2. 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/
2
3. The 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)
3
4. Main 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)
4
5. Social 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)
5
6. Social 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).
6
7. Data tables illustrating
the results from the
New Zealand
Longitudinal Study
Retrieved January 18th 2015 from
http://archpedi.jamanetwork.com/article.aspx?articleid=205
331#poa60020t3
(Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R, 2006)
7
8. Social 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.
8
9. “Outdoor air
pollution is a
silent killer of
millions of
people
worldwide
each year.”
Quote & Graphic by
Su Song/EMBARQ
November 20 2014
Data from WHO
Retrieved January 18th 2015 from
http://thecityfix.com/files/2014/11
/China-death-air-pollution-heart-
disease.jpg
(Song S, 2014)
9
10. Social 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
10
11. LOGIC 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.
Staff
Volunteers
Funding
Resources
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.
11
12. 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/nhds
p_program/evaluatio
n_guides/docs/logic_
model.pdf
12
13. References
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
13
