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Efforts Continue to Understand Societal Impact on Health

American Heart Association News
August 31, 2017

For decades, researchers have been piecing together the unfortunate reality that wide-ranging societal factors affect people’s health.

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It’s still too early to know precisely how these things impact heart disease, stroke and other major health problems.

But, as work continues to fully understand these relationships, there’s no denying the very real effects of these factors known as “social determinants of health.” These factors include culture, education, income, access to health care, housing and environment.

Here’s a look at some efforts around the nation to better understand and address these problems:

In the Denver area, Colorado Black Health Collaborative, Inc., works with physicians, fitness instructors, nutritionists and other medical and wellness professionals to promote healthy habits.

Internist Terri Richardson, M.D., a board member with the Aurora-based nonprofit, said it’s important to recognize the way someone’s job, access to neighborhood parks, availability of public transportation and other conditions may impact health.

“When people think about disease, they think, ‘well, if I’m overweight or obese, I eat too much,’” said Richardson, who works with Kaiser Permanente and has been a physician for 30 years. “People don’t often think, ‘if I have educational attainment, that’s going to impact my health.’”

One of the group’s health education projects is a blood pressure and diabetes check program at salons and barbershops.

Longtime hairstylist Rosalyn Redwine of Denver found the experience to be quite the education.

She knows firsthand how important it is for people to know their health numbers, such as blood pressure and blood sugar. She said her mother never checked hers, and by the time she was diagnosed with congestive heart failure, there’s wasn’t much doctors could do.

Despite her story, at the salon, some of her clients resisted.

“I think that it was fear that made them not want to check their blood pressure, to know how their cholesterol was running for fear of going on medication — of then having to change their diet and lifestyle and the way they eat,” she said. “Because once you have high cholesterol, and when you have high blood pressure, you have to change the way you eat if you want to live.”

A diabetes management education program funded by the federal Centers for Disease Control and Prevention helped Barbara Gordon tackle the high rates of diabetes among seniors in rural Kentucky. According to CDC statistics, the diagnosed diabetes rates in the three-area counties she targeted were higher than the national estimate.

Gordon and fellow health educators at the Kentuckiana Regional Planning and Development Agency partnered with physicians and community groups to distribute information on diabetes management and nutrition. They also offered blood sugar control classes and helped restore education programs.

Gordon, the director of social services for the planning authority, said this is critical in communities such as hers where many are poor, may have grown up eating unhealthy foods and where the nearest diabetes specialist is at least 30 miles away.

For many people who needed help controlling their blood sugar levels, Gordon said: “It wasn’t that the physician didn’t give them the information. The issue was that, ‘Yeah I have all this information but I don’t have a clue on how to make this realistic and practical in my own life.’”

In a predominantly low-income Hispanic and Latino neighborhood near Washington, D.C., a recent study found mothers were concerned their children consumed too much soda and fruit juice and not enough water.

Soon after the findings were published, researchers enlisted food vendors to encourage customers to drink water, said Uriyoán Colón-Ramos, Sc.D., the study’s lead investigator and an assistant professor of nutrition, food programs and policies at George Washington University.

Rigoberto Flores said he signed up right away because he’s noticed how many children and adults around him are overweight or obese. One of his daughters struggled with her weight as a child, Flores said.

“I’ve always thought that a healthy community will yield more fruitful results,” said the 45-year-old businessman from nearby Hyattsville, Maryland.

Flores said he encourages customers at his food establishment to choose water. He said being part of the program has motivated him to eat more fruits and vegetables and drink more water.

George A. Kaplan, Ph.D., former professor of social epidemiology at the University of Michigan, said it’s all well and good to offer people health education programs, but there is a need for much more.

That includes improving the quality of public school education, ensuring land-use policies encourage health living, and enforcing state laws that regulate industrial pollution.

“Landscapes of exposure are drastically different depending on who you are and where you live,” said Kaplan.

Other efforts include large-scale prevention programs that encourage people to exercise, eat healthy foods and keep tabs on their blood pressure, and “that requires political will because that requires money,” said Salvador Cruz-Flores, M.D., chair of neurology at the Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center in El Paso.

Cruz-Flores co-authored a recent American Heart Association report suggesting societal conditions — more than biology — explained why the rates of obesity, high blood pressure and diabetes had shot up over the past 25 years and why health organizations need to press for change.

The longtime stroke specialist said he recognizes it’s daunting to study how and why a person’s social circumstances affect health. He said it’s even harder for physicians to address them during their busy daily schedules.

But, Cruz-Flores said, some of the very basic premises of health care need to be re-examined.

“Let’s start by the definitions,” he said. “How do you define the poor? How do you define a good versus bad place to live? How do you define good social support?”

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