Running Head: HEALTH IMPACT FRAMEWORK/RESEARCH PAPER, CARDIOVASCUAR DISEASE

Health Impact Framework/Research Paper, Cardiovascular Disease

Delaware Technical Community College

NUR 310 Global Heath

Kei-Sha Dollard

April 25, 2019

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Abstract

Cardiovascular diseases (CVDs) are the number one cause of death globally. The burden of

CVDs can be reduced significantly by addressing social determinants leading to health

disparities in the United States and developing countries. Preventative measures to improve

health and reduce the burden of CVD will be discussed using the Health Impact Pyramid which

includes socioeconomic factors, changing the context to encourage healthy decisions, long-

lasting protective interventions, clinical interventions, as well as counseling and education

components. Nurses play a key role in improving health outcomes in every community and

globally by advocating for social justice and providing education to improve health literacy as

well as making recommendations for future interventions for reducing the burden of

cardiovascular diseases. Nurses are not the only professionals that contribute to global health,

there are several other career opportunities that can be pursued in the field to reduce the impact

of cardiovascular diseases and other communicable and noncommunicable diseases worldwide.

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Health Impact Framework To Reduce Cardiovascular Disease

Cardiovascular disease (CVD) is a class of diseases that involve the heart, brain and

blood vessels. CVDs include ischemic heart disease, cerebrovascular disease, hypertensive heart

disease, cardiomyopathy/myocarditis, atrial fibrillation/flutter, rheumatic heart disease,

peripheral vascular disease, aortic aneurysms, endocarditis and other circulatory diseases. The

main two cardiovascular diseases, ischemic heart disease (heart attacks) and cerebrovascular

disease (stroke) are caused by atherosclerosis. Atherosclerosis is a complex pathological

process in the walls of blood vessels that develops over many years. In atherosclerosis, fatty

material and cholesterol (plaque) are deposited inside the lumen of arteries. Overtime the plaque

can rupture, triggering the formation of a blood clot. The blood clot can block blood flow to the

brain or heart leading to a heart attack or stroke (Mendis, Puska, & Norrving, 2011).

Cardiovascular diseases are a leading cause of death in the world and a major barrier to

sustainable human development. According to the Global Burden of Disease 2015 study, there

were an estimated 422.7 million cases of CVD and 17.92 million CVD deaths. The countries

with the highest prevalence of CVD included most countries in West Africa, Morocco, Iran,

Oman, Zambia, Mozambique, and Madagascar (Roth et al., 2017). According to the World

Health Organization (WHO), CVDs are increasing in low and middle-income countries due to

the lack of primary healthcare programs for early detection and treatment of people with risk

factors of CVD compared to people in high-income countries. There are several factors that put

people at risk for developing CVD all over the world including behavioral risk factors: tobacco

use, physical inactivity, consuming unhealthy diets (high in salt, fat and calories), excessive

alcohol consumption; metabolic risk factors: hypertension, diabetes, hyperlipidemia,

HEALTH IMPACT FRAMEWORK TO REDUCE CARDIOVASCULAR DISEASE 4

overweight/obesity; other risk factors: poverty, low educational status, advancing age, gender,

race, ethnicity and stress and depression (Wallace, Ricco, & Barrett, 2014). The burden of CVD

can be reduced by following a public health action plan implementing interventions at all five

tiers of Thomas Frieden’s Health Impact Pyramid. The Health Impact Pyramid’s 5-tiers include

socioeconomic factors, changing the context to encourage healthy decisions, long-lasting

protective interventions, clinical interventions, as well as counseling and education components

to improve health.

Socioeconomic Factors

The bottom tier represents changes in socioeconomic factors also known as social

determinants to health. Social determinants of health (SDH) are conditions in the environments

in which people are born, live, learn, work, play, worship, and age that affect a wide range of

health, functioning, and quality-of-life outcomes and risks according to the Office of Disease

Prevention and Health Promotion (ODPHP). SDH are low income, poverty, decreased levels of

education, lack of health services, lack of social support, culture, health beliefs, race, ethnicity,

sexual identity, disability status, gender, and the environment in which we live. In the United

States, minorities are at a greater risk of CVD. African Americans are at a higher risk for heart

disease and stroke due to a higher prevalence of hypertension, obesity, tobacco use, diabetes, and

physical inactivity, as well as genetic factors, health behaviors (eating habits and avoiding health

check-ups) and social factors (Wallace, Ricco, & Barrett, 2014). Food plays a more significant

role in human life; food is connected to social contexts, cultural values, and identities

(Nordström, Coff, Jönsson, Nordenfelt, & Görman, (2013). Soul food is a big part of the African

American culture; however according to the American Heart Association, the traditional

Southern diet is high in added fats, fried foods, cholesterol, processed meats and sugar-
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sweetened beverages which lead to an increase risk of CVD. Healthy People 2020 plans to

improve socioeconomic factors include reducing poverty, improving education quality,

increasing access to healthcare services (e.g. Affordable Healthcare Act and Telehealth services),

increasing school programs to include education on healthy lifestyle choices, improving access

to nutritious food, clean water and non-polluted air, and decent and safe housing.

Changing the Context to Make Individuals’ Default Decisions Healthy

The second tier of the pyramid represents interventions that change the environment

context to make healthy options the default choice, regardless of education, income, service

provision, or other societal factors (Frieden, 2010). Interventions at this level include food

labeling; reduced sodium, trans fat and added sugar in the food supply; discouraging food

marketing and advertising to children; increased taxes on tobacco, sugary products and alcohol;

supporting efforts to design workplaces, communities, and schools around active living and

integrate physical activity opportunities throughout the day; smoke free laws; eliminating

tobacco sales in pharmacies and other health-related institutions; and promoting policies that

limit the advertising and sale of tobacco products.

Long-Lasting Protective Interventions

The third level of the pyramid represents 1-time or infrequent protective interventions

that do not require ongoing clinical care. Protective interventions include smoking cessation

programs (Frieden, 2010).

Clinical Interventions

The fourth tier of the pyramid represents ongoing clinical interventions, of which

interventions to prevent cardiovascular disease have the greatest potential health impact (Frieden,

2010). Primary clinical interventions include screening for CVD; checking blood pressure,
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blood test to check for hyperlipidemia, imaging studies (e.g. carotid ultrasound, echocardiogram,

stress tests, and electrocardiography). Controlling hypertension, hyperlipidemia and diabetes

with medications and lifestyle changes (e.g. exercising and eating healthy diets) as well as

aspirin and anticoagulation therapies. Implementing the use of electronic health records (EHR)

has not led to improvements in the quality of care; however, EHR are useful in identify

individuals at risk of developing CVD by readily identifying factor clustering (Wallace, Ricco, &

Barrett, 2014).

Counseling and Educational Interventions

The fifth tier represents health education attained during clinical encounters and other

settings. WHO defines health as “a state of complete physical, mental and social well-being and

not merely the absence of disease or infirmity.” WHO also states that health promotion is a

process of enabling people to increase their control over and improve their health. Nurses play a

vital role in the practice of health promotion and preventive care by advocating for client’s needs

and providing education to increase health literacy. For example, a nurse can provide

information on the healthy diets, make physical activity recommendations and coach individuals

to stop smoking. They also use a holistic approach to see what the client’s needs are by

assessing their values, beliefs and behaviors. Nurses can also provide healing of the mind by

assessing coping mechanism for stress and depression and sharing information about support

groups, programs and services available in clients’ communities to deal with emotional health.

Nurses can advocate for social justice and make suggestions on healthcare reforms to have

policies changed to promote better patient outcomes. Nurses can also start companies or non-

profit organizations to help vulnerable population seek the healthcare they need. For example, a
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home healthcare service that helps the elderly population with compliance with diabetes

medication and administration as well as home visits to monitor blood pressure.

There are many professionals working the public health sector that help with decreasing

the global burden of communicable and noncommunicable disease such as policy analysts,

epidemiologists, medical officers, program managers, health scientist, public health advisors,

field consultants, global health educators and disaster relief support technicians to name a few.

They are employed in government agencies, international organizations (WHO), private research

(universities), faith-based charitable groups (World Vision), industry, banking, and finance (The

World Bank), and international charitable foundations (The Gates Foundation) (Macarthur, n.d.).

In conclusion, the global burden of CVD can be greatly reduced by following a public

health plan and providing evidence-based interventions to improve the populations quality of

life. Primary preventative interventions and helping the population overcome health disparities

is the key to reducing the morbidity and mortality rates of CVD worldwide.
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References

American Heart Association (2018). Southern diet could be deadly for people with heart disease.

Retrieved from:

https://www.heart.org/en/news/2018/07/13/southern-diet-could-be-deadly-for-people-

with-heart-disease

Frieden, T. (2010). A framework for public health action: the health impact pyramid.

American Journal of Public Health. 100(4), 590-595. doi: 10.2105/AJPH.2009.185652

Macarthur, S. (n.d.). Top 10 international public health careers. Retrieved from:

https://www.mphonline.org/best-international-public-health-jobs/

Mendis, S., Puska, P., Norrving, B. (2011). Global atlas on cardiovascular disease prevention

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https://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/

Nordström, K., Coff, C., Jönsson, H., Nordenfelt, L., & Görman, U. (2013). Food and health:

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https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke

Roth, G., et al. (2017). Global, regional, and national burden of cardiovascular diseases for 10

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Wallace, M. L., Ricco, J. A., & Barrett, B. (2014). Screening strategies for cardiovascular
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World Health Organization (n.d.) Constitution. Retrieved from:

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