Viewing Cardiovascular Disease Through a Social-Ecological Lens

As a Registered Nurse in the field of cardiology, I’ve seen firsthand the shock experienced by patients when receiving an initial diagnosis. Whether it’s a sudden heart attack, or an insidious heart failure diagnosis, providers must help patients understand the background of their conditions. Patients are told there are both modifiable and non-modifiable risk factors that lead them to this reality. Generally, providers focus on educating the patient on modifiable factors such as cholesterol, exercise, smoking cessation, high blood pressure and blood glucose levels (University of Ottawa Heart Institute, n.d.). Although, it’s been argued that this downstream approach is insufficient in promoting cardiac health as it fails to address the non-modifiable risk factors and the key social determinants of health (SDH) (Raphael, 2003). Thus, Canadians would benefit from a system that views heart disease through a social-ecological lens, with appropriate public policy changes and public health initiatives.

A social-ecological health model focuses on preventative measures by addressing the social context of an individual. This theory explains that each behavioral and lifestyle choice reflect a person’s own characteristics within their environment (Iowa Department of Public Health, n.d.). Figure 1 outlines the four levels that must be targeted by this framework: individual, relationships, community, and society.

Figure 1

Socio-Ecological Model

Note. This diagram illustrates the four targets of the socio-ecological model of health.

From Socio-Ecological Model, by Iowa Department of Public Health, n.d., (https://hhs.iowa.gov/sites/default/files/portals/1/userfiles/55/socio%20ecological%20model%20overview.pdf). Copyright 2023 by Iowa Department of Health and Human Services.

According to Sims et al. (2020), there is a notable increase in prevalence of heart disease in vulnerable populations. SDH such as race/ethnicity, housing instability and poverty can increase stress levels while limiting access to healthcare and healthy diets. Also, a person’s life expectancy and the risk of experiencing cardiovascular disease is heavily influenced by housing status and poor working conditions (Raphael, 2020, p.11). Utilizing the social-ecological model in the long term would allow health care professionals and public health departments to focus on preventative measures and “create the changes and synergy needed to support sustainable improvements in health” (Centers for Disease Control and Prevention, 2015).

Unfortunately, Canada still has a long way to go to properly address these factors. It is proven that although Canada stands as one of the wealthiest countries in the world, our progress in addressing poverty and other health inequities is poor in comparison to other wealthy nations (Raphael, 2020, p.12). Therefore, it is vital that the Canadian government, public policy makers and public health departments utilize a socio-ecological model to address not only heart disease, but many other chronic health conditions experienced by our population.

References

Centers for Disease Control and Prevention. (2015, June 25). Models and frameworks- The

social ecological model of health. Centers for Disease Control and Prevention. https://www.atsdr.cdc.gov/communityengagement/pce_models.html

Iowa Department of Public Health. (n.d.). Socio-Ecological Model.

https://hhs.iowa.gov/sites/default/files/portals/1/userfiles/55/socio%20ecological%20model%20overview.pdf

Raphael, D. (2003, December 01). Barriers to addressing the societal determinants of Health:

Public Health Units and poverty in Ontario, Canada. Health Promotion International, 18(4), 397–405. https://doi.org/10.1093/heapro/dag411

Raphael, D., Bryant, T., Mikkonen, J., & Alexander, R. (2020). Social determinants of health:

The Canadian facts (2nd ed.). Ontario Tech University Faculty of Health Sciences, York University School of Health Policy and Management. https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf

Sims, M., Kershaw, K. N., Breathett, K., Jackson, E. A., Lewis, L. M., Mujahid, M. S., & Suglia,

S. F. (2020). Importance of housing and cardiovascular health and well-being: A scientific statement from the American Heart Association. Circulation: Cardiovascular Quality and Outcomes, 13(8). https://doi.org/10.1161/hcq.0000000000000089

University of Ottawa Heart Institute. (n.d.) Coronary artery disease patient guide- Risk factors.

https://www.ottawaheart.ca/coronary-artery-disease-patient-guide/risk-factors