Impact of Coronary heart disease, its social determinants and way forward

1. B Y A H M E D O T O K I T I , M . B , B . S , C C R P .
SOCIAL DETERMINANTS OF
CORONARY HEART DISEASE

2. INTRODUCTION/BASIC CONCEPTS
• According to the WHO, Health is a state of
complete physical, mental and social well-being.
Not just the absence of disease /infirmity.
• Health is not always opposite of disease.
• Determinants are established scientific factor that
relate to the level of health problem
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3. NO MAN IS AN ISLAND
• Every individual posses such innate identity as
Genetics, Gender, Race e.t.c. These are beyond his
control.
• There is a constant interaction between the
individual and the environment.
• The environment is made up of the social and
physical environment like the weather and
topograhy, Geography.
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4. NO MAN IS AN ISLAND CONT’D
• The individual’s interaction is usually within a
community(e.g school, neighborhood, work).
• Manifested through various relationships such as
family ties, religious groups, friendships e.t.c
• These interactions are usually modified and
influenced by such societal factors as economic
policy, justice system and politics…
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5. SOCIAL
ENVIRONMENT/DETERMINANTS
• Behavioral/lifestyle together with lack of medical
access makes up 59% of determinants of disease
• Social factors are the major determinants of health
inequities(e.g poverty, poor education, low
socioeconomic status)
• Health inequity is the major cause of relative poor
health outcome in the U.S as compared to other
developed Nations.
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6. SOCIAL DETERMINANTS OF CORONARY
HEART DISEASE(CHD)
• Heart disease is the leading cause of death in the
U.S.
• Poverty and Low socioeconomic status(SES) is
associated with increase prevalence of CHD. Daviglus
ML, Talavera GA(2012) Prevalence of major cardiovascular risk factors and
cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in
the United States. JAMA ;308(17):1775-84
• Community affluence is also significant as poor
people who live in affluent communities have
reduced incidence of CHD as compared with those
who don't. Abeita IM, Tuitt NR(2012) Effect of community affluence on the
association between individual socioeconomic status and cardiovascular disease risk
factors, Colorado. J Prev chronic Dis. :E115. Epub 2012 Jun 21
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7. SOCIAL DETERMINANTS OF CORONARY
HEART DISEASE(CHD) CONT’D
• Poverty and Low SES also affects patients ability to
comply to medication worsening affliction and
Disease.
• The health policies and health insurance system
which is not very socially responsive also further rules
out the poor in obtaining adequate health care
hence worsening outcome of disease
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8. SOCIAL DETERMINANTS OF CORONARY
HEART DISEASE(CHD) CONT’D
• In considering the logic model as it relates to health
determinants of CHD. Some specific social factors
exert multiple influences, from the level of exposure
to CHD up to the Disease outcome.
• An example is Poverty and Low SES; Poverty
prevents good dietary habit leading to exposure to
CHD.
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9. LOGIC MODEL; SOCIAL DETERMINANTS
OF CHD
• {CONTRIBUTING FACTORS} → {DETERMINANTS} → { DISEASE/CHD} → { OUTCOME}
• ↑ ↑ ↑ ↑
• -Low SES -Obesity -Low social support -Low SES
• -Poor Nutrition -Hypertension -Poverty
-Health
policy
-Smoking -Diabetes -Health
-In activity/no exercise -Hypercholesterol -Religious/cultural belief -Ethnicity/race
• -Low level of education -Smoking -Ethnicity -Social
protection
• -Smoking -No exercise -Compliance
-Justice
system
• -Substance abuse -community
effort
• -life style changes
• -
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10. PREVALENCE OF TWO OR MORE OF NINE SELECTED CHRONIC CONDITIONS
AMONG ADULTS AGED 45 AND OVER, BY AGE AND PERCENTAGE OF POVERTY
LEVEL: UNITED STATES, 1999–2000 AND 2009–2010
• 1Significantly different from 1999–2000, p < 0.05
SOURCE: CDC/NCHS, National Health Interview Survey.Ahmed
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11. THE PERCENTAGE OF ADULTS AGED 45–64 WITH TWO OR MORE OF NINE
SELECTED CHRONIC CONDITIONS WHO DID NOT RECEIVE OR DELAYED
NEEDED MEDICAL CARE IN THE PAST YEAR DUE TO COST, OR WHO DID NOT
RECEIVE NEEDED PRESCRIPTION DRUGS IN THE PAST YEAR DUE TO COST,
INCREASED OVER THE 10-YEAR PERIOD.
• 1Significantly different from 1999–2000, p < 0.05.
SOURCE: CDC/NCHS, National Health Interview Survey.
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12. REFERENCES
• Abeyta IM, T. N., Byers TE, Sauaia A. (2012). "
Effect of community affluence on the association between individual
socioeconomic status and cardiovascular disease risk
factors, Colorado, 2007-2008.
." Prev Chronic Dis 2012;9:E115.
• Daviglus ML, T. G., Avilés-Santa ML, Allison M, Cai J, Criqui MH, Gellman
M, Giachello AL, Gouskova N, Kaplan RC, LaVange L, Penedo F, Perreira
K, Pirzada A, Schneiderman N, Wassertheil-Smoller S, Sorlie PD, Stamler J.
(2012). “
• Prevalence of major cardiovascular risk factors and
cardiovascular diseases among Hispanic/Latino individuals of
diverse backgrounds in the United States." JAMA 308(17): 1775-
1784.
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