According to The National Center for Biotechnology Information, by 2030, heart disease is projected to be the leading cause of death worldwide, with noncommunicative disease fatality rates continuing to rise across the board. And today, with cardiovascular disease standing as the second leading cause of death in Massachusetts (costing an estimated $1.7 billion dollars in health care expenses) we cannot afford to ignore such a widespread health problem facing our nation (Massachusetts State Health Assessment).
Risk factors such as hypertension, tobacco use, unhealthy lifestyle, physical inactivity and psychosocial stress should be analyzed by asking ourselves the question—What is the cause of these causes? Not surprisingly, these social determinants are not easily pinpointed, as they are both complex and deeply engrained within our societal framework. Basic rights of shelter, food, stability, income, and employment are more readily allocated to those with power and privilege, and more often than not, people of color are disproportionately affected by lack of access caused by institutional and structural racism. (Springer Nature).
Exposure to risk factors such as smoking, diabetes, housing instability, unemployment, food deserts, poor living/working conditions, and reduced access to health care is most prevalent among historically marginalized populations (Springer Nature). For example, African American individuals are at a higher risk for race-related life stress and hypertension, worsening the preexisting systemic inequity surrounding heart disease prevalence. Namely, chronic exposure to discrimination-related stress accounts for tremendously unsettling racial disproportions among patients diagnosed with hypertension, a leading risk factor of CVD.
According to the Massachusetts Department of Public Health, African American adults were five times more likely to be hospitalized for hypertension, with 39.4% diagnosed with the disease in comparison to a much smaller 30.7% of White adults. Racist housing and zoning laws have left a legacy of creating communities that lack access to healthy food and safe neighborhoods that can promote physical activity, which are both huge determinants of health that create these inequities. With such alarming inequities, health reform on prevention and treatment is undoubtedly an issue of social justice and civil rights.
But these health disparities do not manifest overnight; they are reinforced beneath the surface over the course of a lifetime—so much so that by the time an individual reaches the age range at-risk for cardiovascular diseases, substantial cumulative risk has already accrued. During childhood, genetic predispositions for obesity, hypertension, and diabetes combine with environmental influences of restricted access to safe recreational spaces, limited health food access, community health opinions, and poor living conditions to initiate health imbalance from the start (World Health Organization).
In Massachusetts, the “food deserts” common to impoverished and urban communities make fresh produce and health food largely inaccessible in certain areas of the state, specifically the central, western, and Cape Cod regions (see below). With an overwhelming majority of low-income community residents unable to access a supermarket, it is not surprising that food insecurity would have such wide-reaching effects. And because late childhood is the time for healthy diet and exercise habits to be fostered, increased exposure to unhealthy foods (as well as smoking and inadequate physical activity) gives rise to lifetime smoking habits and disinterest in both health foods and exercise (World Health Organization).
With the foundation to further exacerbate risk factors of cardiovascular diseases, disadvantaged youth accumulate additional threats as adults, potentially burdened with other health issues such as smoking addiction, hypertension, diabetes, obesity, and occupational stress (Springer Nature). It is not difficult to see how these factors conspire together to perpetuate the severity of disparity.
Reducing public health risks for cardiovascular diseases would have far-reaching economic and social justice benefits for our nation, an initiative that would improve the individual health of many and lower the overall costs of health care in the United States. Becoming aware of the risk factors of CVD is one of the first steps to minimizing individual vulnerability, and provides the framework to make healthy lifestyle choices to combat heart disease risks.
We’d like to take this opportunity to highlight the work Health Resources in Action is doing to combat these social determinants of health abd promote health equity for all. Springboard to Active Schools is an initiative of the National Network of Public Health Institutes (NNPHI) and Health Resources in Action (HRiA), funded through the Centers for Disease Control. The project promotes active school environments in school districts and schools across the country to improve the health and academic success of students.
Boston Alliance for Community Health is also partnering with Health Resources in Action and Boston Medical Center to improve health through investments in stable housing. One component of the overall investment is the Housing Stabilization Initiative, which will offer grants to community-based organizations and flex funds that the grantee organizations will help stabilize individuals’ and families’ housing in order to prevent eviction.
And to address social determinants of health work with healthcare in a way that fosters collaboration and integrate the perspectives of hospitals, community health centers, and other healthcare stakeholders, HRiA is developing and facilitating a planning process for the Conference of Boston Teaching Hospitals that will establish the Boston CHNA (community health needs assessment) and CHIP (community health improvement plan) Collaborative. This planning process will lay the foundation to conduct a joint citywide CHNA in 2019 and develop a joint CHIP for all of Boston. Conference of Boston Teaching Hospitals (COBTH) is a coalition of thirteen Boston-area teaching hospitals, and additional stakeholders engaged in the planning process include the Boston Alliance for Community Health, Boston Public Health Commission, Massachusetts League of Community Health Centers, and Metropolitan Area Planning Council.