Epidemiological and Social Implications of Cardiovascular Diseases Flashcards
What are the 4 main types of CVD
Coronary heart disease (CHD), stroke, peripheral arterial disease, aortic disease
What are the risk factors for CVD
High blood pressure (hypertension), smoking, high blood cholesterol, diabetes, lack of exercise, being overweight or obese, family history of heart disease, ethnic background
Describe the role of lay epidemiology in CVD
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
What aspects contribute to who are coronary candidates
- Gender
- Ethnicity
- Environment (e.g. family, partner)
- Social class
- Age
- ‘Lifestyle’ (weight, diet)
- Genetics (?) – Weiner and Martin (2008)
What is the relationship between gender and heart disease
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
Why do men have higher rates of heart disease than women
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?
Masculinity and seeing a doctor
Not going to the doctor. Rejection of ‘being ill’ as proof of masculinity. Are ‘forced’ to seek medical help by female partners and relatives
Disparities between masculinity and public health messages
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
Women and heart disease
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
Five key processes involved in CVD for women
- seen as male disease (by health professionals): treatment, diagnosis/symptoms.
- gendered interpretation of symptoms: stress, anxiety, nerves – trivialised, angry
- experiencing hierarchy: denied requests for tests – urged to self-monitor instead.
- not being able to ask questions: anxious & insecure as they did not know how to act.
- adoption of a disease identity: providers missed social aspects of their experience – e.g. divorce, death of spouse, caregiving, dealing with difficult institutions, etc.).
3 processes that limited optimal care for women
- Disappointment in lack of support from others: sadness, isolation, loneliness.
- Hiding health problems: prevent affecting social relationships; support others; guilt.
- Providers framing caring for others negatively: wanted to feel ‘needed’ but health professionals did not get this.
What are the possible explanations for ethnicity and heart disease inequalities
Biological inheritance/genetic differences? Socioeconomic status Cultural practices? Effects of migration? Experiences of medical and health care?
Social stress and social support?
Explain biological inheritance and/or genetic differences:
Genetically inherited diseases like sickle cell anaemia (Africa, Caribbean, etc.) & thalassemia (South Asian, Middle Eastern, etc.) – but only a minor role.
Describe cultural practices and CVD
Important/valued beliefs about disease, bodily impact, disease management – think about the Lee family and epilepsy (Fadiman 1997) – lecture 1
Effects of migration on CVD
Elevated risks of mortality post-migration
Negative experiences of medical and health care
No interpreters; awareness of services; lower hospital attendance rates, underuse of maternity and dental services amongst BME groups
Social stress and social support and CVD
Racism and discrimination, the impact of poverty
Why are rates higher in certain ethnic groups
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.
Ethnicity and hypertension relationship
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
Ethnicity and heart disease
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
4 environment position that are linked to stress and CVD
- work-places.
- transitional spaces (e.g. travelling to work and leisure).
- gendered situations (e.g. hierarchies and domestic routines, sexism).
- exclusions (discrimination)
Social cohesion and heart disease
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”).
Inequalities create sense of unfairness & breakdown in social cohesion
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’)
Which explanations does the weight of evidence point to
Socio-economic circumstances play the major part in subsequent health differences
What can constrain healthy choices
Contextual barriers can constrain ‘healthy choices’
Age and heart disease
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
Social class and heart disease
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?
