In Canada, cardiovascular disease is the second leading cause of death (cancer is number one) and is the leading cause of hospitalization (Government of Canada, 2019). Physiological events that lead to heart disease and its progression include: diabetes, hypertension, obesity, smoking, and high cholesterol (Government of Canada, 2018). But what about the other factors? How does ones environment, community and government affect their health? Using a multi-level model approach, we will examine a few contributing factors that are beyond the individual and affect the occurance of heart disease. The following video is an introduction to issues that affect an individual’s health:
Using the above multi-level model of health, lets break down the interpersonal, organizational, community and policies that affect cardiovascular health.
Interpersonal
Psychosocial factors affect cardiovascular health as much as diet, exercise, health habits and physical inactivity. In a study performed by Valtora et al., poor social relationships were associated with a 29% increase in heart disease and a 32% increase in risk of stroke (2016). Another study by Manrique-Garcia et al, revealed three indicators that led an individual to an increased risk of cardiovascular events: 1) income 2) occupation and 3) education (2011). Combined, these studies revealed that poor socioeconomic status and psychosocial support predisposes an individual to an increased risk of heart disease. This can be demonstrated through a lack of family, friend, provider or patient navigator support as demonstrated by the multi-level model.
Organizational
Prevention is key when it comes to cardiovascular disease. When preventative measures were not implemented, researchers in the United States predicted a hospitalization cost of $173.7 billion during 2017-2021 (American College of Cardiology, 2018). The United States currently report that 40 million adults have uncontrolled hypertension, 54 million adults smoke cigarettes that could benefit from smoking cessation and 71 million adults are not physically active (American College of Cardiology, 2018). These numbers demonstrate a gap in public health programs that educate the public about cardiovascular risks and preventative measures. They may also be affected by poor or nonexistent healthcare coverage and a deficiency of family physicians to provide preventative education and healthcare.
Community
With the aforementioned study published by the American College of Cardiology, the Centers for Disease Control (CDC) and Medicare/ Medicaid Services promoted the Million Hearts initiative (2018). This initiative lobbies the American government to provide funding to agencies and healthcare providers and systems for cardiovascular health maintenance and prevention (American College of Cardiology, 2018). The Government of Canada also recognizes and provides funding to prevent these issues in Canada. Many programs in North America promote physical activity and healthy eating among the public and among employers and their employees (ParticipACTION program and occupational health nursing are examples). The government also provided Universities with increased funding for the training of physicians and nurse practitioners to provide the public with more primary care options. The College of Nurses of Ontario oftentimes takes to the media to lobby and promote healthcare needs to the government and the public to raise awareness of health issues as identified by trends and nurses.
Policy
The Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada ascertained that advancements in the prevention and management of cardiovascular disease have reduced cardiovascular episodes and events in the recent years. Cardiovascular disease used to be the leading cause of death in Canada, but has now become the second leading cause of death (2018). This report recommends prevention by targeting minority or at-risk populations (African, Indigenous, etc) by targeting lifestyle risk factors through increasing funding at the provincial and federal level (Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada, 2018). The government is increasing mental health funding to address the contributing psychosocial factors to cardiovascular disease. The Heart and Stroke Foundation is imperative to education and research and is available online to millions of Canadians. Health care providers also receive recommendations and screening targets from the Heart and Stroke Foundation to screen the public for potential heart disease and to intervene early on. The Canadian government also releases reports occasionally that details cardiovascular disease prevalence, causation and prevention as obtained through death certificates, physician billing numbers and statistics.
Overall there are many areas to continue to build and improve upon to increase access of healthcare to Canadians. What would you recommend?
Heart of Health Policy: CDC: Staggering Number of CV Deaths and Hospitalizations; Million Hearts Offers Solutions For Health Care Providers and Systems (October 19, 2018). American College of Cardiology. Retrieved from https://www.acc.org/latest-in-cardiology/articles/2018/10/14/12/42/heart-of-health-policy-cdc-staggering-number-of-cv-deaths-and-hospitalizations-million-hearts-offers-solutions-for-health-care-providers-and-systems
Manrique-Garcia E, Sidorchuk A, Hallqvist J, et al
Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis
Journal of Epidemiology & Community Health 2011;65:301-309.
Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada, 2018. Public Health Agency of Canada, 2018. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-heart-disease-Canada-2018.html#s2-3
Valtorta NK, Kanaan M, Gilbody S, et al
Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies
Heart 2016;102:1009-1016.
What Health Professionals Need To Know About Heart Disease and Conditions (2019). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/diseases/heart-health/heart-diseases-conditions/for-professionals-heart-diseases-conditions.html
Comments