Social Determinants of Health as Risk Factors for Cardiovascular Disease in Australia
Cardiovascular disease is one of the leading causes of death for the high-income countries such as Australia. It is projected that it will be the leading cause of death in the world by the year 2030. Majority of the research on the disease has been focused on identifying, modifying and treating the risk factors at the individual level. In spite of the massive achievements, great inequalities persist over time and space. The increase in the cardiovascular diseases has led to a movement towards the study of the risk factors (Davidson, 2014). The risk factors that are currently being studied include the causes of the disease which include social determinants of health such as the inherent inequalities that are observed in the health between the different regions in Australia. The paper will focus on the role of the social determinants as well as the epidemiological transition and inverse social gradient also known as the persistent trend, the impacts of the social determinants in Australia will also be explored and possible solutions and the future directions that medical practice should take to reduce the varied impacts of the social factors on the cardiovascular health.
Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity in Australia accounting for more than one-third of the total deaths (Mirzaei, Truswell, Taylor & Leeder, 2009). CVD is also the leading cause of con-communicable mortality and morbidity especially in the middle-income and low-income countries (Page, Lane, Taylor & Dobson, 2011; Psaltopoulou et al, 2017). The most important advancement that has been made is with regards to the identification of the risks factors of CVD thus allowing for the development of treatments and rigorous testing that focuses on the modification of the risk factors with the main goal of prevention.
A study undertaken by INTERHEART by Yusuf et al (2004) as cited in Garcia et al (2017) that considered over 27,000 cases from 5 control countries came to the conclusion that over 90 percent of the risks for myocardial infarction can be explained through nine modifiable risk factors:
- Apolipoprotein B/apolipoprotein A ratio
- Smoking is a major
- Abdominal obesity
- Fruit/ vegetable consumption
- Psychosocial factors
- Alcohol consumption
- Physical activity
Therefore, the modification of such risk factors will significantly reduce the risk factors thereby improving the cardiovascular health of an individual. Even in the case of the advances in both the secondary and primary prevention of the cardiovascular disease, some inequalities still exist between time and space. To the present date, most of the epidemiological studies have mostly emphasized the identification, modification, and treatment of the individual risk factors that are linked to CVD. The risk factors for the cardiovascular conditions have been on the rise in the different countries including Australia.
The social determinant of health is a term that is used to describe the impact of the social environment in which a person lives on their health such as the conditions of work, where a person grew, where they were born and their current age. Also, they describe the economic conditions such as the distribution of power, money, and resources at both the national, local and global levels. The social determinants of health also include the healthcare systems that are in place especially the role the healthcare systems play in creating the inequalities that exist (Davidson, 2014; WHO, 2010). Research undertaken has indicated that economic development significantly impacts the social health of individuals. The risk factors for some cardiovascular diseases such as hypertension, obesity, and diabetes has been on the rise in the globe. The section below will explore the social determinants of health in terms of CVD and in the aboriginal communities in Australia.
Epidemiological transition refers to the patterns of disability and death that have been observed over a period of time. When societies become more underutilized and urban, the infant mortality decreases thus leading to a shift of major causes of disability and death from infectious diseases and nutritional deficiencies to on-communicable diseases such as CVD resulting in an increase in the life expectancies. This shift is known as an epidemiological transition (Sanderson, et al, 2007). The transition takes five main stages: first, the age of famine and pestilence where the countries go through their earliest stages of development. Here, the deaths from CVD are very minimal accounting to less than 10 percent of all deaths. The second stage is the age of receding pandemics were the burden of infectious diseases is significantly reduced due to the improvements in nutrition. This is the stage where the deaths from CVD start to increase especially manifested through coronary heart diseases, rheumatic heart diseases, stroke, and hypertension. The third stage is the age of human-made and degenerative diseases characterized with increasing life expectancy, cigarette smoking, diets that are high in fat contents especially the increased consumption of fast foods and people adopting more sedentary lifestyles (Psaltopoulou, et al. 2017).). The fourth stage is referred to as the age of delayed degenerative diseases where the deaths from CVD account for up to 50 percent of all the deaths. People start to die from heart failure, stroke, and artery diseases, especially in their old age. Finally, there is the age of social upheaval and health regression in cases of breakdown in the healthcare systems. The epidemiological transitions occur at both the federal level and the state levels in Australia with the transition occurring due to the increases in the levels of income, industrialization, rural to urban migration and wider access to healthcare. A demographic transition also takes place where the fertility declines and the age mortality rates also reduce (Fawcett & Blakely, 2007). When the life expectancy increases, the result would be a shift in the nutrition thus exposing the population to diets that are high in fat and animal products, low physical activity, sedentary behaviour and the elevation of blood pressure, blood sugar, body weight and lip concentration. In Australia, this condition has been true as there is a dramatic increase in the body mass index (BMI) and high blood cholesterol levels due to the increase in fat consumption in the fast foods.
Cardiovascular risk factors and their social determinant in Australia will be discussed. According to the high mortality rates that it leads between 7.2% and 3.1 % in 1993 to 2015 for the people who aged between 55 and 64 years (AIWH, 2017). Put another way, CVD affects one out of every six Australians translating to 4.2 million people. A total of 45,392 Australians dies in 2015 due to CVD representing approximately 30 percent of all the deaths in 2015. All the deaths from CVD could be prevented if appropriate healthcare was provided (Heart Foundation, 2017). The prevalence rates when comparing the age and sex across the different groups in Australia indicate that there is an increase. The above data can be considered based on the inverse social gradient. Low income households have a higher vulnerability to the CVD as compared to those with higher economic and social status. This can help to explain the above statistics by the government that the rates have been reducing. These statistics is consistent with the view that people in the lower income groups especially in the urban centres have a greater risk factor to smoking.