The African American population within the US makes up the largest minority group. This group is majorly concentrated in the southern states more so than in the urban areas. The major health issues that lead to hospitalization among this faction of the population is cardiovascular diseases. The risk of dying as a result of heart disease is very high among the African American population than any other racial groups. Cardiovascular disease is a broad term used to describe heart diseases that include High blood pressure, stroke, atherosclerosis, heart failure among others. This paper discusses health promotion intervention for the African Americans in the US through detailing: the description of the population; description of cardiovascular disease as the health Issue; related statistics; description of intervention proposed; why the proposed intervention is the best route; recommendations to government for policy changes; and recommendations to individuals.
Description of the Population
Rastogi, Johnson, Hoefel, and Drewery, (2011) notes that as per the 2010 census, the American population was estimated to be above 308 million but out of that total population, 38.9 million were African Americans. Additionally, 3.1 million individuals were reported to be a mixed race of African Americans and other ethnicities. Rastogi, et al., (2011) adds that the population of African Americans in the US grew from 12% in 2000 to 13.3% in 2015. In 2000, the population of African Americans was 34.7 million.
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According to United States Census Bureau, (n.d.), the African American population in the US as of 2015 was estimated to be 46.5 million. The figure translates to about 13.3% of the entire American population. However, the African Americans population keeps on growing steadily as other Africans migrate into the US. Of the black people, one-third of those in the rural areas live below the poverty line. That figure represents 34% of the rural African Americans population. For those residing in the countryside, fewer health services are available. 12% of the African Americans as compared to 10% of the whites live in the rural areas with the US. A majority of the Counties occupied by the African Americans also have 6.2 physicians for every 10,000 population. Centre for Disease Control and Prevention, (2016) states that among the African Americans, the Birth rate per 1,000 women ranging between 15 and 44 years is 64.5. The percentage of all ages for black Americans in poor or fair health conditions is 13.5%. 22% of total African American population were found to be smoker between 2012 and 2014. However, for women of 18 years of age and above, only 14.6% were linked to cigarette smoking. Regarding their health, between 2011 and 2014, 40.9% of men aged 20 years or older had hypertension. Similarly, the percentage of women aged 20 years and above who suffer from hypertension was found to 44.8%. Further, among the African Americans, 13.5% of those under age 65 have no health insurance cover. Based on these analysis, it is evident that the main root of deaths among African Americans is heart diseases, followed by cancer and stroke in that order.
Description of the Health Issue
Cardiovascular disease is a term used to define a series of conditions that affects the heart. The conditions under the cardiovascular disease umbrella include arteriosclerosis, heart problems, and congenital heart flaws among others. The phrase is often applied interchangeably to refer to the heart diseases. The following are types of cardiovascular diseases: coronary heart disease which occur due to reduced movement of blood rich in oxygen to the heart. When such a condition occurs, the heart experiences an increased strain, which normally result in Angina, heart attacks, or heart failure. The second is stroke and TIAS. A stroke emerges when the supply of the blood to the parts of an individual’s brain is cut off. Consequently, the condition may result in the face drooping to one side, numbness or weakness on a person’s arm or leg, slurry speech or inability to talk at all. Additionally, there is the peripheral arterial disease, which occurs when an artery to the limbs is blocked. The condition can cause cramping leg pains, hair loss or persistent ulcers on the feet or legs. Finally, there is the aortic disease which results from a group of conditions that may affect an individual’s aorta.
Cardiovascular diseases can be brought about by many factors: the first is high blood pressure. It is also referred to as hypertension and can damage one’s blood vessels. The second is smoking. The harmful substances in tobacco like nicotine can cause narrowing of the blood vessels, thereby destroying them. The third is high cholesterol. It refers to the fatty substances found in blood. When the cholesterol levels are elevated in the blood, they can cause narrowing of the blood vessels, leading to a blood clot. The fourth is diabetes, which is a lifelong condition and causes one’s blood sugar to be high. The condition can also narrow one’s blood vessels. The fifth is overweight or simply obesity. A BMI of 25 and above is a huge risk factor for cardiovascular disease. Others may include family history in cases where one's parents could have been diagnosed with cardiovascular disease before they were 55 years old (Go, Mozaffarian, Roger, Benjamin, Berry, Borden, & Franco, 2013).
Cardiovascular heart diseases are indeed the leading cause of death amongst African Americans (Lloyd-Jones, et al., 2010). Nonetheless, some of the heart diseases can be treated or managed while others have no cure and can only be managed. Coronary heart diseases can be controlled effectively by combining lifestyle changes and medicine. Also, in some cases, surgery may be necessary in restoring one’s health. Doctors may prescribe some of these options, which may reduce the symptoms of heart diseases and increase the heart functionality. Life changes like smoking cessation will reduce an individual’s risk of having a heart attack. Medicines are also available, and physicians may prescribe them to a patient to reduce blood pressure or widen one’s arteries. Some of the medicinal prescriptions may include anti-platelets which lessen the risk of heart attack; statins for those with high cholesterol levels to help lower them; Nitrates to widen one’s blood vessels and ACE inhibitors that treat high blood pressure among others. Surgeries include coronary angioplasty for those with angina and coronary artery bypass graft for patients whose arteries have become narrowed and blocked. In extreme cases where the heart has failed, a heart transplant may be necessary.
Related Statistics
According to Centre for Disease Control and Prevention (2016), about 610,000 persons die of heart-related diseases in the US each year. The figure represents one in every four deaths that occur in the US. For both Men and women, heart diseases are the major cause of mortality. Coronary heart disease is the leading cardiovascular disease that causes death in the US. About 750, 000 Americans suffer a heart attack every year. However, the situation is direr among the African American ethnicities. According to Go, et al. (2013), among the African Americans, 44.4% of 20 years or older men and 48.95% of women suffer from cardiovascular illness. In 2009, Cardiovascular claimed the lives of about 46,334 and 48,070 males and females respectively all of them coming from the African American ethnicity. However, by 2011, the overall death rates in the US for cardiovascular disease was 236.1. in the same period, the death rate for the African Americans was approximated to be 267.9 and 387.0 for the females and males respectively.
A statistical breakdown of some of the specific diseases that constitute cardiovascular diseases reveal the much information about the suffering of the black community. According to Go, et al. (2013), among the African-American population of 20 years and above, 6.8% of men and 7.1% of women all suffer coronary heart diseases. Also, 3.9% and 2.3% of men and women correspondingly have been victims of myocardial infarction. The death rates as a result of coronary heart disease in the US in 2009 was 116.1. Comparatively, for the African American ethnicities, it was 181.1 for males and 110.3 for females. Additionally, among the African American ethnicities of 20 years old and above, 4.7% and 4.3% of females and males respectively have been victims of stroke. Of the same population, 47.0% of women and 42.6% of men suffer from high blood pressure. In 2009, the overall mortality rate as a result of high blood pressure in the US was 18.5 while among the African Americans, the rate was above 50.0 for males and above 38.3 for females.
Among some of the cause of cardiovascular diseases are smoking, stress, physical inactivity, and feeding the habit. According to American Heart Association (2013), in 2011, 23.3% of males and 15.1% of females of the African American ethnicity smoke a cigarette. On blood cholesterol and other lipids among the 20 years and above African Americans, men recorded 38.6% and women 40.7% on aggregate blood cholesterol levels of 200 mg/dL or higher. Also, 10.8% of men and 11.7% of women have 240 mg/dL and above. Further, 33.1% of men and 31.2% of women recorded LDL cholesterol of 130 mg/dL and above (American Heart Association, 2013).
Also, African American communities have registered a reduced number of physical exercises. Go, et al. (2013) established that African Americans have the highest prevalence of inactivity registering at 26.7% in 2011. In African American families, the prevalence of girls who watch television for 3 or more hours a day is 54.9%. However, for boys, it was 54.4%. Regarding overweight and obesity, the data on African American communities also showed a worrying trend. Of the African American communities, 36.9% of boys and 41.3% of girls of between 2 and 19 years are obese or overweight. For those who are 20 years and above, 68.7% of men and 79.9% of women are obese or overweight. On diabetes prevalence, 13.5% of men and 15.4% of women among the African American communities have diabetes. On pre-diabetes, 35.7% of men and 29.0% of women of age 20 and above have all been diagnosed with pre-diabetes conditions. In 2009, the overall death rate as a resulting of diabetes in the US was 20.9. However, for the African American communities, the death rate stood at 44.2 for males and 35.9 for females.
Description of Intervention Proposed
So as to address the high cardiovascular disease prevalence and its effects among the African American population, it is prudent to give an intervention that ensures immediate action on what is already known. The paper proposes a behavioral strategy for cardiovascular risk reduction among the African American ethnicity. The program focuses specifically on the African-American ethnic minority to address cardiovascular disease as a principal source of deaths in the United States. Therefore, the program focuses on health communication as its main component of the intervention.
Perceived susceptibility: despite published data showing the effectiveness of both secondary and primary prevention of cardiovascular disease risk factors, the African Americans ethnicity achievement of risk reduction has been very minimal. Consequently, they have become susceptible to cardiovascular diseases. Achieving the risk reduction will mean reduced death as well as disabilities resulting from cardiovascular disease. The behaviors that increase the risk factors include poor diet, physical inactivity, and smoking, among others.
Perceived severity: due to lack of adequate communication on the behavioral causes of cardiovascular diseases, the African American communities continue to engage in the risk behaviors that increasingly exposes them to the disease. The rates of cardiovascular deaths are far too high, raising the federal statistics.
Presided benefits: the benefits of the behavioral strategy for cardiovascular risk reduction among the African American ethnicity will be to inform on the risk behaviors that make them susceptible to cardiovascular diseases. The African American Communities require the best knowledge from the program to empower them with information on the preventive measures they could take to protect themselves from cardiovascular diseases. Prevention is better than cure, and since the disease has no cure, the best would be to prevent individuals from getting it. The positive effect of the program will be reduced the number of people affected by cardiovascular diseases leading to reduced mortalities as a result of the same.
Perceived barriers: a behavioral strategy for cardiovascular risk reduction among the African American ethnicity as a program will address the barriers related to access to information on risk factors for cardiovascular disease. So as to ensure the message is home, volunteers shall be recruited to be part of the program and reach out to the African-American ethnicities especially those in rural America. Volunteers will help in ensuring communication materials like posters as well as fliers for organized meetings and conferences reach the target group.
Cues to action: once the information has been passed to the African American communities, trained professionals will be dispersed to conduct training and conferences on behavioral strategy for cardiovascular risk reduction. There will be an emphasis on the need to have a behavioral change as a preventive measure for the cardiovascular disease. The trained professionals will also engage the use of social media to reach out to their audiences in their bid to promote awareness of the risk factors. Thy will also emphasize change towards a healthy lifestyle.
Self-efficacy: the behavioral strategy for cardiovascular risk reduction among the African American ethnicity as a program will further train trainers who will lead the program for continuity. The trained trainers shall educate the rest of the public who inform their peers, hence, creating a ripple effect. They will consistently address the importance of behavior change in dealing with the high prevalence of cardiovascular diseases among the African American communities.
Health communication is crucial in bringing about behavior change to the target population. Even in cases where the ideal policy environment is lacking, the health communication efforts have demonstrated effectiveness in encouraging community behavior change.
The communication intervention will target behaviors like smoking, physical activity, nutrition. On smoking cessation, the program shall combine a culturally tailored cognitive behavioral counseling with tobacco cessation medication. The program will include the use of health care providers to achieve smoking cessation in most of the population. On physical activity and dietary intake, cognitive and behavioral techniques shall deliver the best outcome. Individuals will receive counseling to modify how they view situations, appraise the meaning of such cases and make decisions regarding them. Overall, the behavioral strategy for cardiovascular risk reduction among the African American ethnicity as a program will engage partners from the health care providers to the community health workers to achieve a positive outcome.
Why this Intervention is the Best Route
From the related statistics discussed above, the prevalence rate of pre-disposing factors for cardiovascular disease are very high among the African American communities. They include obesity prevalence which is the highest in the US surpassing the federal statistic by a huge margin. The pre-obesity prevalence is also very high. Consequently, it is evident that obesity is one of the major factors contributing to high rates of cardiovascular diseases and mortality among the African Americans. The data also details a high rate of physical inactivity. The majority of the African Americans spend more than three hours watching television, and their rate of physical inactivity is greater than the required for healthy body. On dietary or nutritional health, it is also evident that the African Americans record very high cholesterol concentration in their blood. This finding is an indicator of poor feeding habit based on a wrong choice of diet. Another behavioral factor is smoking where 23.3% of males and 15.1% of females from African American communities partake of (American Heart Association, 2013). From smoking to diet, physical inactivity and obesity, it is a clear indication that the high prevalence of cardiovascular disease among the African American community is majorly a behavioral issue more than anything else. Therefore, to give an intervention, there has been an approach that targets behavior change. The behavioral strategy for cardiovascular risk reduction among the African American ethnicity as a program is the best route since it offers a cognitive behavioral technique that seeks to communicate the best practices aimed at preventing the problem. The program involves providing a wealth of information to the African Americans to stir a behavior change that includes smoking cessation, healthy dietary take, increased physical activity and overall weight check.
Recommendations to Government for Policy Changes
The government should develop an awareness program targeting those who are highly exposed to risk factors among the population. Effective public health intervention on preventing cardiovascular disease depends on the level of the information available to the public (U.S. Department of Health and Human services & Centre for Disease Control and Prevention, n.d). Information that leads to preventive actions/ behaviors is the best in addressing the health problem. Ensuring availability of the information will lead to an informed public regarding the cardiovascular risk factors, which in turn will make efforts to reverse their community-acquired behaviors. Without effective communication to ensure preventive measures are taken by the public there will be a huge cost to be met by both the government and the public in treating the burden of these conditions.
The government should transform the public health infrastructure so as to provide leadership and ensure partnerships that will facilitate the implementation of the proposed actions. In the prevention of cardiovascular diseases, there is an array of partners that the government can bring on board. The preventive measures cut across different disciplines and involve health workers, teachers, nutritionists, and physiologists among others. Developing an infrastructure for partnership and providing leadership will enable the various stakeholders in this health issue to come together towards a solution. For instance, teachers should provide the information on the good dietary uptake for student, need for physical exercise among others that can be taught in school. On the other end, community health workers can be used to provide information at the community level and ensure that the community takes the initiative to prevent cardiovascular diseases.
Strengthen the capacity of the public health agencies to ensure they can have the required competencies to address the cardiovascular problems at early stages. All the public health agents at both federal and local levels need to be strengthened so that they have adequately equipped laboratories for adequate testing. There should also be enough skilled human resources to handle the cardiovascular disease as well as robust health data system to ensure monitoring and evaluation of the intervention programs undertaken (U.S. Department of Health and Human services & Centre for Disease Control and Prevention, n.d).
The government should create training opportunities, and offer model standards for cardiovascular disease prevention including making the consultation support a continuously available service to the public. The health issue demands robust strategies and interventions that can only materialize from practical training and continuous consultation. The situation of the African American in regards to cardiovascular diseases is dire. Consequently, the government should take advantage of the training available through partnerships to ensure that the at-risk individuals benefit from its interventions.
The government should define the criteria for group health data sources. Individuals suffer from different kinds of diseases. For instance, in this case, the African Americans are having the highest prevalence of cardiovascular disease. Expanding the sources of health data for the various groups enables close and adequate monitoring of the interventions and changes in such groups.
The government should emphasize the roles played by arteriosclerosis as well as high blood pressure in cardiovascular diseases. There is a need for research on the cardiovascular disease pattern, causes, and causal relationships. The cultural, social or environmental determinant should be well researched and the information transmitted to the health system to inform decision making in the medical practice.
Work with both local and global partners in developing preventive measures that will see a reduced level of cardiovascular morbidity and fatalities. Partnerships ensure sharing of information and skills that may lead to better care and prevention of health issues. The government should build partnerships with other agencies that have an experience in prevention and care of cardiovascular disease to enable them compare notes and improve on its efforts as per necessary.
Recommendations to Individuals
To the individuals, there is a need for one to understand the causes of cardiovascular disease as the beginning point. Modification of behavior is the key to keeping one safe from the disease. Among the recommendations include keeping away from smoking, eating a balanced diet, engaging in regular physical exercise to keep fit and healthy (Schneider, Grim, Rainforth, Kotchen, Nidich, Gaylord-King, & Alexander, 2012). The recommendations and backing evidence are as follows:
The citizens must be advised to keep off cigarettes or cease smoking for those who are in the habit. Smoking cessation has a beneficial effect on coronary heart disease mortality. Ten years of smoking cessation could result in reducing coronary heart disease to that of an individual who has never smoked at all.
People should watch their diet. Since the cardiovascular effects of fats and cholesterol are in the diet. It is prudent for one to watch their dietary uptake carefully. Saturated fats often raise individual’s cholesterol levels. Also, when a person engages in a high intake of fat, they increase their uptake of saturated fats. Individuals can opt to replace saturated as well as trans-unsaturated fats with monosaturated or polyunsaturated fats for it is useful in the prevention of coronary heart disease. Additionally, fish based fats can be beneficial in reducing the risks of cardiovascular morbidity or mortality in patients. Therefore one should consider consumption of fish in their diet. Still keeping with the diet, Individuals should watch their consumption of dietary salt as it has been associated with high blood pressure. The efficacy of reduced salt intake in lowering blood pressure is indeed a proven strategy. Further individuals should increase uptake of fruits and vegetables in their diets. Fruits and vegetables reduce cardiovascular disease risks through providing antioxidants and micronutrients. As such a cardio-preventive or cardio-protective diet should aim at a good overall dietary uptake, healthy body weight, and a desirable blood pressure.
Individuals should engage in regular physical activity to keep fit and stay healthy. Lack of adequate physical activity has been widely responsible for a third of death due to coronary heart diseases (American Heart Association, 2013). In both men and women, studies show that physical activity in leisure contributes to low cardiovascular risk. Engaging in physical activity will enhance an individual’s endothelial function improving vasodilation, and vasomotor functions of vessels. However, sedentary life is associated with increased cardiovascular risk levels.
Individuals should watch their weight to prevent obesity or overweight. There is a direct correlation between overweight and obesity to cardiovascular morbidity. Obesity causes various cardiovascular risk factors like type 2 diabetes, high blood pressure, and glucose intolerance. Individuals should engage in weight loss programs that can reduce significantly their weight especially those in the pre-diabetes stage.
People should avoid stress, social isolation, and anxiety. Studies show that social isolation, stress, depression, and anxiety are a cause for high cardiovascular risks (Schneider, Grim, Rainforth, Kotchen, Nidich, Gaylord-King, & Alexander, 2012). Also important is for individuals to check their blood pressure, avoid too much consumption of alcohol and other risk factors that could be psychological or behavioral to prevent cardiovascular disease.
Conclusion
Cardiovascular disease is a main cause of deaths all over the world. Despite the rate being high in the U.S, it is the African Americans who are hugely affected. The disease is one of the chief causes of premature death among the African American communities. Also, it is a primary cause of disabilities. Arteriosclerosis is one of the underlying pathologies often developed over an extended period only presenting symptoms at a very late stage. Coronary heart diseases have no cure and can only be managed. It can be managed effectively by combining lifestyle changes and medicine. Also, in some cases, surgery may be necessary. Doctors may prescribe some of these efforts may reduce the symptoms increasing the heart functionality. Some of the medicinal prescriptions may include anti-platelets, used to decrease the risk of heart attack, statins for high cholesterol levels, Nitrates to widen one’s blood vessels and ACE inhibitors for high blood pressure among others. Modification of the risk factors has been shown to reduce both morbidities as well as the fatality of victims of cardiovascular diseases.
This paper has discussed health promotion and intervention for cardiovascular diseases as a multicultural health issue affecting the African American communities. It details that, cardiovascular disease is a broad term used to describe usually used to describe heart conditions that include High blood pressure, stroke, atherosclerosis, heart failure among others. Cardiovascular diseases can be brought about by many factors like high blood pressure, smoking, cholesterol, diabetes, and overweight or simply obesity. Cardiovascular heart diseases is indeed a leading cause of death amongst African Americans. Also, African American communities have registered the highest prevalence of inactivity, overweight and obesity, diabetes prevalence, pre-diabetes conditions and high cardiovascular morbidity and fatality. The paper recommends a behavioral strategy for cardiovascular risk reduction among the African American ethnicity, includes awareness creation to prevent cardiovascular diseases. The intervention is route because it tackles the gap of information, a problem that has made the African American communities be exposed to high-risk factors. The program creates awareness on smoking cessation, dietary uptake, physical activity and obesity to propose a behavioral change. This discussion gives recommendations to government for policy changes. Some of the policies include capacity building, the formation of partnerships and collaboration, improve research, training, and developing health data for monitoring interventions. Further, the paper put more emphasis on the roles played by arteriosclerosis as well as high blood pressure in cardiovascular diseases. Also, it offers model standards for cardiovascular disease prevention including making the consultation support a continuously available service to the public and among others. Finally, the paper gives recommendations to individuals which include weight check to prevent obesity, smoking cessation or complete avoidance, regular exercising to keep fit, proper dietary uptake and blood pressure checking as well as avoidance of stress, anxiety and social isolation. The recommendations are made for cardiovascular risk factors management to protect and prevent the individuals from the cardiovascular disease.
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