The determinants drive the risk factors

• The determinants drive the risk factors:

  • The Dahlgren and Whitehead model (1991) of health determinants provides a valuable insight into the many determinants that may affect health behaviours and health outcomes, and gives us an appreciation for how their influence can relate to the distribution of health effects among different population groups
  • Cardiovascular health is a subset of general health and wellbeing, and is moderated by the wider socio-economic, cultural and environmental conditions within which the individual lives

  
• The determinants drive the risk factors:

  • Cardiovascular health is greatly influenced by social determinants
  • According to the WHO, the social determinants of health are the conditions in which people are born, grow, live, work and age
  • When working with your patients, its worth considering some of the social determinants influence health throughout the life course:
  • gender
  • early child development
  • education
  • literacy
  • culture
  • employment status & working conditions
  • income and social status
  • housing
  • local environment
  • personal health practices
  • healthcare access
  • social support network
• Social and Economic Factors:

  • An individual’s social and economic position is directly linked to health
  • It has long been recognised that a health inequalities gradient exists; with the least advantaged populations experiencing the worst health
  • This has also been the focus of considerable research in cardiovascular disease; with an inverse relationship being found between CVD and many socio-economic indicators
• Social and Economic Factors:

  • NICE public health guidance 6, ‘Behaviour change at population, community and individual levels’ (2007) recognises the impact of this social and economic position and its direct link to health, with health inequalities being the result of a set of complex interactions, including:
  • The long term effect of a disadvantaged social position
  • Differences in access to information, services and resources
  • Differences in exposure to risk
  • Lack of control over own life circumstances
  • A health system that may reinforce social and economic inequalities
• Psychosocial Determinants:

  • Psychosocial factors include both the social conditions and the psychological processes that can potentially influence health
  • examples:
  • Personal behaviour & lifestyle influences – diet, physical activity, smoking & alcohol consumption
  • Cognitive factors & attitudes to health – control, self-efficacy, risk perception & perceived susceptibility
  • Dispositional influences – personality type & coping styles
  • Emotional factors & chronic stressors – depression, anxiety, work stress
  • Social factors – living & working conditions, social support & social participation
• Psychosocial Determinants:

  • Psychosocial risk factors, such as inadequate social support or lack of social networks, work stress and depression, have been found to contribute to the risk of CHD and worsen the clinical course and prognosis (Piepoli et al, 2016)
  • Many studies have linked stress, depression, and anxiety to an increased risk of coronary heart disease and cardiovascular death
  • A number of mechanisms are deemed responsible for this increased risk of CVD in the presence of psychosocial risk factors and have been the subject of intense scientific research for decades
• Psychosocial Determinants:

  • One area of study has focused on the physiological changes which take place in the body when exposed to emotional factors or chronic stressors, for example, when an individual is experiencing significant work/family related stress
  • Physiological changes, such as the activation of the renin-angiotensin system and its effects on blood pressure and inflammation, may accelerate the development of coronary atherosclerosis and therefore increase the risk of CVD (Theorell et al, 2015)
• Psychosocial Determinants:

  • Emotional factors and chronic stressors, such as stress and depression, may also change the behaviour of the people exposed to them, leading to an increase in unhealthy behaviour patterns such as smoking, excessive alcohol intake, unhealthy eating and non-adherence to cardio-protective medication, all of which contribute to an increased risk of CVD (Chandola et al, 2008; Whooley et al, 2008)
• Psychosocial Determinants:

  • Furthermore, in examining this link between psychosocial risk factors and increased risk of CVD we also need to consider the impact of socioeconomic factors
  • Research has shown that psychosocial risk factors tend to be more prevalent among individuals in lower socioeconomic groups, with more people within this social bracket developing and dying from coronary disease because of a clustering of CVD risk factors, including psychosocial, lifestyle and biomedical factors (Perk et al, 2012)