaged groups often experience a perpetual sense of urgency to respond to immediate needs such as food, shelter and employment (Miller and Brown, 2005;Hankivsky, 2007). They are characterized by a strong present-time orientation (short-termism) and weaker preventative attitudes; living close to economic necessity reduces the ability to invest in future health whereas more affluent socioeconomic groups have greater latitude in this regard (Boltanski, 1971;Dumas and Bournival, 2011;Savage et al, 2013). Indeed, social epidemiologists have presented a growing and convincing body of data linking social and material deprivation with ill-health at the population level, thus bringing attention to upstream social determinants of health (that is, income level, housing quality, job security, early life circumstances) over an exclusive focus on individual (biological) characteristics and lifestyles (Raphael, 2009;Braveman et al, 2011).…”

Low control beliefs in relation to school dropout and poor health: findings from the SIODO case–control study

“…[1–4]). Control beliefs can be defined as a person’s belief that he or she is able to actually perform a (desired) action or behaviour (self-efficacy) and the belief that his or her actions matter for outcomes and events (mastery) [5].…”

“…Some have labelled low control beliefs as powerlessness or “socialised fatalism” [6]. The latter emphasises the embedding in the socioeconomic environment [4, 7]. Low income hampers the number of available options; control over what to purchase is thus restricted.…”

Cardiovascular Health Among an Underserved Population

“…Lowest adherence to cardiovascular medications is highest among marginalized groups. 13,14 In a Canadian study looking at cultural barriers to participation in cardiac rehabilitation programs, Savage and colleagues 15 identified that although there is universal health care, there is a 5.4-year difference in life expectancy of men of lower socioeconomic status compared with men of highest socioeconomic status, with an 8.4-year difference in women in the same comparison groups. The investigators concluded that participation in cardiac rehabilitation and making healthy lifestyle choices are socially sensitive matters.…”

“…The investigators concluded that participation in cardiac rehabilitation and making healthy lifestyle choices are socially sensitive matters. 15 Because socioeconomic status is such a key determinant of health status, it must be addressed in the context of improving cardiovascular health. There are many barriers to deal with in an underserved population that make it challenging to achieve the previously identified cardiovascular metrics.…”