Capitalizing on Crisis: How the Medical Establishment, Food Industry, and Government Agencies Shaped America's Heart Disease Epidemic, 1948-1985

Abstract

The recognition of coronary heart disease as an epidemic, national health emergency in the late 1940s in the United States created a series of overlapping crises within and across the health sciences, agricultural, and government. Embedded within these crises was the inability of heart disease researchers to reach consensus about appropriate ways to intervene in the disease, including whether diets low in saturated fats and cholesterol and high in polyunsaturated fats would help prevent heart disease. Uncertainty around the efficacy of dietary change amongst the health sciences community prompted the development of stakeholders in the dietary prevention concept. Stakeholders from the health sciences, agricultural, and government spheres capitalized on this uncertainty and inter-related crises in order to profit from coronary heart disease, whether through gaining access to research funding, by positioning themselves as respected authorities on health and disease, or by staving off government regulations of their practices, products, or public communications. In using coronary heart disease as a means to individual ends, stakeholders in these spheres ultimately forced a reconceptualization of the epidemic. Initially understood as a complex, multi-causal disease entwined within broader socio- cultural circumstances, by the mid-1980s heart disease was commonly framed as the consequence of personal choices. The reframing of coronary heart disease as an individual rather than public health issue prevented serious, coordinated efforts to stop the disease and contributed to a broader American ethos that private industry, rather than government organizations, should be involved in managing public health emergencies.