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Health Impact Framework/Research Paper

Cardiovascular Disease

Rodricka D. Richardson

Delaware Technical Community College

NUR 310 Global Health

April 23, 2019



As noncommunicable diseases take the lead in causing death around the globe, cardiovascular

disease has raised particular concern. It is now the leading cause of death around the world and

particularly impacts low to middle income countries, with the poor carrying the highest burden.

Cardiovascular diseases have many risk factors, several of which are behavioral and preventable

with adequate education and treatment. However, other factors, such as socioeconomic status,

education, location and access to healthy food choices and healthcare, play a major role in both

individual and population wide health. In order to address this, the World Health Organization

and other global health groups have developed numerous interventions to help prevent, detect

and provide early treatment of cardiovascular disease on both individual and population wide

levels. The challenge is overcoming the financial, individual, population wide and political

barriers in order to implement the necessary changes to combat the cardiovascular global burden

of disease.

Health Impact Framework/Research Paper

Cardiovascular Disease

With the advancement of how humans understand health, the causes of disease and

biology, there have been great strides made in reducing disease in many areas. Vaccinations,

antibiotics and other advancements in treatment and prevention measures, have minimized the

incidence of communicable diseases. However, while deaths as a result of communicable

diseases have decreased, there has been an increase in deaths as a result of non-communicable

disease (Nascimento, Brant, Moraes & Ribeiro, 2014). With this shift, cardiovascular diseases

(CVD’s) are one of these non-communicable diseases that have become a global health concern.

Presently, CVD is the leading cause of death around the world (World Health Organization

[WHO], 2017). Cardiovascular disease is an umbrella term for many types of heart and vessel

related illnesses. According to WHO, cardiovascular diseases are a group of disorders of the

heart and blood vessels; this includes diseases such as coronary heart disease, and peripheral

arterial disease (2017). Cardiovascular diseases have had a significant impact around the globe.

It is estimated that in 2016, 17.9 million people around the world died as a result of CVDs; in

other words, 31% of all deaths were a result of CVD’s (WHO, 2017). While the global CVD

burden of disease is concerning, it is important to know it is not spread evenly amongst all

countries or groups.

The percentage of deaths that result from CVD or complications of CVD are worrying.

However, global CVD mortality rates in some areas have been improving (Mendis, Puska, &

Norrving, 2011). Specifically, this change has occurred in high income countries (HICS), which

appears to be a result of a decrease in tobacco uses and improvements in treatment; however, this

progress has not been made in low- to middle-income countries (LMIC) (Mendis et al, 2011).

The burden of disease falls onto the populations in LMIC’s more than it does in high income

countries. Presently, low- and middle-income countries are impacted the most by CVD’s and the

deaths that occur in these countries make up three quarters of global deaths (WHO, 2017). The

poor from certain ethnic backgrounds and regions and the young are particularly affected

(Nascimento et al, 2015). In these countries where the individual and government financial state

is lower, the populations face several barriers that increase the risks for morbidity and mortality.

Individuals located in LMIC’s face many barriers to prevention and treatment of CVD’s

and CVD related deaths. There is a general understanding that lack of income can impact every

aspect of life on an individual level. For some groups, fresh fruit and vegetables can quickly

become too expensive and paying for medications and care may be a decision that makes one

unable to pay for other things needed in the household. On a government level, if the country

itself does not have adequate income, it may struggle to provide all citizens with what they need.

Individuals located in low- and middle incomes countries do not have access to care that

identifies people with risk factors for CVD and detection and treatment measures (WHO, 2017).

If people in these low to middle income countries already have some form of CVD, the lack of

access to healthcare that would otherwise help them manage and treat the disease leads to late

detection that results in death at younger ages (WHO, 2017). If the groups impacted are the

poorest in LMIC’s, the access gap widens, and outcomes worsen. The poorest of these countries

are the groups most impacted, due to high cost of treatment and, at times, lack of access to

equitable and accessible care (WHO, 2017). Poorer individuals unfortunately face many barriers

and factors as a result of their socioeconomic status that put them at higher risk that other groups.

Impoverished communities and societies do not always have access to quality education

or food in addition to quality healthcare. Level of education and CVD have been shown to be

inversely associated; when education is increased, cardiovascular disease incidence decreases

and the reverse is also true (Dégano et al, 2017). Impoverished individuals and families may not

have the ability to even complete primary education let alone secondary education due to the

need to have all able bodies working to provide income or access. Without adequate education,

these high-risk populations may be simply ignorant on how to make better health choices when,

increasing their risk even further. Also, when a member of the family falls ill, labor is lost and

couple with the cost of treatment or hospitalization, this can place a heavy financial burden on

the family unit. The cost of the impact of this non-communicable disease does not only impact

the individual and familial finance status. On a large scale, the economies of low- and middle-

income countries are negatively impacted by the high cost of CVD’s (WHO, 2017). Reducing

the impact of CVD’s in LMIC’s is a target of the Sustainable Development Goals (SDGs) set by

the United Nations General Assembly and it addresses multiple aspects of CVD risks and causes.

The steps taken to decreasing incidence of CVD will require actions and interventions

that can address multifactorial causes. Many CVD risk factors are behaviors that can be changed

on an individual level, such as smoking and diet modification. According to WHO, most CVD’s

can be avoided by focusing on behavioral risk factors such as unhealthy diet, obesity and tobacco

use (2017). Primary care can play an important role in helping individuals. Primary care settings

may assist high risk individuals or those already affected by CVD manage their disease by

providing medications and surgeries that are necessary (WHO, 2017). Doctors, nurses and other

staff can all play a role, within their education level, in helping patients learn to better manage

and treat their disease. Healthcare workers can also go out into the community to educate

populations on risks factors, preventative measures and provide screenings. The Global atlas on

cardiovascular disease prevention and control, sponsored by WHO, also recommends policy

changes, which is considered population wide interventions, as individual behaviors can be

difficult to change (Mendis et al, 2011). In some environments or neighborhoods, access to

healthcare, health insurance or healthy, whole foods can be limited. A way to make an adjustment

to behaviors such as poor diets that include high salt concentrations and processed food, would

be to develop policies that make access to healthier foods the norm. In other words, creating a

healthy environment by changing public policies that impact health (Mendis et al, 2011).

Changes can include adding more health focused courses in public education, reducing salt

concentrations in processed foods, making fresh fruit and vegetables more affordable and

increasing costs and taxes on tobacco and alcohol products to deter use (Mendis et al, 2011).

There are many other policy changes that can be made in order to help individuals make and

maintain healthy choices. Outside of individual choice, there are other factors that are out of

individual control that are addressed in other CVD intervention recommendations.

Some situations that individuals find themselves in are not results of individual choice.

For many people in poverty, they are born into it without access to the resources to move up the

socioeconomic ladder. According to Dégano et al, opportunities to reduce morbidity and

mortality due to CVD are associated with addressing the social determinants of CVD as

disparities have increased over time (2017). WHO has noted that health determinants include

socioeconomic status and environments, as well as individual behaviors (Dégano et al, 2017).

Certain environments can make it more difficult to gain access to quality healthcare and healthy

foods. Urban areas are one of the locations, where the poor have the least access. The process of

urban development is not well managed, and this poor development prevents progress of CVD

prevention (Dégano et al, 2017). Lower socioeconomic status has also been shown to increase

risk of CVD (Dégano et al, 2017). This could be related to the many barriers that individuals in

low- and middle-income countries face in relation to low income, lack of access to care and low-

level education. It has been more challenging for treatment and prevention of CVD to reach

groups who fall in low socioeconomic status (Dégano et al, 2017). One way to help the poor in

situations such as these is to begin to make steps to move towards universal healthcare. High

impact CVD interventions may assist the health sector in addressing inequities and move

towards universal healthcare (Mendis et al, 2011). The recommendations WHO has made for

individual and population wide interventions are supposed to cost effective so that they can be

implemented in low resource settings like LMIC’s (WHO, 2017). It is also important to focus on

policies that may fall outside of healthcare, but directly impact the individual’s access, equity

and affordability of care, in order improve the socioeconomic status of these groups as well.

Policy implementation appears to be a strong move in order to promote a healthy

environment, however there are several barriers to executing this as well as some other

interventions. Presently, in order to assist in prevention, there is a need for policies that assist in

the reduction of exposure of populaces, including assessing individual behaviors that increase

risk and ensuring those who are at high risk have access to treatment and prevention (Mendis,

2017). Mendis stated that the current rate of success in prevention of NCD/CVD is inadequate to

reach the global voluntary targets by 2025 and that bolder measures are required to improve

prevention on both populace and individual levels (2017). Due to the multiple collaborators

involved, the policies are more complicated and difficult to be agreed upon and implemented

(Mendis, 2017). Globalization and urban development also impede movement forward in

implementation of prevention measures. Advertisements that promote smoking or target kids for

unhealthy snacks are supported by large food corporations (Mendis et al, 2011). As previously

mentioned, urbanization also has negative impacts. Urban development increases air pollutants,

healthy food options are limited, and the environment does not promote physical activity

(Mendis et al, 2011). Another barrier worth mentioning is poor healthcare financing. Poor

financing in healthcare slows the progress of improvement of coverage for at risk groups

(Mendis, 2017). According to Mendis, low- and middle-income countries do not have the

capability to deal with many of these barriers (2017). It important that these barriers are

addressed, and financially reasonable and affordable solutions are reached.

Cardiovascular disease is a non-communicable disease that burdens many around the

globe, with LMIC’s sharing the majority of this burden. There are multiple factors that play a

role in how CVD impacts some areas and groups over others, and due to this, there needs to be a

multifactorial resolution in addressing the global burden of disease. This can be accomplished by

implementing policy changes that promote healthy behaviors, addressing policy’s that create

barriers to improving the burden and working to assist patients in prevention and treatment and

ensuring equitable access to care. In order to make sure these interventions are available to

LMIC’s, they must also be cost-effective and attainable with minimal financial necessity.

Addressing and implementing these changes is crucial if the cardiovascular global burden of

disease is to be improved upon.



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