Integrated Analysis: Addressing the Burden of Heart Disease in Canada

As a Registered Nurse and Clinical Care Leader in the field of heart disease, I’ve spent many years solidifying my knowledge and skills related to cardiovascular diseases, rehabilitation, and treatment modalities. Throughout this course, I’ve had the opportunity to shift my focus to a broader understanding of heart disease by expanding my knowledge of the various complexities within the Canadian healthcare system. I discovered that to properly address cardiovascular disease prevention and treatment, it is important to understand the key components that influence the overall health of Canadians. An important first step is reflecting on modern definitions of health and the importance of the social determinants of health (SDM) to target the complex needs of vulnerable populations in Canada, such as minority groups and Indigenous Peoples. This allows providers to properly address the inevitable influence of social structures on the health of Canadians by utilizing a multi-level socio-ecological health model to address cardiovascular disease (Collaborative for Health & Environment, n.d.). Each component is an important piece of the puzzle that must be recognized by healthcare providers, policy makers and public health agencies to ease the burden of heart disease on Canadians.

Defining Health

Earlier in the semester, the course learnings focused on past and present definitions of health. Notably, the most well-known definition of health was created by the World Health Organization (WHO) in 1948. The WHO defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, n.d., para 1). This definition is often critiqued by modern health professionals, due to its lack of consideration for the social determinants of health (SDH). Misselbrook (2014) argues that this definition is unattainable and unrealistic as it focuses solely on the absence of abnormalities. I analyzed this definition further in my blog post “Defining Health in our Modern World”, and presented an alternate definition by Starfield (2001) that effectively considers the influence of social, interpersonal, biological and physical environments on the total health of individuals.

The Social Determinants of Health

Moreover, the SDH outline the non-medical factors that influence an individual’s health (Ontario Hospital Association, n.d.). This includes elements such as race, housing stability and working conditions. A complete list of SDH affecting Canadian’s health are demonstrated below in Figure 2.

Figure 2

Eco-Social Determinants of Health

From Social Determinants of Health, by Think Upstream, n.d. (https://www.thinkupstream.ca/social-determinants-of-health). Copyright 2023 by Think Upstream: a project of the CCPA.

In the context of heart disease, understanding and applying the SDH in cardiac care and prevention is essential. This was made clear through my literature review and content curation throughout this course. The burden of heart disease in Canada is undeniable, with over 2.5 million Canadians affected in their lifetime (Public Health Agency of Canada, n.d.). Also, it is confirmed as the second most prevalent cause of hospitalization and death in Canada aside from cancer. Through a social lens, it is proven that a person’s life expectancy and risk of cardiovascular disease is strongly linked to their housing status and working conditions (Raphael et al., 2020). In addition, according to Sims et al. (2020), Canadians facing racial and socio-economic challenges are more likely to face increased levels of stress, limited access to health care and heart healthy foods. Due to these inequities and challenges related to the SDH, vulnerable populations are at an increased risk of developing heart disease in their lifetime.

Marginalized Populations in Canada

Furthermore, the variability and imbalances described within these structural factors create marginalized populations (Baah et al., 2019). During the course module specific to vulnerable populations, I explored further into the disparities experienced by Indigenous Peoples, ethnic minorities, and women in the context of heart health. Each of these groups face unique geographical, historical, genetic, and social challenges that have proven to increase their risk of developing and dying from heart disease (Canadian Women’s Heart Health Centre, n.d.). For example, the risk of mortality from cardiovascular disease for people aged 25-34 years old is 217% higher for Indigenous women compared to non-Indigenous women (McMaster University Health Sciences, 2023). This is largely due to poor socio-economic and legislative factors that have been established over time and worsened throughout Canadian history. According to Vervoot et al. (2022), “socioeconomic status, trust in the healthcare system, social supports, access to education and health literacy, and the affordability of cardiovascular medications have also been associated with cardiovascular health and worse outcomes among 8 First Nations communities across Canada” (p.783). Likewise, Indigenous Peoples face greater challenges in accessing culturally sensitive and high-quality health care in a timely manner. Figure 2 further outlines the relationship between ethnic minorities, the SDH and the risk of cardiovascular disease.

Figure 2

Ethnic Minorities and the Social Determinant of Health Framework

From “Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease” by Javed et al., 2022, Circulation: Cardiovascular Quality and Outcomes, 15(1), p. 74 (https://doi.org/10.1161/CIRCOUTCOMES.121.007917). Copyright 2021 by American Heart Association.

Unfortunately, Canada’s progress of addressing poverty and other health inequities faced by marginalized populations falls far behind other wealthy nations (Raphael et al., 2020). This is attributed to weakening of social supports and cuts in social assistance programs available. The Canadian healthcare system continues to primarily utilize downstream behavior-modifying methods to heart health education, which are deemed as insufficient in addressing the systemic social issues at the root of cardiovascular disease (Raphael, 2003).

The Social-Ecological Model

Subsequently, these findings highlight the importance of utilizing a multi-level approach in addressing cardiovascular health treatment and prevention. The social-ecological model (SEM) is a healthcare framework that recognizes the undeniable influence of the environment on an individual’s overall health (Centers for Disease Control and Prevention, 2015). To view and treat heart disease through a SEM lens, providers and public health agencies must consider four important targets: the individual, their relationships, community, and society. Thus, putting the focus on improving the quality of social structures rather than only individual behavior modification.

The individual level encompasses one’s personal traits such as age, health history, financial status, and level of education (Iowa Department of Public Health, n.d.). It is best targeted by downstream methods and reducing at-risk behaviors through education. In the case of heart disease, most sectors focus on risk factor modification strategies like weight and blood pressure control, heart healthy diets, lowering stress triggers and quit smoking programs (University of Ottawa Heart Institute, n.d.). The second layer focuses on one’s close relationships including friends, families, and colleagues. These close bonds are proven to directly influence behaviors and habits (CDC, 2015). Evidence shows that ensuring proper support at this level and reducing social isolation can reduce the risk of heart disease in individuals (Hold-Lunstad & Smith, 2016). Further, the community level can be addressed by ensuring affordable and safe housing, as well as sufficient employment opportunities to reduce disparities faced by vulnerable populations (Raphael et al, 2020). Implementing effective initiatives within communities is key due to the strong evidence demonstrating the link between poor neighborhood conditions and increased risk of heart disease (Sims et al, 2020). Lastly, utilizing policy approaches and media marketing to target heart disease at the society tier has been proven effective in reducing the likelihood of heart disease throughout many countries worldwide (Pearson, 2011). For example, by increasing the price of tobacco and restricting purchasing accessibility, policy makers can target at-risk behaviors. They can also promote healthy behaviors by reducing costs of heart healthy foods in grocery stores and markets. Likewise, many socio-economic challenges can be addressed by governments through adequate minimum wage and social assistance programs (Raphael, 2001). For marginalized communities, each of these pillars of the SEM model must be addressed to ease the burden of heart disease on Canadians.

Conclusion

As healthcare providers, our responsibilities to patients span further than providing care in a clinical setting. With millions of Canadians affected by heart disease in their lifetime, understanding the intricacies of our healthcare system and modern definitions of health is key in preventing many of the medical conditions we are treating on the frontlines. Throughout this course, I developed a broader understanding of the various social predispositions of heart disease and in turn became a better advocate and educator for marginalized populations. Evidently, public health agencies and policy makers still have progress to make to reduce the prevalence of chronic health conditions. Therefore, the overall heart health of Canadians depends on the contributions and prioritizations of society, and this must be considered while planning and establishing future directions within our healthcare system.

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