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The Impact of Social Determinants on Cardiovascular Disease

A brief history of the before, after, and in-between.

 

Evidently, there are dozens of populations that face inequities in healthcare. This was even more so accelerated due to the COVID-19 pandemic. This international state of emergency heavily impacted the large-scale interventions in the daily lives of those with social determinants. There are many medical factors that have been swept under the rug during the pandemic, so let us shine a light on the heart of the matter.


Before the pandemic, heart failure was the leading cause of admission into hospitals-- which can strike anyone at any age. But what other factors go towards getting a heart attack so severe at any given moment, that your body may never be able to be the same again?


If you were on your big and clunky computer just two decades ago, and (for whatever reason) looked up; what’s the leading cause of death in the world? You would get hundreds of websites in less than a second, all of them saying the same thing: Infectious diseases. If infectious disease has been what’s killing people for millennia, how has cardiovascular disease so suddenly (but not too subtly) risen to the top?


Before the pandemic, 1 in every 5 deaths was due to heart disease. Now, it’s 1 in every 3. In 2020 alone, 697,000 people died from heart disease or stroke during the COVID-19 pandemic.Cardiovascular deaths are heavily determined by environmental and genetic risk factors. The increasingly high global mortality rate that resulted from cardiovascular deaths only after the pandemic, shows that environmental and socioeconomic risk factors now play an even larger role that must not be overlooked.


In theory, heart attacks can happen to anyone; but, there are many social determinants that impact the health of people living in certain communities subjugated to health inequity. For example, more than 80% of cardiovascular deaths occur in low-income countries. The epidemiological transition of industrialization shifts major deaths rates from infectious disease or nutritional deficiencies to degenerative diseases of the heart. It is even predicted that China will soon “experience a rapid escalation of coronary artery disease surpassing the current one-third of total lives that it claims each year” due to the shift towards “Westernized diets”. The greatest determinant of health is not age, or any other factor that can be controlled. It is socioeconomic status, which has been controlled from the start.



The Income Gap of Cardiovascular Diseases. Shows that Aborignal peoples (indigenous, American Indian/Alaska Native) have lower income and a much higher risk of CVD (cardiovascular death).

 

In the early times of the Sars-Cov-2 pandemic, there were studies being conducted about the correlation between heart attacks and the virus, but research stopped after the need to create a vaccine became more prevalent. People who experience symptoms of Covid-19 are 63% more likely to develop heart issues for the next year, even if their symptoms were minor. The confusing part is that symptoms of the virus can mimic those of a heart attack. This perplexing disease has left the cardiology field underfunded.


However, marginalized communities in America were even so more impacted by CVD after the pandemic. Studies have found that African Americans living in the most impoverished neighborhoods have a higher risk of CVD due to less investment in parks, leading to fewer opportunities for safe exercise. In addition, 25.4% of Native Americans are living in poverty, anexperienced a loss of insurance and decrease in quality food as a result of the pandemic, directly increasing the likelihood of developing a cardiovascular disease.


Those who face disadvantages in healthcare due to social determinants have“half the deck” than people who are not impacted by the same socioeconomic factors.


So what? Why should we care about ethnic disparities in healthcare?The US is increasing in diversity, and the burden of mortality for marginalized communities results in higher costs for health for everyone. A cardiovascular disease that is left untreated can result in higher and more expensive complications such as transplants or surgeries for everyone. Overuse of services by people at an economic advantage just because they have access leads to diagnostics that ⅔ of the time are not related to CVD in any way. This reduces the efficiency of care and treatment response time.


Thus, it is crucial for disadvantaged groups to be identifies and intervention plans to be made in order to improve population health. National health through surveillance screenings and monitoring systems are already established; but, there are simply too many groups at a disadvantage to account for them all. There are homeless people living under bridges and single mothers taking care of families on their own. Who’s there to screen them? People in the scientific community especially need to advocate and educate others on these socioeconomic disadvantages in healthcare.


As per the famous words of Micheal Curry, the CEO of the Massachusetts Public Health Association, Michael Curry said that “sometimes it takes time for truth to catch up to history.”


Be the voice. Light the way for change. Make a difference in the hearts of those who are most disadvantaged in American society.







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