Running head: CARDIOVASCULAR DISEASE AND HEALTH IMPACT 1

The Application Of Cardiovascular Disease To The Health Impact Framework Pyramid

Diane Kerr
Delaware Technical Community College
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Abstract:

The Health Impact Pyramid defines significant public health issues and provides a

framework for interventions to improve health. Non-communicable diseases, specifically

cardiovascular issues, are of immense and escalating importance globally. The health impact

pyramid addresses various types of public health interventions that can reduce or prevent

cardiovascular disease. The Health Impact Pyramid has 5 levels of public health interventions.

The base of the pyramid involves interventions that reach a broad segment of the population and

they require the lease amount of individual effort. Interventions require increasing individual

effort as one ascends the levels of the Health Impact Pyramid. It is important to successfully

implement changes at all levels of the pyramid for maximum cardiovascular public health

benefits.
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The Health Impact Pyramid defines significant public health issues and provides a

framework for interventions to improve health. Non-communicable diseases, specifically

cardiovascular issues, are of immense and escalating importance globally. The health impact

pyramid addresses various types of public health interventions that can reduce or prevent

cardiovascular disease. Friedens (2010) framework describes the following:

A 5-tier pyramid best describes the impact of different types of public health

interventions and provides a framework to improve health. At the base of this pyramid,

indicating interventions with the greatest potential impact, are efforts to address

socioeconomic determinants of health. In ascending order are interventions that change

the context to make individuals' default decisions healthy, clinical interventions that

require limited contact but confer long-term protection, ongoing direct clinical care, and

health education and counseling. Interventions focusing on lower levels of the pyramid

tend to be more effective because they reach broader segments of society and require less

individual effort. Implementing interventions at each of the levels can achieve the

maximum possible sustained public health benefit. (p. 590)

The base of the health impact pyramid addresses socioeconomic factors and the social

determinants of health involving cardiovascular disease. The base of the health pyramid reflects

interventions that potentially have the most impact on health because they reach entire

populations at once and these interventions require less effort from individuals. Community-

wide approaches have a broad health impact. It is critical to reduce poverty and increase

educational levels. Educational status correlated with cardiovascular risk factors like smoking.

Early childhood education programs foster socio-emotional, cognitive development, physical

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activity, and nutrition. Evidence suggests that these educational programs are related to a

reduction in BMI and obesity.

Another strategy to improve the quality of air and the environment involves retrofitting

bus fleets to operate using clean diesel technology. Scientific evidence suggests that there is an

association between policies that implement clean diesel technology with fewer cardiovascular

events. The 17 Sustainable Developmental Goals (SDGs) strive to build on the Millennium

Developmental Goals and balance the three dimensions of the economy, social and

environmental. SDG # 6 is to ensure availability and sustainable management of water and

sanitation for all. According to the World Health Organization (2016), "civil society

organizations should work to keep governments accountable, invest in water research and

development, and promote the inclusion of women, youth and indigenous communities in water

resource governance." Awareness will lead to action and increase sustainability for humans and

the environment. SDG #13 involves taking urgent action to combat climate change and its

impacts. According to UN Health Association (2017), polluted environments kill 1.7 million

children a year. Air pollution can stunt brain development and reduce lung function and trigger

asthma in the long term, exposure to air pollution can increase the childs risk of contracting

heart disease, a stroke or cancer. The WHO Director, Marie Neira, (2016) said, by investing

in the removal of environmental health risk to health, such as improving water quality or using

cleaner fuels, will result in massive health benefits."

Introducing, expanding, and increasing access to public transportation systems has

several advantages. The use of public transpiration reduces traffic. By reducing air pollution

and increasing levels of physical activity are both associated with a decrease in the modifiable
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risk factors for cardiovascular disease. There must be an increase in nutritional options available

to reduce cardiovascular disease.

The second tier on the health framework pyramid involves changing the context to make

healthy choices easier and recommended future interventions. Changing the context requires

interventions such as creating school-based programs that increase physical activity. This goal

increases physical activity of school children before, during, and after classes. The program

enhances the current physical education classes and incorporates physical activity into the

learning experience in the classroom. Evidence indicates that physical activity programs lead to

an increase in student's activity level and this, in turn, has a beneficial effect on Body Mass Index

(BMI) and the prevention of obesity.

Tobacco use is a huge modifiable risk factor for cardiovascular disease. Several effective

tobacco control interventions assist in changing the context to make healthy choices easier. The

first response involves simply increasing the taxes and price of smoking. According to the

Center for Disease Control (2017), evidence has shown that a 20 percent increase in

the unit price of tobacco can reduce the number of young people who start

smoking, can increase quitting among adolescents and adults ages 30 and older,

and can reduce tobacco use and demand (para. 5). Another high impact

intervention includes the use of mass-media anti-tobacco campaigns to change the

social context or norm of smoking. Mass media campaigns reach large audiences

through the use of television, radio, digital, and print media and are successful at

changing knowledge, beliefs, attitudes, and behaviors about tobacco. Anti-tobacco

campaigns not only reduce the adult use of tobacco and promote cessation but they

prevent the initiation of using tobacco among young people. Comprehensive

smoke-free laws prohibit smoking in all workplaces, bars, and restaurants. There is
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an association between smoke-free laws and exposure to second-hand smoke,

improvements in health outcomes related to cardiovascular disease and reducing

the number of heart attacks.

There is a link associated with unsafe consumption of alcohol and an increased risk of

cardiovascular disease. Pricing strategies for alcohol products involve raising the price of

alcohol to reduce the use of alcohol.

Obesity is associated with cardiovascular disease and is considered a modifiable risk

factor. Multi-component worksite obesity prevention is another way to change the context to

health. Obesity prevention at the workplace provides information, education, behavioral and-

social change ideas, environmental and financial incentives. According to the Center for

Disease Control (2017), "worksite obesity prevention programs are associated with a reduction in

BMI and help employees lose weight" (para. 9).

Societies must encourage physical activity from citizens by building more walking and

bike paths. Safe routes to schools is an intervention that promotes students and families to walk,

bike, or utilize another form of active transportation. This program combines safety education

and infrastructure improvements. The infrastructure improvements include appropriate

sidewalks, crosswalks, and lighting for both walking and biking.

People must be encouraged to change from cooking with saturated fat to unsaturated fat

and there should be efforts made to eliminate artificial trans-fat from food and sodium reduction

in processed food and in restaurants. A reduction of the dietary intake of sodium especially in

packaged foods and foods prepared in cooked in restaurants can lower hypertension at the

population level.

The third level on the Health Impact Pyramid is long-lasting protective interventions.

This level describes infrequent health care interventions and ones that do not need ongoing
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clinical involvement to treat cardiovascular disease. Usually, the interventions on this level do

not have as high an impact because they that are higher on the pyramid and require interaction

with people as individuals. According to Frieden (2010), "smoking cessation programs increase

quite rates, life expectancy among men who quit at age 35 is almost 7 years longer than those

who continue to smoke (p. 592). Implementation of evidence-based tobacco cessation

programs that include individual, group, telephone counseling, and cessation medications are

long-lasting protective interventions for cardiovascular disease. There should be the removal of

barriers that impede access to treatment, such as co-pays and referrals.

The next level on the Health Impact Pyramid entails ongoing clinical interventions that

prevent cardiovascular disease. Interventions to prevent cardiovascular disease have the largest

potential health impact. Access often limits clinical interventions. Frequently patients do not

adhere and are not consistent with interventions that prevent cardiovascular disease. This type of

situation is a significant problem in countries that lack universal health care coverage. Many

cardiovascular diseases such as hypertension and hyperlipidemia are chronic and asymptomatic.

There is a critical non-adhesion rate to medications. There must be a promotion of interventions

that improve access and adherence to antihypertensive and lipid-lowering drugs. It is important

for patients with coronary heart disease to be prescribed aspirin therapy. To treat

cardiovascular disease it is critical to improve health care services by promoting a team-based

approach to control hypertension. The team includes the patient, nurse, physician, pharmacist

and lay healthcare workers. Patients should have access to self-measured devices to monitor

blood pressure at home. The health system, provider, and patient would have incentives for

compliance and meeting goals.

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The highest tier on the Health Framework Pyramid incorporates cardiovascular health

counseling and education. During clinical encounters education is provided. Patients learn

about the importance of weight reduction, a heart-healthy diet, and increasing physical activity.

Also, it is essential to provide educational opportunities in other settings on cardiovascular

disease. Other possibilities include public education and seminars on unhealthy lifestyle. It is

vital for patients to realize that cardiovascular disease is a way of life mediated disease. Many of

the risk factors associated with cardiovascular disease are considered modifiable. Educational

interventions are often time the only response available and this can be very effective.

The Health Behavior Change theory involves the development of effective global health

interventions. This intervention includes the ability to assess the needs of various populations

and their adaption to more healthy and protective behaviors. Providing a holistic approach and

increasing people's knowledge leads to more favorable outcomes. The Health Behavior Change

Theory suggests that a change in health behavior can be encouraging through awareness and

understanding. Many patients can improve their health by managing their chronic cardiovascular

diseases. They can engage in specific health promotion behaviors. For many, this requires

behavior change. For example, cardiovascular patients with obesity, and low levels of physical

activity can improve their condition by managing their health behaviors. Patients with chronic

conditions require a behavior change process. There are many theories of health behavior change

that include enhancing the health of people. To implement health behavior change, a thorough

understanding of the culture's actions, motivations and the way they relate to health is required. When

thinking about applying a model of health behavior change to reduce the risk of cardiovascular diseases, it

is important to include several approaches. The leading causes of death in low-and-middle-income

countries for all age groups in 2010 were stroke and ischemic heart disease. The most important risk

factors for the cardiovascular disease involves nutrition, obesity, and the use of tobacco, all of which are
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modifiable behaviors. Smoking correlates closely as a leading risk factor for cardiovascular disease.

Usually, individuals start smoking while they are young adolescents; therefore, steps should be taken to

change these habits and behaviors. Skolnik states (2016), How would the efforts to change behavior

have to differ if one tried to stop adolescents from taking up smoking, compared to helping adult smokers

to quit (p.151). The Diffusion of Innovations Model is based on the idea that communication is

necessary to encourage social change. Diffusion is the process utilized for the communication of

innovations throughout different groups and societies. When applying the Diffusion of Innovations

Model to cardiovascular disease, Skolnik (2016) found the following:

The model may apply to efforts to change diets in high-income countries away from certain fats

and toward more fruits and vegetables, fewer processed foods, and whole grains. Some people

change their diets relatively quickly. Others in the community make these shifts only as they can

overcome some of their long-held dietary patterns. Some people move as they learn more from

their friends, some of whom become role models for change. Others may simply not be willing or

able to modify the way they and their families have always eaten. (p.153)

Nurses play a significant role in counseling, educating and identifying behaviors critical

to health. Nurses assess the needs of individuals and communities, prepare and implement

interventions, and evaluate the effectiveness of the outcomes. According to Frieden (2010),

comprehensive public health programs should attempt to implement measures at each level of

intervention to maximize synergy and the likelihood of long-term success (p.594).

Global health is a growing field, and there are a vast array of opportunities in a career

involving cardiovascular disease prevention and treatment. These areas of global health include

research, policy, program design, implementation, evaluation, and advocacy. There are several

organizations that one can engage in such as nongovernmental organizations, Doctors Without

Borders, the United Nations (UN), public-private partnerships, consulting firms, foundations,
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academia, and advocacy organizations. One must approach an opportunity of a career in global

health with an attitude of humility. A global health career in nursing requires a solid

comprehension of economic development and an understanding of various cultures and

languages. Often the location of these jobs is in low-and-middle-income countries. Efforts

must be taken to increase the development and management of adequate health care that protects

and prevent cardiovascular diseases. It is far more cost-effective to prevent illness than it is to

treat cardiovascular disease. There are many opportunities to develop and manage high-quality,

cost-effective healthcare plans that are equitable for all socioeconomic populations across the

globe. It is critical to continue to focus on prevention and protection and not just treatment of

cardiovascular disease. Martin Luther King, Jr. stated, "of all forms of inequity, injustice in

healthcare is the most shocking and inhumane" NEJM. (n.d.).

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