The heart of the matter.

Coronary heart disease deaths have declined in New Zealand, as in other Western countries, during the past two decades. This is probably due to a combination of population lifestyle changes and improved treatment of the disease. However, the social class gradient for coronary disease has reversed and it is now more common in lower socio-economic groups who are increasingly disadvantaged in our community. Socioeconomic factors are powerful, primary determinants not only of coronary disease but also of many of the other health problems outlined in the New Zealand Health Charter. Policy making and health services delivery shape societal conditions essential for true health. These factors are considered in relation to the spectrum of human communication and the current transitional changes in our health system.