Epidemiological and Social Implications of Cardiovascular Diseases

Question 1

What are the 4 main types of CVD

Answer 1

Coronary heart disease (CHD), stroke, peripheral arterial disease, aortic disease

Question 2

What are the risk factors for CVD

Answer 2

High blood pressure (hypertension), smoking, high blood cholesterol, diabetes, lack of exercise, being overweight or obese, family history of heart disease, ethnic background

Question 3

Describe the role of lay epidemiology in CVD

Answer 3

May not take part if think that behavioural change is statistically unlikely to benefit them as individuals. LE accommodates official messages of behavioural risks within the important cultural fields of luck, fate and destiny. Possible barrier to the aims of health education

Question 4

What aspects contribute to who are coronary candidates

Answer 4

1. Gender
2. Ethnicity
3. Environment (e.g. family, partner)
4. Social class
5. Age
6. ‘Lifestyle’ (weight, diet)
7. Genetics (?) – Weiner and Martin (2008)

Question 5

What is the relationship between gender and heart disease

Answer 5

CHD affected mostly men in industrialised countries and had rapid onset in England/Wales. E.g. men: fatty foods & CHD mortality. Sex differences largely result of environmental factors – so not inevitable

Question 6

Why do men have higher rates of heart disease than women

Answer 6

Risk behaviours Work/occupational hazards Social roles and relationships? Social structural differences in society? Ideas of masculinity/masculinities Disadvantage and discrimination? Other forms of inequality?Something else?

Question 7

Masculinity and seeing a doctor

Answer 7

Not going to the doctor. Rejection of ‘being ill’ as proof of masculinity. Are ‘forced’ to seek medical help by female partners and relatives

Question 8

Disparities between masculinity and public health messages

Answer 8

Many men draw on discourses associated with masculinity when talking about the implications of the disease for their identity, relationships, and paid work. Men do' gender when they give the impression of not doing’ health. Yet public health messages may encourage men to do the opposite of norms of traditional masculinity

Question 9

Women and heart disease

Answer 9

Heart disease risk in women is often underestimated due to the misperception that females are ‘protected’. E.g. women excluded from original clinical trials: early trials in USA for white M/C men. Research has often reinforced association between men and heart disease – e.g. white, middle-class executive types

Question 10

Five key processes involved in CVD for women

Answer 10

1. seen as male disease (by health professionals): treatment, diagnosis/symptoms.
2. gendered interpretation of symptoms: stress, anxiety, nerves – trivialised, angry
3. experiencing hierarchy: denied requests for tests – urged to self-monitor instead.
4. not being able to ask questions: anxious & insecure as they did not know how to act.
5. adoption of a disease identity: providers missed social aspects of their experience – e.g. divorce, death of spouse, caregiving, dealing with difficult institutions, etc.).

Question 11

3 processes that limited optimal care for women

Answer 11

1. Disappointment in lack of support from others: sadness, isolation, loneliness.
2. Hiding health problems: prevent affecting social relationships; support others; guilt.
3. Providers framing caring for others negatively: wanted to feel ‘needed’ but health professionals did not get this.

Question 12

What are the possible explanations for ethnicity and heart disease inequalities

Answer 12

Biological inheritance/genetic differences? Socioeconomic status Cultural practices? Effects of migration? Experiences of medical and health care?
Social stress and social support?

Question 13

Explain biological inheritance and/or genetic differences:

Answer 13

Genetically inherited diseases like sickle cell anaemia (Africa, Caribbean, etc.) & thalassemia (South Asian, Middle Eastern, etc.) – but only a minor role.

Question 14

Describe cultural practices and CVD

Answer 14

Important/valued beliefs about disease, bodily impact, disease management – think about the Lee family and epilepsy (Fadiman 1997) – lecture 1

Question 15

Effects of migration on CVD

Answer 15

Elevated risks of mortality post-migration

Question 16

Negative experiences of medical and health care

Answer 16

No interpreters; awareness of services; lower hospital attendance rates, underuse of maternity and dental services amongst BME groups

Question 17

Social stress and social support and CVD

Answer 17

Racism and discrimination, the impact of poverty

Question 18

Why are rates higher in certain ethnic groups

Answer 18

Social determinants. Smoking rates vary considerably between ethnic groups.
Men: rates high in Black Caribbean (37%) and Bangladeshi (36%) populations (women’s rates mostly lower): explained by socioeconomic differences between groups.

Question 19

Ethnicity and hypertension relationship

Answer 19

Disproportionately affecting Afro-Caribbean people in England. Social factors: migration, cultural adaptation, racism, discrimination, etc. Understandings of HT differed greatly from medical descriptions. Care-providers need insight into how migration and cultural adaptation may create major disruption to an individual’s life – and affects their response and adaptation to a diagnosis

Question 20

Ethnicity and heart disease

Answer 20

Lifelong exposure to social/economic stressors associated with early onset of HD in African American-women (contribute to “bad heart”): stress; family disruption & obligations (aging parents, caring for many children, divorce); work / economic hardship; environmental hazards (e.g. housing displacement, crime, residential stability); social pressures – e.g. to be a ‘strong woman’ and play down health issues

Question 21

4 environment position that are linked to stress and CVD

Answer 21

1. work-places.
2. transitional spaces (e.g. travelling to work and leisure).
3. gendered situations (e.g. hierarchies and domestic routines, sexism).
4. exclusions (discrimination)

Question 22

Social cohesion and heart disease

Answer 22

Roseto, Pennsylvania, had nearly no heart attacks for the otherwise high-risk group of men 55 to 64, and men over 65 enjoyed a death rate of 1% while the national average was 2%. But they smoked unfiltered cigars, drank lots of wine, ate fatty foods, and they often worked in hazardous environments (state quarries). Due to Greater social cohesion of this group (“The Roseto Effect”).

Question 23

Inequalities create sense of unfairness & breakdown in social cohesion

Answer 23

breakdown of support for communal structures, loss of private investment and commitment. Individual perceptions of inequality lead to feelings of shame, envy, worthlessness, stress and its poor health consequences, loss of mutuality and reciprocity. These feelings also determine health through: debt, overwork, unhealthy coping behaviours (‘demoralisation’)

Question 24

Which explanations does the weight of evidence point to

Answer 24

Socio-economic circumstances play the major part in subsequent health differences

Question 25

What can constrain healthy choices

Answer 25

Contextual barriers can constrain ‘healthy choices’

Question 26

Age and heart disease

Answer 26

Top causes of death for men aged 20-34 in the UL in 2013: suicide, accidental poisoning, transport accidents. Top causes of death for men aged 65-70 in the UK in 2013: heart disease, lung cancer, emphysema/ bronchitis

Question 27

Social class and heart disease

Answer 27

Are social class differences in health inevitable? Does your social position determine how likely you will be at having a heart event? Health selection (ill health leads to social position) or social selection (social position leads to health)? The feckless - personal ‘lifestyle choices’ of those in difficult circumstances? How does this fit with a medical professional ethic?