Cardiovascular Disease: Social Determinants and Nursing Role in USA

This report provides a comprehensive analysis of cardiovascular disease (CVD) in the United States, examining its prevalence, social determinants, and impact on public health. The report highlights key social determinants like socioeconomic position, race and ethnicity, residential environment, access to care, and social support, illustrating their influence on CVD prevalence. It reviews epidemiological studies that explore the relationship between physical activity, sleep duration, and coronary heart disease with CVD. Furthermore, the report emphasizes the crucial role of primary care nurses in managing and preventing CVD through interventions such as risk management, medication counseling, and smoking cessation programs. The report concludes by advocating for cultural competence in nursing to address health disparities and improve healthcare access for diverse populations, emphasizing the need for a socio-ecological framework to enhance community, individual, and societal interactions for better health outcomes. The report underscores CVD as a leading cause of death in the USA and emphasizes the role of nurses in mitigating the burden of the disease.

Cardiovascular Disease in the United States of America
Cardiovascular disease includes several health conditions that affects the functioning
or the structure of the heart. According to Nhs.uk (2017), conditions that affect the blood
vessels or heart are categorised under general term of cardiovascular disease and is usually
associated with atherosclerosis, that is, fatty deposits in the arteries. Arterial damage can be
linked to damage to the organ it is associated with, that is, eyes, kidneys, heart and brain. The
common cardiovascular disease include coronary artery disease, heart valve disease,
arrhythmias and failure, congenital heart disease and cardiomyopathy. According to
American Heart Association (2019), the leading cause of mortality in the United States of
America is cardiovascular disease, with the count of 840,768 deaths in the year 2016. Nearly
half of the adult population of the America is suffering any kind of cardiovascular disease
and the total prevalence of the disease group is around 9% in the country. The set of disease
associated with heart and blood vessels is the causing immense economic burden in the
country, with estimation of $351.2 billion for the year 2014-15, in which, nearly $213.8
billion was associated with direct cost of cardiovascular disease.
The following sections of the paper will discuss cardiovascular disease in the United
States of America with greater details regarding the sociological determinants of the disease,
epidemiological studies and role of nurses in the primary health care units to address the
health issue associated with the disease.
Social Determinants
Social determinants, as defined by the World Health Organisation, is the
circumstances in which the general population of a sample area are born, live, work, grow
and other subsystems that help to categorize the illness in the region. This definition critically
underlines that health issue is not randomly distributed in the region and neither are the
resources to address the health issues.
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According to a report “U.S. Health in International Perspective: Shorter Lives, Poorer
Health” by the Institute of Medicine, socials and adverse economic conditions are the greatest
factors contributing to high prevalence of cardiovascular disease in the United States of
America. Social determinants of cardiovascular disease in the America are highly
interrelated, which makes them difficult to catalog. The following section of the paper will
highlight five social determinants of cardiovascular disease in the chosen region, which have
either contributed in causing the health issue or resolving.
Socioeconomic Position
In a stratified structure of the society, the position status of an individual can be
determined by several categories, including social class and socioeconomic status. However,
the prime factor is the socially derived economic status, which affects the health status of the
population majorly. Socially and economically advantaged group control the resources, be it
cultural, social, political, economic or materialistic, which often dominates or excludes the
disadvantaged groups in the society. Unequal distribution of cardiovascular disease is highly
dependent on the distribution of resources and unequal distribution leads increased exposure
of the disadvantaged group to the disease. The prime markers of socioeconomic position of
an individual includes, education, access to valued activities, environment political voice,
income, wealth and physical insecurity such as violence or crime.
Race and Ethnicity
Race and ethnicity are another crucial determinant of cardiovascular disease in the
USA. The racial and ethnic minorities of the country have disproportionate burden of poor
health. Significant differences in the life expectancy has been observed; the Asian Americans
having average 84.9 years of life expectancy, where the southern rural blacks and other black
in poor urban areas have 71.1 years of life expectancy, a significant difference between the
two. According to the Heart and Stroke Disease Statistics by the American Heart Association,
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black people are more prone to die from cardiovascular diseases, 2 to 3 times higher than the
majority of white population. Racism experiences have been linked to increase in the blood
pressure levels in the black population. Moreover, decreased quality of clinical interaction
between the health care professionals and the racial or ethnical minorities affects the health
care process, increasing the burden of poor health in the minorities.
Residential Environment
The basic principles of epidemiology of any disease highlights the importance of
population, place and time in the variation of a disease prevalence. Paradigm shift has been
observed while examining the association of health outcomes and locations considering the
modern epidemiology. According to study conducted by Brown et al. (2011), the research
findings concluded that the population living in the disadvantaged location or region were at
70-90% increased risk of getting affected with cardiovascular disease, in which 40% blacks
were at higher risk due to individual level characteristics. Such increased exposure to disease
is highly dependent on the availability of the socioeconomic resource in the particular region.
Access to Care
Access to medical care determines the risk of individual getting affected by health
issues. The five dimensions that determine this social determinant are affordability,
appropriateness, accommodation, availability, acceptability, and approachability.
Affordability includes the cost associated with health care such as opportunity, indirect and
directs costs, that the individual is capable of spending the resources on. Increased mortality
rate due to cardiovascular diseases have been observed in the population without the support
of insurance or resources available to spend. As the Hispanics and blacks have lower median
household incomes, they have lower access to stroke preventive care or high quality health
care services. Improvement in the attributes that increase the access to care can significantly
reduce the incidence of cardiovascular disease in the United States of America, which has
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been the leading cause of deaths in the country. To improve this attribute, proper attention to
equal geographic distribution of cardiac services along with improvement in accessing
subspecialty cardiovascular for patients under Medicaid is required.
Social Support
Cultural and linguistic differences in the disadvantaged groups contributes to poor
cardiovascular health in them. A revised version of the National Standards for Culturally and
Linguistically Appropriate Services in Health and Health Care in 2013 by the US Department
of Health and Human Services directs 5 states from the country to provide linguistic
assistance while proving cardiovascular related health care services. Such actions by the
government helps the remove cultural and linguistic related disparity in provision of health
care and facilitate timely access to cardiovascular related health care services, helping to
reduce the incidence of such disease in the disadvantaged group.
Epidemiological Studies
A study was conducted by Katzmarzyk, Lee, Martin & Blair (2017), with objective of
providing an overview of epidemiology of physical activities and its associated effect on
cardiovascular disease prevalence in the United States of America. According to the authors,
the current prevalence of physical activity levels in the target population is significantly
lower than the suggested levels and the people are not meeting the standards mentioned in the
physical activity guideline. Research findings conclude that only 27% of the adolescents and
23% of the adult population is currently meeting the aerobic and muscle-strengthening
guidelines. Promotion of physical activities is highly required to obtain optimal level of
health benefits and reduce the prevalence of cardiovascular disease in the country.
Another study by Covassin & Singh (2016), aims at finding out epidemiological
evidence of association of cardiovascular disease with sleep duration. According to the
authors, sleep loss has adverse effects on the physiological functions of the body, heightening
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the risk of cardiovascular disease and its associated morbidity and mortality. The research
findings conclude that 20% of the US adult population fails to meet the sleep duration
recommendation by the National Sleep Foundation and get less than six hours of sleep per
night.
Sanchis-Gomar, Perez-Quilis, Leischik & Lucia (2016) conducted a study to find out
the epidemiology of coronary heart disease and acute coronary syndrome. According to the
study finding, over one-third of population aged over 35 years are suffering from coronary
heart disease and the authors highlight the need of effective primary prevention approaches
and their implementation to identify the risk groups and provide interventions. The research
findings foretell that one-third of the middle-aged women and half of the middle-aged man
population will have some manifestation of coronary heart disease.
Andersson & Vasan (2018) conducted a research study to find out the epidemiology
of cardiovascular disease in the target population of younger individuals ranging from 18 to
45 years old. According to the authors, the target population in the past two decades has
developed increased unhealthy risk, which includes physical inactivity, poor diet and obesity.
Increased rate of substance abuse among the younger individual and adults has led to
increased incidence of cardiovascular disease in the group. One important statement drawn
from this research study is that population aged between 18 to 45 years old has been observed
with constant increase in the incidence rate of cardiovascular disease, in contrast to the
population aged above 50 years, where a slight decline in the incidence of cardiovascular
disease has been observed in the past decade.
Role of Primary Care Nurses
Nurses comprises the largest proportion of health care professionals in the world and
have a crucial role to play in controlling the prevalence of cardiovascular disease, which has
put immense economical and health burden in countries like the United States of America.
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The nurse practitioners in the primary care settings of the nation have a significant role in
providing cardiovascular health care services as they are located in the prime setting with
greater exposure to the population affected by cardiovascular disease. Nursing individuals
and professionals in the primary care settings can decide a few interventions to improve the
health outcomes associated with the cardiovascular health of the population. These
interventions include cardiovascular risk management and cost evaluation, cardiovascular
disease management and medication counselling, and cardiovascular disease risk reduction.
These interventions would require nurses to ensure lifestyle changes in the target population
and evaluating the associated cost regularly. The significant positive outcomes from these
interventions would be cost-effectiveness, lowering of cardiovascular disease risk factor and
reduced progression of the disease group. Another critical intervention that nursing
professionals can ensure is smoking cessation as smoking is one of the prime risk factors for
cardiovascular diseases. For smoking cessation intervention, the nurses have to provide
education to the target population, making them aware of the ill-effects of smoking, conduct
counselling sessions and set follow-up meetings to ensure successful smoking cessation
(Despoina & Vogiatzis, 2018). Effective communication skills among the primary care
nurses are required to deliver the interventions successfully and effectively.
Reflection
Analysing the abrupt increase in the prevalence of the cardiovascular disease in the
United States of America, it can be stated that the health care providers need to increase their
awareness on the disease and provide better services to reduce the prevalence. One major
issue identified from the above sections of the paper that increases the risk of cardiovascular
disease in the racial and ethnic groups is the cultural and linguistic differences. This includes
the minorities of black and Hispanic in the country. To address this specific issue of health
care, cultural competence in nursing professionals are required to provide better health care to
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linguistically and culturally diverse segment of the population. The lack of cultural
competence in the health care providers and professionals can lead to inequity and disparity
of health care access by the minorities, forcing them to increased risk of cardiovascular
diseases (Betancourt, Green, Carrillo & Owusu Ananeh-Firempong, 2016). Promoting the
access of such segment to cardiovascular health care services can be achieved with the
implementation of a socio-ecological framework model to increase the interaction between
the community, individuals and society (Woods, Mentes, Cadogan & Phillips, 2017). With
the revised definition of culture as a social determinant of cardiovascular disease in the
country, the health outcomes of the overall population can be significantly improved.
Conclusion
Cardiovascular disease is the top cause of deaths in the United States of America and
is constantly increasing the economic burden on the health care system. From the analysis of
information made available in the above sections of the paper, it can be concluded that the
nurses have a crucial role to play in reducing the prevalence of the disease by ensuring
cultural competency and increasing the efficacy of health care services provided in the
primary care settings.
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References
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