Intergenerational Heart Health: A Case of Unfathomable Inequity

2025

Authors

Berning, H., McGowan, R., Smith, S., Cotter, J., Reihana, K., Bullen, C., Matthews, K., Burton, N., Daniels, N., Roxburgh, B., Davies, L., Rolleston, A.

Abstract

Background

Westernisation exposes cardiovascular systems, en masse, to stressors that constrain cardiovascular health, use resource-intensive interventions, and comprise the leading cause of death. Indigenous knowledge and perspectives are concurrently marginalised, yet important for decolonisation and valuing intra- and inter-generational equity and sustainability. An enormous yet ignored consequence of this focus on individuals’ autonomy and longevity jeopardises the heart health (and existence) of unfathomably more lives. Therefore, the aims of this project were to 1) develop and critique representative cases of current and future lives to display how the environment impacts their heart health, and 2) use this evidenced extent of inequity to identify the changes required for intergenerational equity.

Methods

Six cases were developed, based upon New Zealand Treasury’s Living Standards Framework for population wealth, and were evidenced using publicly-available data for the heart health categories that aligned almost directly with the Framework’s four pillars (human capability, social cohesion, natural environment, and physical and financial capital). Cases were normalised for relative population size.

Outcomes and Implications

Aim 1: The six cases - within and between themselves - illustrate the enormity of heart health inequity propagating intra-generationally and inter-generationally. For example, today’s heart-health environment contributes in multiple ways directly and indirectly to humanity living outside most planetary boundaries and jeopardising heart health of potentially >10,000 times more future people’s lives (based on the timespan of a typical species).



Aim 2: Changes required for an equitable future include honouring Te Tiriti o Waitangi and incorporating the Living Standards Framework in policy processes. Finally, reflective questions were developed that intend to support the initial application across disciplines of the six cases.

Publication Link

https://www.heartlungcirc.org/article/S1443-9506(25)00372-5/fulltext