1Key Social Determinants Related to Cardiovascular Disease (CVD)BY JEANRUTH ALBANOBENEDICTINE UNIVERSITY1/18/2015

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Graphic to portray the social determinants of health that surround an individual and population. Retrieved January 18th 2015 from https://epianalysis.wordpress.com/2011/07/14/sdhcalculations/

3The Relevance of Social Determinants Social inequalities in health are not improving and cardiovascular diseases

affect women and certain ethnic groups disproportionally. Otherwise unexplainable spikes in CVD incidence nationally and globally after

rapid social change point to related determinants as the only probable cause. While diseases of the cardiovascular system are caused by a complex interplay

of contributing risk factors ranging from genetic disposition to lifestyle and nutrition there are also many forcefully related, typically overlooked, social determinants to consider from infancy to adulthood.

Psychological stress has been scientifically linked to the cause of stroke and the development of CVD risk factors such as hypertension and atherosclerosis.

Low education, low income, unemployment, high general stress, etc. are all significantly related to the development of cardiovascular risk factors. New research displays that not only do these determinants have a direct casual link to traditionally recognized clinical risk factors but also a direct effect on the onset and management of CVD itself.

(Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012)

4Main Categories of Social Determinants Related to CVD

In an article titled, Social Determinants of Cardiovascular Diseases (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012), published in Public Health Reviews, four key determinants related to CVD were identified and discussed. The authors provided sound, supportive evidence for the determinants with reference to multiple renowned studies pertaining to health and cardiovascular disease.

The 4 Main Determinants Related to CVD: Professional Context Social Relationships and Isolation Geographic Environment Ethnicity

(Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012)

5Social Determinant: Professional Context Stress at work.

(Interheart) A large international case-control study in 2004, with almost 25,000 participants in 52 countries, determined that chronic occupational stress is a significant indicator for cardiovascular mortality an morbidity (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012).

Stressful work situations were associated with a mean 2.7 increased risk of myocardial infarction and contributed to 35% of the population attributable risk.

(ORSOSA) In a hospital based study of 3,837 nurses and nursing assistants diastolic blood pressure, but more significantly systolic blood pressure was associated with poor relationships between coworkers (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012).

The findings are consistent with other studies which display ‘conflicts’ at work leading to higher incidence of CVD.

Unemployment/Job Insecurity Unemployment and inconsistent employment (internships, by-commission, seasonal work, etc.)

has well observed effects on the cardiovascular system. Numerous studies show dramatic increases in CVD within organizations that experience staff cuts.

One study in Finland (1993-2000) analyzed the effects of staff cuts across multiple companies in 4 towns. There was a 50% increase in CVD when there was 18% or lower staff reductions and 100% increase in CVD when there was greater than 18% staff cuts.

(Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012)

6Social Determinant: Isolation Research shows that social isolation significantly increases the risk of death by myocardial infarction

(Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012). Isolation has negative cardiovascular effects for women, but more specifically men when observing

mortality rates. There are multiple points of measurement within this determinant and the degree to which it affects

CVD is more accurate when considering all potential factors of social integration rather than just binary measurement, as in, simply whether someone lives alone or not. Extensiveness of social network

Number of friends, potential contacts, family members, work colleagues, classmates, etc. Emotional support Financial support Encouragement to seek medical care

According to a longitudinal study in New Zealand using an entire birth cohort of 1037 children, from birth to age 26, those who experience social isolation early in life have a significantly higher risk of cardiovascular disease and other health problems later in adulthood. These findings are independent of other clinical risk factors and poor lifestyle behaviors (Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R, 2006).

7Data tables illustrating the results from the New Zealand Longitudinal Study

Retrieved January 18th 2015 from http://archpedi.jamanetwork.com/article.aspx?articleid=205331#poa60020t3

(Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R, 2006)

8Social Determinant: Geographic Location Scientific links between CVD, hospitalizations or mortality and fluctuations in

atmospheric pollution, relating to the ozone layer, sulphur dioxide, carbon monoxide, and nitrogen dioxide have been well documented (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012).

Availability of ‘green space’, where one lives is a major determinant of cardiovascular health (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012). Provides a place outdoors to be physically active Trees, and any other plants and shrubbery contributes to oxygen quality

Population distribution is reflected through socio-economic status (Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012). Low income residents typically live in the most highly polluted areas due to

property costs. In the short term, low temperatures also have cardiovascular effects (Lang T, Lepage B,

Schieber AC, Lamy S, Kelly-Irving M, 2012). The inability or ability to sufficiently heat one’s home during cold weather is a

determining factor. Homeless people, living in geographic regions that experience extreme winter

conditions and are exposed daily to environmental pollutants of a city are obviously at high risk for myocardial infarction and other cardiovascular events.

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“Outdoor air pollution is a silent killer of millions of people worldwide each year.”Quote & Graphic by Su Song/EMBARQNovember 20 2014Data from WHORetrieved January 18th 2015 fromhttp://thecityfix.com/files/2014/11/China-death-air-pollution-heart-disease.jpg(Song S, 2014)

10Social Determinant: Ethnicity Published studies in the US

and globally establish clear links between SES, ethnicity, discrimination and poor heart health Specifically hypertension &

institutional racism in the United States

The 1999 Health Survey for England displayed highest rates of heart disease and stroke for Indian men age 55 and older.

SES is an important predictor of cardiovascular health within ethnic groups.

(Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M, 2012).

Prevalence of cardiovascular disease among women, separated by ethnic group.2014 Heart Disease & Stroke Statistical Update from the American Heart Association.Retrieved January 18th 2015 from https://circ.ahajournals.org/content/129/3/e28.extract#cited-by

11LOGIC MODEL FOR CVD SOCIAL DETERMINANTS PREVENTION

Processes Outcomes

Assumptions/Contextual Factors: The success of this logic model is dependent upon the assumption that funds for community surveillance through quantitative and qualitative research will be available, as well as funding for the development of the programs to address the assessed social determinants related to CVD. The most important contextual factor is the willingness of participants for community surveillance and the staffing of these social determinant prevention programs, whether through paid employment or volunteer work. The positive short and long term outcomes of such programs are also under the assumption that their efforts are effective and successful.

StaffVolunteersFundingResources

Community surveillance of social determinants related to CVD.

Organization and development of programs to address, target and eliminate observed social determinants of CVD.

Accurate view of how social determinants are affecting the prevalence of CVD on the population level.

Programs allow the ability to address the CVD related determinants in the community.

The overall prevalence of CVD is reduced due to the reduction of related social determinants.

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The CDC’s logic model for CVD prevention from the CDC Division for Heart Disease and Stroke Evaluation Guide.

Retrieved January 17th 2015 from http://www.cdc.gov/dhdsp/programs/nhdsp_program/evaluation_guides/docs/logic_model.pdf

13References American Heart Association. (2014). AHA Statistical Update. Heart Disease and Stroke Statistics-2014 Update. [Graph

illustration depicting prevalence of women with cardiovascular disease, organized by ethnic group]. 129: e28-e292. Published online before print December 18, 2013. Retrieved January 18th 2015 from https://circ.ahajournals.org/content/129/3/e28.extract#cited-by

Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. (2006). Socially Isolated Children 20 Years Later: Risk of Cardiovascular Disease. Arch Pediatr Adolesc Med.160(8):805-81. [Data tables displaying results of longitudinal study]. Retrieved January 18th 2015 from http://archpedi.jamanetwork.com/article.aspx?articleid=205331#poa60020t3

Centers for Disease Control and Prevention. Evaluation Guide. CDC Division for Heart Disease and Stroke. State Heart Disease and Stroke Prevention Program. [Graphic of logic model for the CDC heart disease and stroke prevention program]. Retrieved January 17th 2015 from http://www.cdc.gov/dhdsp/programs/nhdsp_program/evaluation_guides/docs/logic_model.pdf

Commission on Social Determinants of Health (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission of Social Determinants of Health. Geneva, World Health Organization. Retrieved on January 16th, 2015 from http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf

EpiAnalysis. (2011, June 14). How many Americans die from racial segregation? About 176,000 a year. Social Determinants of Health. [Graphic to visualize surrounding social determinants]. Retrieved January 18th 2015 from http://epianalysis.files.wordpress.com/2011/07/determinants_of_health.jpg?w=500&h=336

Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M. (2012). Social determinants of cardiovascular diseases. Public Health Reviews. 33:601-22. Retrieved January 17th 2015 from http://www.publichealthreviews.eu/upload/pdf_files/10/00_Lang.pdf

Quarells RC, Liu J, Davis SK. (2012, June 1). Social determinants of cardiovascular disease risk factor presence among rural and urban Black and White men. J Mens Health. 9(2):120-126. Retrieved January 17th 2015 from http://www.ncbi.nlm.nih.gov/pubmed/22902779

Song S. (2014, November 20). China’s clean air challenge: The health impacts of transport emissions. The City Fix. Embark. [Graphic depicting deaths related to outdoor air pollution-breakdown by disease]. Retrieved January 18th 2015 from http://thecityfix.com/files/2014/11/China-death-air-pollution-heart-disease.jpg