Escolar Documentos
Profissional Documentos
Cultura Documentos
Cardiovascular Disease
Rodricka D. Richardson
Abstract
As noncommunicable diseases take the lead in causing death around the globe, cardiovascular
disease has raised particular concern. It is now the leading cause of death around the world and
particularly impacts low to middle income countries, with the poor carrying the highest burden.
Cardiovascular diseases have many risk factors, several of which are behavioral and preventable
with adequate education and treatment. However, other factors, such as socioeconomic status,
education, location and access to healthy food choices and healthcare, play a major role in both
individual and population wide health. In order to address this, the World Health Organization
and other global health groups have developed numerous interventions to help prevent, detect
and provide early treatment of cardiovascular disease on both individual and population wide
levels. The challenge is overcoming the financial, individual, population wide and political
barriers in order to implement the necessary changes to combat the cardiovascular global burden
of disease.
CARDIOVASCULAR DISEASE HEALTH IMPACT 3
Cardiovascular Disease
With the advancement of how humans understand health, the causes of disease and
biology, there have been great strides made in reducing disease in many areas. Vaccinations,
antibiotics and other advancements in treatment and prevention measures, have minimized the
diseases have decreased, there has been an increase in deaths as a result of non-communicable
disease (Nascimento, Brant, Moraes & Ribeiro, 2014). With this shift, cardiovascular diseases
(CVD’s) are one of these non-communicable diseases that have become a global health concern.
Presently, CVD is the leading cause of death around the world (World Health Organization
[WHO], 2017). Cardiovascular disease is an umbrella term for many types of heart and vessel
related illnesses. According to WHO, cardiovascular diseases are a group of disorders of the
heart and blood vessels; this includes diseases such as coronary heart disease, and peripheral
arterial disease (2017). Cardiovascular diseases have had a significant impact around the globe.
It is estimated that in 2016, 17.9 million people around the world died as a result of CVDs; in
other words, 31% of all deaths were a result of CVD’s (WHO, 2017). While the global CVD
burden of disease is concerning, it is important to know it is not spread evenly amongst all
countries or groups.
The percentage of deaths that result from CVD or complications of CVD are worrying.
However, global CVD mortality rates in some areas have been improving (Mendis, Puska, &
Norrving, 2011). Specifically, this change has occurred in high income countries (HICS), which
appears to be a result of a decrease in tobacco uses and improvements in treatment; however, this
progress has not been made in low- to middle-income countries (LMIC) (Mendis et al, 2011).
CARDIOVASCULAR DISEASE HEALTH IMPACT 4
The burden of disease falls onto the populations in LMIC’s more than it does in high income
countries. Presently, low- and middle-income countries are impacted the most by CVD’s and the
deaths that occur in these countries make up three quarters of global deaths (WHO, 2017). The
poor from certain ethnic backgrounds and regions and the young are particularly affected
(Nascimento et al, 2015). In these countries where the individual and government financial state
is lower, the populations face several barriers that increase the risks for morbidity and mortality.
Individuals located in LMIC’s face many barriers to prevention and treatment of CVD’s
and CVD related deaths. There is a general understanding that lack of income can impact every
aspect of life on an individual level. For some groups, fresh fruit and vegetables can quickly
become too expensive and paying for medications and care may be a decision that makes one
unable to pay for other things needed in the household. On a government level, if the country
itself does not have adequate income, it may struggle to provide all citizens with what they need.
Individuals located in low- and middle incomes countries do not have access to care that
identifies people with risk factors for CVD and detection and treatment measures (WHO, 2017).
If people in these low to middle income countries already have some form of CVD, the lack of
access to healthcare that would otherwise help them manage and treat the disease leads to late
detection that results in death at younger ages (WHO, 2017). If the groups impacted are the
poorest in LMIC’s, the access gap widens, and outcomes worsen. The poorest of these countries
are the groups most impacted, due to high cost of treatment and, at times, lack of access to
equitable and accessible care (WHO, 2017). Poorer individuals unfortunately face many barriers
and factors as a result of their socioeconomic status that put them at higher risk that other groups.
Impoverished communities and societies do not always have access to quality education
or food in addition to quality healthcare. Level of education and CVD have been shown to be
CARDIOVASCULAR DISEASE HEALTH IMPACT 5
and the reverse is also true (Dégano et al, 2017). Impoverished individuals and families may not
have the ability to even complete primary education let alone secondary education due to the
need to have all able bodies working to provide income or access. Without adequate education,
these high-risk populations may be simply ignorant on how to make better health choices when,
increasing their risk even further. Also, when a member of the family falls ill, labor is lost and
couple with the cost of treatment or hospitalization, this can place a heavy financial burden on
the family unit. The cost of the impact of this non-communicable disease does not only impact
the individual and familial finance status. On a large scale, the economies of low- and middle-
income countries are negatively impacted by the high cost of CVD’s (WHO, 2017). Reducing
the impact of CVD’s in LMIC’s is a target of the Sustainable Development Goals (SDGs) set by
the United Nations General Assembly and it addresses multiple aspects of CVD risks and causes.
The steps taken to decreasing incidence of CVD will require actions and interventions
that can address multifactorial causes. Many CVD risk factors are behaviors that can be changed
on an individual level, such as smoking and diet modification. According to WHO, most CVD’s
can be avoided by focusing on behavioral risk factors such as unhealthy diet, obesity and tobacco
use (2017). Primary care can play an important role in helping individuals. Primary care settings
may assist high risk individuals or those already affected by CVD manage their disease by
providing medications and surgeries that are necessary (WHO, 2017). Doctors, nurses and other
staff can all play a role, within their education level, in helping patients learn to better manage
and treat their disease. Healthcare workers can also go out into the community to educate
populations on risks factors, preventative measures and provide screenings. The Global atlas on
cardiovascular disease prevention and control, sponsored by WHO, also recommends policy
CARDIOVASCULAR DISEASE HEALTH IMPACT 6
healthcare, health insurance or healthy, whole foods can be limited. A way to make an adjustment
to behaviors such as poor diets that include high salt concentrations and processed food, would
be to develop policies that make access to healthier foods the norm. In other words, creating a
healthy environment by changing public policies that impact health (Mendis et al, 2011).
Changes can include adding more health focused courses in public education, reducing salt
concentrations in processed foods, making fresh fruit and vegetables more affordable and
increasing costs and taxes on tobacco and alcohol products to deter use (Mendis et al, 2011).
There are many other policy changes that can be made in order to help individuals make and
maintain healthy choices. Outside of individual choice, there are other factors that are out of
Some situations that individuals find themselves in are not results of individual choice.
For many people in poverty, they are born into it without access to the resources to move up the
mortality due to CVD are associated with addressing the social determinants of CVD as
disparities have increased over time (2017). WHO has noted that health determinants include
socioeconomic status and environments, as well as individual behaviors (Dégano et al, 2017).
Certain environments can make it more difficult to gain access to quality healthcare and healthy
foods. Urban areas are one of the locations, where the poor have the least access. The process of
urban development is not well managed, and this poor development prevents progress of CVD
prevention (Dégano et al, 2017). Lower socioeconomic status has also been shown to increase
risk of CVD (Dégano et al, 2017). This could be related to the many barriers that individuals in
CARDIOVASCULAR DISEASE HEALTH IMPACT 7
low- and middle-income countries face in relation to low income, lack of access to care and low-
level education. It has been more challenging for treatment and prevention of CVD to reach
groups who fall in low socioeconomic status (Dégano et al, 2017). One way to help the poor in
situations such as these is to begin to make steps to move towards universal healthcare. High
impact CVD interventions may assist the health sector in addressing inequities and move
towards universal healthcare (Mendis et al, 2011). The recommendations WHO has made for
individual and population wide interventions are supposed to cost effective so that they can be
implemented in low resource settings like LMIC’s (WHO, 2017). It is also important to focus on
policies that may fall outside of healthcare, but directly impact the individual’s access, equity
and affordability of care, in order improve the socioeconomic status of these groups as well.
environment, however there are several barriers to executing this as well as some other
interventions. Presently, in order to assist in prevention, there is a need for policies that assist in
the reduction of exposure of populaces, including assessing individual behaviors that increase
risk and ensuring those who are at high risk have access to treatment and prevention (Mendis,
2017). Mendis stated that the current rate of success in prevention of NCD/CVD is inadequate to
reach the global voluntary targets by 2025 and that bolder measures are required to improve
prevention on both populace and individual levels (2017). Due to the multiple collaborators
involved, the policies are more complicated and difficult to be agreed upon and implemented
(Mendis, 2017). Globalization and urban development also impede movement forward in
implementation of prevention measures. Advertisements that promote smoking or target kids for
unhealthy snacks are supported by large food corporations (Mendis et al, 2011). As previously
mentioned, urbanization also has negative impacts. Urban development increases air pollutants,
CARDIOVASCULAR DISEASE HEALTH IMPACT 8
healthy food options are limited, and the environment does not promote physical activity
(Mendis et al, 2011). Another barrier worth mentioning is poor healthcare financing. Poor
financing in healthcare slows the progress of improvement of coverage for at risk groups
(Mendis, 2017). According to Mendis, low- and middle-income countries do not have the
capability to deal with many of these barriers (2017). It important that these barriers are
globe, with LMIC’s sharing the majority of this burden. There are multiple factors that play a
role in how CVD impacts some areas and groups over others, and due to this, there needs to be a
multifactorial resolution in addressing the global burden of disease. This can be accomplished by
implementing policy changes that promote healthy behaviors, addressing policy’s that create
barriers to improving the burden and working to assist patients in prevention and treatment and
ensuring equitable access to care. In order to make sure these interventions are available to
LMIC’s, they must also be cost-effective and attainable with minimal financial necessity.
Addressing and implementing these changes is crucial if the cardiovascular global burden of
References
Dégano, I. R., Marrugat, J., Grau, M., Salvador-González, B., Ramos, R., Zamora, A., Marti, R.,
& Elosua, R. (2017). The association between education and cardiovascular disease
incidence is mediated by hypertension, diabetes, and body mass index. Scientific reports,
Lee, E. S., Vedanthan, R., Jeemon, P., Kamano, J. H., Kudesia, P., Rajan, V., Engelgau, M., &
Moran, A. E. (2016). Quality Improvement for Cardiovascular Disease Care in Low- and
https://doi.org/10.1371/journal.pone.0157036
Mendis, S., Puska, P., & Norrving, B. (2011). Global atlas on cardiovascular disease prevention
https://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/
Nascimento, B. R., Brant, L. C. C., Moraes, D. N., & Ribeiro, A. L. P. (2015). Almanac 2014:
Global health and cardiovascular disease. Romanian Journal of Cardiology, 25(3), 276–
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=110166932&site=ehos
t-live
World Health Organization. (2017, May 17). Cardiovascular diseases (CVDs). Retrieved April
diseases-(cvds)