PART 1
Effects of Population Health Determinants on Cardiovascular Disease
Population health management is a new concept that has gained significance in influencing health policy and programs. The urgency with which this new discourse is approached stems from the understanding that over 49 million Americans are uninsured and almost half (45%) of Americans suffer from at least one chronic condition. The initiative to establish the correlation and association between major components of health outcomes, health determinants, and policies is critical to revolutionizing the healthcare industry. One area in which such initiatives are needed is in the management of cardiovascular diseases (CVD), which is classified by the Center for Disease Control and prevention (CDC) to be among the top 10 public health issues affecting Americans. Based on a population health framework developed by Kindig, Asada, and Booske (2008) health determinants directly impact health outcomes in the management of population health issues.
Access to health care is critical directly impacts the prevention, treatment, and management of CVD and a significant number of people with limited access to medical care are likely to have exacerbated outcomes because of delayed diagnosis hence delayed intervention of CVD development and progression. Individual behaviors such smoking, exercise, and eating habits have been empirically determined to contribute to the development and progression of CVD. Individual behaviors act as predisposing factors for instance eating habits are correlated to high incidence of obesity, a precursor of CVD.
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The social environment can be argued to influence other population health determinants and can increase the risk of CVD significantly. Income, education level, and occupation contribute to ease or lack of it in access to helpful information which influences access to medical care. Variation in these factors among population segments is responsible for health related disparities in the management of CVD. The physical environment especially the built environment which includes physical infrastructure that make up communities also contributed to the prevalence rates of CVD. For instance, the presence or absences of public parks due to poor planning can limit of enhance exercise trends in the community hence contribute to variation in the risk of developing CVD. Availability and absence of road networks can impacts access to health care services hence contribute to variation in access to management of CVD. Genetics is responsible for the variation in risk of CVD as evidence has shown different population groups to have different prevalence rates due to their genetic make-up.
One can argue that the most impactful determinants of population health in CVD are access to health care, individual behavior, and genetics. Access to health care is of more significance because it incorporates other elements including social factors and physical environment. Individual behavior can increase the risk of developing CVD independent of other population health determinants. Similarly, genetics, which is the most impactful of the three is independent and is major risk factor, especially given that unlike others, it cannot be controlled.
The Roles of Epidemiological Data
The study of the incidence, distribution, and control of CVD is a major public health concern issues. The significance of CVD among policy makers has reached record high levels as prevalence rates continue to rise. According to Kelly and Fuster (2010), progressive knowledge of how the trends in CVD change over time is crucial to understand the evolution of CVD causes and their impacts. The global mortality rates from CVD are lowest in industrialized countries and parts of Latin America; while the highest rates are incident in Eastern Europe and low and middle income countries. The World Health Organization and the American Heart Association posit that CVD is the leading cause of death in the US and globally. The latest data indicates that CVD are responsible for approximately 801,000 deaths annually, an average of 1 in every 3 deaths. On average, 2,200 Americans die of CVD daily, representing 1 death every 40 seconds. The situation presents an immense challenge to population health management as an approximated 92.1 million adult Americans live with some form of CVD. Prevalence rates are high among black adults with nearly equal rates between males and females. As a result, annual direct and indirect costs in lost productivity and expenditure for CVD are estimated at $316 billion (American Heart Association & American Stroke Association, 2017).
According to Santulli (2013), CVD are the leading cause of preventable deaths worldwide, hence the need for strategies to improve lifestyle, control related risk factors, aid in the prevention of its incidence. Population health determinants play a significant role in aiding the development of effective policies needed to address the challenges and realize positive outcomes in the management of CVD. The process has been assisted with hard evidence in form of epidemiological data that has helped policy makers in developing care and management plans based on emerging annual trends. The data is also crucial in prioritization of target populations as population health determinants have been established to contribute to variation in severity of CVD among populations.
References
American Heart Association & American Stroke Association. (2017). Heart disease and stroke statistics 2017 at-a-glance. Retrieved 14/06/2017 from: https://www.heart.org/idc/groups/ahamahpublic/@wcm/@sop/@smd/documents/downloadable/ucm_491265.pdf.
Kelly, B. B., & Fuster, V. (Eds.). (2010). Promoting cardiovascular health in the developing world: a critical challenge to achieve global health . National Academies Press.
Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083. Santulli, G. (2013). Epidemiology of cardiovascular disease in the 21st century: updated numbers and updated facts. J Cardiovasc Dis , 1 (1), 1-2.
PART 2
American Heart Association posits in its fact sheets that the prevalence of CVD among Non-Hispanic black age 20 or older is 44.4% in men and 48.9% in women. The percentage of people at risk of coronary heart disease or myocardial infarction increases with age at levels higher than those in the general population. Therefore, the question worth asking is: “What are contributors to the high prevalence of risk factors for CVD among black American populations?” In reference to the management of CVD, Winston Gandy, a cardiologist and chief medical marketing officer with the Piedmont Heart Institute in Atlanta and a volunteer with the American Heart Association posited: “Get checked, then work with your medical professional on your specific risk factors and the things that you need to do to take care of your personal health” (American Heart Association, 2015).
However, the situation is not as straight forward as depicted by Gandy’s answer. According to Adler and Stewart (2010), many cohorts of the population bear a disproportionate burden of disease, an outcome that empirical evidence has linked to existence of racial and ethnic disparities. The theory linking socioeconomic status and health has shown over time, the correlation between improvement in education, income, occupation, or wealth with better health outcomes. The theory is corroborated by the findings in Braveman, Cubbin, Egerter et al. (2010) that people with the least income and least educated were consistently unhealthy, a trend that was also observed across socioeconomic classes. For instance, people with medium income and education were also found to be less healthy than the most wealthy and educated. One ca argue that historical injustices and inequalities that limited access of blacks to education, and thus wealth played a significant role in contributing to the high prevalence of CVD among this community based on the theory. It is not a coincidence that black Americans are 2 or 3 time more likely to die from CVD than white Americans. Employment of Kindig, Asada, and Booske (2008) framework shows that genetics is of little significance under the context, implying that other modifiable population health determinants play a critical role in influencing the outcomes of CVD.
However, the role of socioeconomic disparities as the leading cause of racial and ethnic disproportionate disease burden has been refuted by evidence from the surveys of health practitioners. According to Yancy, Wang, Ventura et al. (2011) only about one third of cardiologists acknowledged the existence of racial or ethnic health disparities, evidence that has been found to be consistent with data from other health care providers. It leads to a question of whether health disparities are creations of historical racial and ethnic injustices that have influenced negative attitudes of black Americans towards health care systems. Evidence from Betancourt, Green, Carrillo et al. (2016) and Yancy, Wang, Ventura et al. (2011) highlights the role of sociocultural factors and the need for frameworks to address issues such language barriers, cultural perceptions and attitudes, and other racial or ethnic related factors in a bid to improve cultural competency of the health care system.
References
Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: meaning, methods, and mechanisms. Annals of the New York Academy of Sciences , 1186 (1), 5-23.
American Heart Association. (2015). African-Americans and heart disease, stroke. Retrieved 15/06/2017 from: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp#.WUIgoYyGO00.
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: what the patterns tell us. American journal of public health , 100 (S1), S186-S196.
Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports .
Yancy, C. W., Wang, T. Y., Ventura, H. O., Piña, I. L., Vijayaraghavan, K., Ferdinand, K. C., & Hall, L. L. (2011). The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo). Journal of the American College of Cardiology , 57 (3), 245-252.
PART 3: Developing an Advocacy Campaign
Description of CVD and the Most Affected Population
For almost a decade, cardiovascular diseases have been ranking as the leading cause of death in the US ahead of different types of cancer and chronic lower respiratory disease which complete the top three. According to Santulli (2013), arterial hypertension, tobacco smoking, and household air pollution from solid fuels were identified as the leading risk factors in the global burden of disease. Using Kindig, Asada, and Booske (2008) framework, it can be identified that these are elements of the five population health determinants, hence their significance in CVD. However, the prevalence rate of CVDs varies across populations in the US despite a disparities based assertion that a person race or ethnicity should not be a risk factor for CVD.
The American Heart Association posits that prevalence of CVD among racial or ethnic minorities higher and so are related risk factors. Aged-adjusted death rates for CVD among black Americans are 33% higher than in the overall population. The risk of stroke and the likelihood of dying from stroke is twice as high among blacks than whites. Blacks affected by CVD are likely to die earlier than expected and the most virulent risk factors are associated with them. Non-Hispanic black Americans have a higher prevalence rate high blood pressure, higher prevalence of diabetes, and a higher rate of obesity. The evidence corroborates the need for advocacy campaigns in tackling CVD in this population, especially given the disparities in cardiac care quality among racial or ethnic minorities.
Summary and Analysis of Advocacy Campaigns in Selected Articles
Jørgensen, T., Capewell, S., Prescott, E., Allender, S., Sans, S., Zdrojewski, T., ... & Volpe, M. (2013). Population-level changes to promote cardiovascular health. European journal of preventive cardiology , 20 (3), 409-421.
In this article, Jørgensen, Capewell, Prescott et al. recognize the significance of CVD and need for working measures to address is incidence and prevalence. The article shares damning statistics on epidemiology of CVD, and is crucial in corroborating the state of CVD worldwide. The researchers and authors of the article posit that the 1.8 million preventable and premature deaths in Europe due to CVD can be avoided through the most efficient and cost-effective strategies at the community level. The advocacy campaign in this article seeks to equip relevant authorities with relevant knowledge for selection of effective strategies for managing CVD. The article advocates for emphasis on modifiable CVD risk factors including food, physical inactivity, alcohol, and smoking, which are influenced by some of the population health determinants in Kindig, Asada, and Booske (2008). Jørgensen, Capewell, Prescott et al. (2013) argue that changes in the society and commercial influences play a significant role towards the present unhealthy environment where individual lifestyles are defined by default options that increases the risk of CVD.
The article challenges relevant authorities to ensure measures for adoption of healthy defaults. Jørgensen, Capewell, Prescott et al. (2013) present a paradigm shift in the discourse of CVD management from the population based preventive measures that are fiscal such as taxation, regional and national policies smoke free legislation, and environmental changes in the form of alcohol availability. The new advocacy campaign places emphasis on addressing the complex area of food through strategies that increase intake of fruits and vegetables while lowering the intake of salt, fats, and fee sugars that increase the risk of CVD. There is need to regulate local availability of alcohol and tobacco products as well as changes in national policies and physical built environment to integrate physical exercise into lifestyles.
One can argue that the advocacy campaign proposed in the article captures many determinants of population health corroborating the importance of the new framework in the development of CVD management strategies. However, it is imperative to address some of the root causes contribute to high prevalence of CVD in the selected population. Access to health care, behavioral changes, social factors, and physical environment can be transformed through elimination of socioeconomic disparities that have come to be associated with the black American community. New advocacy campaigns must show the will to shift from the management of existing CVD cases to a prevention based approach that can be achieved through dissemination of information, but through tangible development to empower the most at risk populations socially and economically and increase their choices of healthcare plans.
Zoghbi, W. A., Duncan, T., Antman, E., Barbosa, M., Champagne, B., Chen, D., ... & Logstrup, S. (2014). Sustainable development goals and the future of cardiovascular health: a statement from the Global Cardiovascular Disease Taskforce. Journal of the American Heart Association , 3 (5), e000504.
Unlike the previous article whose advocacy campaign is at community level, Zoghbi, Duncan, Antman et al. examined the possibility of such a plan that can be effective in a global scale. The need for a global health policy that can transform millions of lives is paramount. This article specifically highlighted the rare opportunity presented to the membership and volunteers across the health sector to convince international stakeholders to devote resources into curbing the rise on non-communicable diseases including CVD. The advocacy campaign was targeted at the UN convention set to debate and decide on sustainable development goals of 2015 and beyond. Zoghbi, Duncan, Antman et al. (2014) emphasized on the need for political backing amidst advocacy for collective approach towards the prevention and management of CVD in a bid to lower mortality and morbidity and improve health.
One can argue that this advocacy campaign was instrumental in the launch the new initiative to curb the incidence and prevalence of CVD globally. In 22nd September of 2016, the WHO and global partners launched “Global Hearts,” as the new initiative, an outcome of the UN General Assembly. The WHO (2017) posits that through use of Global Hearts initiative, it is possible to management CVD in communities and countries. Emphasis is placed on populations at high risk through early diagnosis and treatment by strengthening primary health care services. The assertions are an outcome of evidence-based data that shows the US and Finland have been able to reduce CVD in men by 40% and 80% respectively. It implies Global Hearts, which comprises of a new set of evidence-based policy (SHAKE) for backing government initiatives; a package that gives countries technical tools for incorporation of CVD management practices in primary health care (HEARTS); and a set of practical, affordable, and achievable measures for control of tobacco use (MPOWER), proves to be an effective strategy for tackling the epidemiology of CVD in the most at risk population such as black Americans.
However, despite the effective of Global Hearts initiative, major challenges face the adoption and implementation of the initiative in low income and developing countries. The lack of political will at national level is compounded by the missing acknowledgement of CVD as a growing global health burden by global stakeholders responsible for funding coordinated implementation of health programs in such settings. The importance to establish the capacity to adopt and successful implement Global Hearts initiative is a must. Low income and developing countries face significant hurdles as they do not have sufficient evidence-based data to inform changes in policy. Therefore, advocacy campaign should focus on drumming up the need for research to establish the significance of CVD and elicit the political will at national level before incorporation of aspects of Global Hearts initiative into the primary health care level.
References
American Heart Association – Advocacy Department. (2017). Bridging the gap – CVD health disparities. Retrieved 14/06/2017 from: https://www.heart.org/idc/groups/heartpublic/@wcm/@hcm/@ml/documents/downloadable/ucm_429240.pdf.
Jørgensen, T., Capewell, S., Prescott, E., Allender, S., Sans, S., Zdrojewski, T., ... & Volpe, M. (2013). Population-level changes to promote cardiovascular health. European journal of preventive cardiology , 20 (3), 409-421.
Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083.
Pearson, T. A., Palaniappan, L. P., Artinian, N. T., Carnethon, M. R., Criqui, M. H., Daniels, S. R., ... & Goff, D. C. (2013). American heart association guide for improving cardiovascular health at the community Level, 2013 Update. Circulation , CIR-0b013e31828f8a94.
Santulli, G. (2013). Epidemiology of cardiovascular disease in the 21st century: updated numbers and updated facts. J Cardiovasc Dis , 1 (1), 1-2.
World Health Organization. (2017). New initiative launched to tackle cardiovascular disease, the world’s number one killer. Retrieved 14/06/2017 from: http://www.who.int/cardiovascular_diseases/global-hearts/Global_hearts_initiative/en/.
Zoghbi, W. A., Duncan, T., Antman, E., Barbosa, M., Champagne, B., Chen, D., ... & Logstrup, S. (2014). Sustainable development goals and the future of cardiovascular health: a statement from the Global Cardiovascular Disease Taskforce. Journal of the American Heart Association, 3(5), e000504.
