University Name - Population Health: Rheumatic Heart Disease Report

This report analyzes Rheumatic Heart Disease (RHD), a significant health concern, especially in New Zealand, and applies the Biopsychosocial Model to understand its multifaceted influences. The report defines RHD, its causes (such as untreated streptococcal infections), and its global prevalence, highlighting disparities among populations like Māori and Pacific Islanders. It then explores the Biopsychosocial Model, detailing biological, psychological, and social factors contributing to the disease. Biological factors include genetics and immune responses; psychological factors involve emotional stress; and social factors encompass socioeconomic status and access to healthcare. The report emphasizes the interrelation of these factors in influencing health outcomes and the importance of considering them in treatment strategies, ultimately advocating for a holistic approach to manage and prevent RHD. The conclusion reiterates the model's significance for a comprehensive understanding of the disease and its impact on individuals' well-being, supporting the need for multidisciplinary healthcare interventions.

Population Health 102
Rheumatic Heart Disease
Student Name
University Name
Author Note

1
Rheumatic heart disease is one of the prevailing conditions that has been diagnosed in
New Zealanders and other global nations which require immediate attention from the
authorities. It is required to adopt the Biopsychosocial Model to understand the influencing
factors of the condition and how to prevent them from happening henceforth. Rheumatic
heart disease is a disorder in which rheumatic fever causes irreversible damage to the heart
valves (Carapetis et al., 2016, pp. 1-24). Immediately after untreated or under-treated
streptococcal infection, such as strep throat or scarlet fever, damage to the heart valve may
evolve. Rheumatic fever is a preventable disease that is caused by an autoimmune response to
a highly contagious Group A Streptococcus (GAS) throat infection. It affects the body's
connective tissue, causing acute, debilitating arthritis as well as other side effects. Rheumatic
fever in some cases does long-term damage to the heart and its valves.
Acute Rheumatic Fever (ARF) is the consequence of an autoimmune responsemalfunction to
pharyngitis caused by infection with group A Streptococcus. The long-term damage to
cardiac valves caused by ARF, which can result from a single severe episode or from
multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD).RHD
has many morbidity and mortality in resource -poor settings all around of world. ARF
progress leads to different type of disease which can effect on different parts of body such as
joint pain and swelling, cardiac valvular regurgitation with the potential for secondary heart
failure, chorea, skin and subcutaneous manifestations and fever (Carapetis et al., 2016, pp. 1-
24).
According to Bennett et al., (2019, pp.633), RHD has affected 34 million people worldwide
and it is shown that an additional 47 million people have a form of asymptomaticRHD,
which can impact the cardiovascular system. It is estimated that there are 517,000 mortality
rates due to acute GAS each year (Carapetis et al., 2005, pp.658-694).Worldwide age-
standardized fatalities attributed to a decline in RheumaticHeartDisease by 47.8 percent from
1990 to 2015, but substantial variations were found across continents. Throughout 2015,
Oceania, South Asia and central sub-Saharan Africa saw the greatest age-standardized deaths
attributed to RHD(Watkins et al., 2017, pp. 713-722). There is also an increased rate of
incidences for ARF and RHD in different population groups of same countries,such as Māori
and non-Māori in New Zealand.Here the RHD mortality rates are indicated at 5-10 times
higher among Māori and Pacific population in compare to non-Māori and non-Pacific. The
prevalence rate of ARF is still high in New Zealand and has an effect particularlyon children

2
and young adults. It is shown that the recurrence of ARF is high among Māoricompared to
non-Māori people, which is also the case in the rates of RHD. This can be the result of some
inequalities such as household crowding and less access to healthcare which lead tomain side
effects and a shortening of life expectancy.The socioeconomic limitations such as education
and employment opportunities might increase the dependence on social assistance (Burgess,
H.M., 2016).
Task 2:
The biopsychosocial model is a scientific model which was established in 1997. According to
a philosophy of body-mind cohesion, it postulates that study must concentrate on better
understanding of a person and how a person is exposed to both internal and external factors,
such asbiological, psychological and social, that can affect the health and illness of the
person. The model is prominent and frequently cited in clinical contexts and health education,
and continues to be the basic structure for contemporary health care. The biopsychosocial
model offers a multidimensional context for health clinicians to optimize treatment and
understand differences in medical experiences by a process of conceptualizing patients and
explores a variety of causes through macro-and micro-level structures (Summer &Nicassio,
2016, pp. 3-20).
Bio-psycho-social models have proven helpful in addressing complex problems such chronic
disease and disorder function (Buckner, Heimberg, Ecker & Vinci, 2013). Importantly, bio-
psycho-social models require several variables to play a role and lead to treatment responses.
Therefore, these models have the ability to have greater predictive capacity than restrictive
models(Jensen, Adachi, Tomé-Pires, Lee, Osman & Miró, 2015, pp. 34-75).
Biological health factors include the genetic makeup of a person and evidence of physical
damage or infection.Genetics could be established as playing a valuable part in the
development of different diseases that are diagnosed in a person (Pilgrim, 2015, pp. 164-
180). For those with pre-existing genetic vulnerability,non-biological (i.e., environmental)
factors affect the presentation of the disease (Isvoranu et al., 2016, pp. 870-873). It is now
wellrecognized that influences such as physical, occupational and social factors affect the
development of severe health problems beyond the existence of genetic factors.
The biopsychosocial model's clinical dimension attempts to find a neurological cause for a
single disorder or series of symptoms (e.g. irritability, impulsivity, excessive depression,

3
etc.). Humans with genetic susceptibility can be more likely to show suicidal thoughts that
places them at risk of depression. Social factors may intensify mental component by
positioning a genetically and biologically vulnerable group or an individual at risk for certain
risk habits(Kusnanto, Agustian&Hilmanto, 2018, pp. 497). One of the factors that aid in a
person's emotional growth is the individual's psychological capacity to cope with stress.
The biopsychosocial approach is not a promoter for Mind-Body Integration but is seekingto
explore psycho-neuro-immunological or psycho-neuro-endocrinological mechanisms to
disorders and their management, unlike clinical science. The paradigm highlights a complex
combination of medicine's biological and psychosocial aspects. Primary care clinicians
should use thebiopsychosocial paradigm to enhance health outcomes through increasing
understanding of the relationships between biological, psychological, socio-cultural, and
moral influences, and improving patient self-management by the complex and dyadic doctor-
patient partnership and multidisciplinary patient care strategy. The biopsychosocial model is
especially useful for addressing chronic disorders and ill-defined conditions to which patients
have unusual responses (Kusnanto, Agustian & Hilmanto, 2018, pp. 497).
There are clinical guidelines and clinical performance indexes which are based on
biomedical, thusthere is possibility for primary care doctors to usethe biopsychosocial model
practically.Workload and lack of primary care expertise may impede the adoption of the
biopsychosocial model. The bio-psycho-social model significantly increases health outcomes
of primary care with chronic disorders and serious illnesses (Kusnanto, Agustian&Hilmanto,
2018, pp. 497).
Socio-economic standing, history, infrastructure, and religion are all social factors that need
to be taken into account when assessing illness. For example, losing one's job (Andreeva et
al., 2015, pp. 1045) or terminating a loving relationship (Pohl, Young & Bosch, 2019, pp. 54-
63) will bring some at risk of developing depression and serious illness. Such events in life
can predispose another person to experience depression, which then, in turn, can cause
physical health problems (Cabaniss, Moga& Oquendo, 2015, pp. 579-581). Cultural factors
are also included in the social domain as differences in conditions, perceptions and beliefs of
different cultural groups have been shown to contribute to different prevalence rates and
symptoms of disorders (Santini et al., 2015, pp. 53-65).
Thesocial, biological and psychological factors influence the overall mental and physical
wellbeing of the individual such that the person is able to enjoy life as they desire. It is

4
important for the medical specialists to consider the three factorsof an illness experienced by
a person and then prescribe a remedy according to their condition (Lehman, David & Gruber,
2017, pp. e12328). The three factors are interlinked so to understand the mental and physical
condition of the patient and then deduce the appropriate treatment possibilities for the
diagnosed medical condition such that a positive health outcome can be established(Lehman,
David & Gruber, 2017, pp. e12328).
Task 3:
The biopsychosocial approach helps in considering the biological, psychological and social
influences of an individual suffering from a disease, like rheumatic heart disease, and
establishes a diverse relationship to understand the distribution of wellness and disease in the
person and the clinical care needed. The genetic factors responsible for rheumatic heart
disease have been correlated with the socio-cultural circumstances and mental wellbeing by
healthcare professionals to understand the contributing factor in the disease (Kudrina, Shir &
Fitzcharles, 2015, pp. 156-163). It can be understood that one of the factors cannot be
undertaken into consider understanding the growth of the patient because of its inter-
relationship. The mental wellbeing of the individual is correlated with the social status of the
individual. Hence, the three aspects taken into considerationin the biopsychosocial model by
Ergen (Borrell-Carrió, Suchman & Epstein, 2004) helps in analyzing the medical condition of
the patient from all aspects and understand the major influencing factors for the subsequent
development of the medical condition of Rheumatic Heart Disease.
For the development of Rheumatic Heart Disease, there are certain biological factors
that contribute to the onset of symptoms that are observed in the patient. Cytokines appear to
play a crucial role in the enactment of immunological and incendiary reactions in rheumatic
fever that result in RHD (He et al., 2016, pp. 222-232). It has been indicated that Peripheral
Blood Mononuclear Cells (PBMC) from children with rheumatic fever produce more TNF-α
than controls (Li et al., 2016, pp. 2531-2536). In addition, interleukin-6 (IL-6) and TNF-α are
viewed as inducers of the intense period of rheumatic fever and are firmly connected with C-
receptive protein.
In addition to the biological factors, a psychological factor also influences the health
condition of the patients who have been diagnosed to suffer from RHD. The emotional stress
that is experienced by the patient because of personal or professional reasons may increase

5
the heart rate or the cardiac rate output while also including abnormalities in the rhythm of
the heart (Yılmaz, Umay, Gündoğdu, Karaahmet & Öztürk, 2017, pp. 127). Hence, medical
specialists must consider the emotional and psychological stability of the individual.
Certain risk factors in the domain of social influencers also play a critical role in the
development of strep throat infection, rheumatic fever and subsequent Rheumatic Heart
Disease. The social factors influence the mental health condition, for example, if an
individual does not earn much and have a huge family under him, it gets stressful for him to
manage the finances and feed the family. In these situations, the individual is unable to get a
proper access to healthcare and hence, there is a chance that he may be void of treatment
(Coffey, Ralph & Krause, 2018, pp. e0006577). People belonging to a lower level of socio-
economic status require equal access to healthcare such that they are eligible for the treatment
from the medical professionals, irrespective of their background and origin and establish a
positive health outcome (Sheridan et al., 2015, pp. 32-43).
Conclusion
In conclusion, it can be observed that RheumaticHeartDisease has been experienced
by most populations globally and in New Zealand. Considering the difficult situation for the
patient, the healthcare professionals must take further action and consider the different
influencing factors involved in the development of the disease. The three factors of the
biopsychosocial model are interlinked to understand the mental, physical and social
conditions of the patient to deduce the appropriate treatment possibilities for the diagnosed
medical condition so that a positive health outcome could be established. As per the
biopsychosocial framework, the associations between the genetic structure of individuals,
their mental wellbeing and temperament, and socio-cultural circumstances lead to their
wellbeing or disease experience.
The biopsychosocial model is prominent and frequently cited in clinical contexts and
health education, and continues to be the basic structure for contemporary health care. The
biopsychosocial approach offers a multidimensional context for health clinicians to optimize
treatment and understand differences in medical experiences by a process of conceptualizing
patients. It explores a variety of causes through macro-and micro-level structures. These three
factors influence the overall mental and physical wellbeing of the individual,and help a
person to enjoy the life they desire.

6
References
Andreeva, E., Hanson, L. L. M., Westerlund, H., Theorell, T., & Brenner, M. H. (2015).
Depressive symptoms as a cause and effect of job loss in men and women: evidence
in the context of organisational downsizing from the Swedish Longitudinal
Occupational Survey of Health. BMC public health, 15(1), 1045. Doi:
https://doi.org/10.1186/s12889-015-2377-y
Azevedo, P. M., Merriman, T. R., Topless, R. K., Wilson, N. J., Crengle, S., & Lennon, D. R.
(2016). Association study involving polymorphisms in IL-6, IL-1RA, and CTLA4
genes and rheumatic heart disease in New Zealand population of Māori and Pacific
ancestry. Cytokine, 85, 201-206, doi: https://doi.org/10.1080/03014460.2018.1461929
Bennett, J., Moreland, N. J., Oliver, J., Crane, J., Williamson, D. A., Sika-Paotonu, D., ... &
Baker, M. G. (2019). Understanding group A streptococcal pharyngitis and skin
infections as causes of rheumatic fever: protocol for a prospective disease incidence
study. BMC infectious diseases, 19(1), DOI: 633. https://doi.org/10.1186/s12879-019-
4126-9
Cabaniss, D. L., Moga, D. E., & Oquendo, M. A. (2015). Rethinking the biopsychosocial
formulation. The Lancet Psychiatry, 2(7), 579-581. Doi:
https://doi.org/10.1016/S2215-0366(15)00180-7
Carapetis, J. R., Beaton, A., Cunningham, M. W., Guilherme, L., Karthikeyan, G., Mayosi, B.
M., ... &Zühlke, L. (2016). Acute rheumatic fever and rheumatic heart disease. Nature
reviews Disease primers, 2(1), 1-24. Doi: https://doi.org/10.1038/nrdp.2015.84
Carapetis, J. R.,CStreer, A., Mulholland, K., Weber, M. (2005).The global burden of group A
streptococcal disease.5(11),685-694.Doi: https://doi.org/10.1016/S1473-
3099(05)70267-X
Coffey, P. M., Ralph, A. P., & Krause, V. L. (2018). The role of social determinants of health
in the risk and prevention of group A streptococcal infection, acute rheumatic fever
and rheumatic heart disease: a systematic review. PLoS neglected tropical
diseases, 12(6), e0006577, doi: https://doi.org/10.1371/journal.pntd.0006577
Burgess, H.M., (2016). Māori whānau experiences of rheumatic fever: reflections of social
and structural inequity (Unpublished master’s thesis). The University of Auckland.

7
He, V. Y., Condon, J. R., Ralph, A. P., Zhao, Y., Roberts, K., de Dassel, J. L., ... &Carapetis,
J. R. (2016). Long-term outcomes from acute rheumatic fever and rheumatic heart
disease: a data-linkage and survival analysis approach. Circulation, 134(3), 222-232.
Doi: https://doi.org/10.1161/CIRCULATIONAHA.115.020966
Isvoranu, A. M., Borsboom, D., van Os, J., &Guloksuz, S. (2016). A network approach to
environmental impact in psychotic disorder: brief theoretical
framework. Schizophrenia Bulletin, 42(4), 870-873. Doi:
https://doi.org/10.1093/schbul/sbw049
Jensen, M. P., Adachi, T., Tomé-Pires, C., Lee, J., Osman, Z. J., & Miró, J. (2015).
Mechanisms of hypnosis: toward the development of a biopsychosocial
model. International Journal of Clinical and Experimental Hypnosis, 63(1), 34-75.
Doi: https://doi.org/10.1080/00207144.2014.961875
Kudrina, I., Shir, Y., &Fitzcharles, M. A. (2015). Multidisciplinary treatment for rheumatic
pain. Best Practice & Research Clinical Rheumatology, 29(1), 156-163. Doi:
https://doi.org/10.1016/j.berh.2015.04.029
Kusnanto, H., Agustian, D., &Hilmanto, D. (2018). Biopsychosocial model of illnesses in
primary care: A hermeneutic literature review. Journal of family medicine and
primary care, 7(3), 497. Doi: https://dx.doi.org/10.4103%2Fjfmpc.jfmpc_145_17
Lehman, B. J., David, D. M., & Gruber, J. A. (2017). Rethinking the biopsychosocial model
of health: Understanding health as a dynamic system. Social and Personality
Psychology Compass, 11(8), e12328. Doi: https://doi.org/10.1111/spc3.12328
Len. S., (2006). Biopsychosocial Model of Chronic Illness. Psychological treatment of
chronic illness: The biopsychosocial therapy approach (pp. 25-39). Washington, DC,
US: American Psychological Association.
Li, H. W., Xie, Y., Li, F., Sun, G. C., Chen, Z., & Zeng, H. S. (2016). Effect of miR-19a and
miR-21 on the JAK/STAT signaling pathway in the peripheral blood mononuclear
cells of patients with systemic juvenile idiopathic arthritis. Experimental and
therapeutic medicine, 11(6), 2531-2536. Retrieved from: https://www.spandidos-
publications.com/10.3892/etm.2016.3188

8
Pilgrim, D. (2015). The biopsychosocial model in health research: its strengths and
limitations for critical realists. Journal of Critical Realism, 14(2), 164-180. Doi:
https://doi.org/10.1179/1572513814Y.0000000007
Pohl, T. T., Young, L. J., & Bosch, O. J. (2019). Lost connections: Oxytocin and the neural,
physiological, and behavioral consequences of disrupted relationships. International
Journal of Psychophysiology, 136, 54-63. Doi:
https://doi.org/10.1016/j.ijpsycho.2017.12.011
Santini, Z. I., Koyanagi, A., Tyrovolas, S., Mason, C., &Haro, J. M. (2015). The association
between social relationships and depression: a systematic review. Journal of affective
disorders, 175, 53-65. Doi: https://doi.org/10.1016/j.jad.2014.12.049
Sumner, L. A., &Nicassio, P. M. (2016). The importance of the biopsychosocial model for
understanding the adjustment to arthritis. In Psychosocial Factors in Arthritis (pp. 3-
20). Springer, Cham. Doi: https://doi.org/10.1007/978-3-319-22858-7_1
Watkins, D. A., Johnson, C. O., Colquhoun, S. M., Karthikeyan, G., Beaton, A., Bukhman,
G., ... & Nascimento, B. R. (2017). Global, regional, and national burden of rheumatic
heart disease, 1990–2015. New England Journal of Medicine, 377(8), 713-722. Doi:
10.1056/NEJMoa1603693
White Dsc, H., Walsh, W., Brown, A., Riddell, T., Tonkin, A., Jeremy, R., … Brieger, D.,
Zeitz, Ch. Z., Kritharides, L. (2010). Heart, Lung and Circulation, 19(5-6), 273-281.
Doi: https://doi.org/10.1016/j.hlc.2010.02.019
Yılmaz, V., Umay, E., Gündoğdu, İ., Karaahmet, Z. Ö., &Öztürk, A. E. (2017). Rheumatoid
Arthritis: Are psychological factors effective in disease flare?. European journal of
rheumatology, 4(2), 127. Doi: https://dx.doi.org/10.5152%2Feurjrheum.2017.16100