Cardiovascular diseases (CVDs)

In the US, cardiovascular diseases (CVDs) are the primary cause of early death. As a result, these cardiac problems are extremely expensive for Americans. Ironically, the majority of the risk factors for diseases like heart disease and stroke are mostly avoidable. These are only a few of the factors that led the Healthy People 2020 program to list heart disease and stroke as two ailments that Americans must address in order to lower the nation's morbidity and mortality rates. In particular, heart disease and stroke are two disorders that are affected by several of the factors discussed in this article. The commitments that the healthy people 2020 have in terms of dealing with CVDs are also highlighted. There have been multiple interventions aimed at dealing with heart disease and stroke as well as other heart conditions in the US. Two of these interventions: health promotion and risk reduction in the general population, as well as integrated programs are discussed in this text. Health educators are essential players in the fight against heart disease and stroke. Their exact role in this fight is highlighted.

Keywords: CVD, heart disease, stroke, healthy people 2020, interventions

Heart Disease and Stroke

Heart disease refers to any form of cardiovascular condition that affects the normal functioning of the heart. Some of these conditions may involve the narrowing or blocking of blood vessels which may, in turn, lead to stroke, heart attack or angina. Some other conditions which are also considered to be cardiac illnesses include those which affect the hearts muscles, valves and rhythm. Heart disease and stroke is a major community health issue in the US as it is the country’s leading cause of death (Murphy, Kochanek, Xu & Arias E, 2014). The geographical distribution of heart related health conditions is also such that they are the most widespread in the United States. Furthermore, these conditions cost a considerable amount in terms of financial resources. In fact, according to Healthy People 2020 website, the two aforementioned conditions cost the nation approximately $320 million per year (Mozaffarian et al., 2016). This lays a heavy burden on the nation’s annual budget as compared to other health conditions.

Apart from the direct, quantifiable financial costs, heart disease and stroke also lead to a decreased quality of life by the affected and sometimes even disability. This combination of factors leads to a great dent in the American economy in terms of lost revenues from workers who are forced into retirement by these conditions. All these concerns make the issue of dealing with these sicknesses urgent and of significant importance to the American government and even the American citizen.

Cardiovascular events are so prevalent among adults in the US to the extent that more than 1 out of every 3 American adults is affected (Yoon, Fryar & Carroll, 2014). Unfortunately, however, among those affected, just approximately 50% of them have the condition under control. The distribution of heart disease and stroke in terms of age, gender, race, geographical location, and socioeconomic status is highly irregular and disproportional. According to Roger et al., (2010), more than 82.6 million people in the US had a form of heart condition in 2010. About 16.3 million people aged 20 years and above suffer from coronary heart disease (CHD). Whereas the prevalence for men is 8.3% while that of women is 6.1 percent, the general population prevalence for CHD is about 7%. White men of non-Hispanic origin have the highest prevalence of heart disease, at 8.5%. Following closely are non-Hispanic black men, with a prevalence of about 7.9%. At 6.3 percent, Mexican American men are the lowest among the male gender. Among the women, Non-Hispanic black women are at the top, at 7.6%. Non-Hispanic white women follow at a distance with a prevalence rate of 5.8%. Mexican American women are the lowest at 5.6%. This data clearly suggests that men are at a higher risk of suffering from heart disease as compared to women. Also, people of the Hispanic origin seem to have the most resistance to heart disease.

As of stroke, about 7 million people aged 20 years and above have had at least one stroke incidence. People who have had a stroke before tend to be very likely to experience recurrent episodes. Considering the age above 18 years, 2.7% of men have had a stroke, compared to a figure of 2.5% for women. In terms of race, according to reports by NHLBI, blacks are twice as more likely to encounter a stroke for the first time as compared to whites. Out of 1000 black males and females, 6.6 and 4.9 of them aged between 45 and 84 are likely to encounter a stroke, respectively. On the other hand, the same population of white males and females has 3.6 and 2.3 of them getting a stroke, respectively.

As the data above indicates, Americans have to bear a huge burden due to CVDs both in terms of morbidity and mortality. Mortality data indicates that 2200 Americans lose their lives each day to heart related conditions (Roger et al., 2010). Needless to say, more men than women lose their lives to these cardiovascular conditions.

The aim of this paper is to examine the risk factors as well as the health enhancing factors connected with heart disease and stroke, as well as the various interventions that have been put in place to combat this condition.





Risk Factors and Health Behaviours

There are many health risk factors that contribute to the development of most cardiovascular conditions including heart disease and stroke. There are behaviours that can be adopted to reduce the risk of developing heart disease and stroke among other CVDs.

The issue of heart disease and stroke is complicated by the fact that a combination of factors may contribute to its deterioration. Elevated total blood cholesterol, often if combined with some other factors, can be deadly. High cholesterol levels lead to atherosclerosis, which may lead to or get worsened by high blood pressure. As a person’s cholesterol levels are also affected by age, sex, hereditary traits or even diet, a potential victim of CVD may have these conditions accelerate the development of heart complications. Between 2005 and 2008, more than 33 million adults in the US had high total blood cholesterol, with only less than half of this number aware of this condition.

Physical inactivity is also another significant risk factor when it comes to cardiovascular diseases. The engagement in moderate to vigorous physical activities substantially reduces the possibility of heart disease and stroke. Physical activity aids in eliminating some of the CVD accelerating factors such as cholesterol, hypertension, diabetes, and obesity. Engaging in regular physical activity leads to the heart beating at 70% the maximum heart rate and above. The physical activity guidelines suggest more than 60 minutes of physical activity on most days of the week. Unfortunately, less than half of young people aged 14 to 17 years old meet this threshold in the USA.

Obesity, on the other hand, comes about due to the lack of physical activity, often in combination with unhealthy eating habits. Stress is also a major contributor to obesity in most Americans. Obesity alone can lead to the development of heart conditions, even without other factors coming into play. Furthermore, being overweight affects other CVD risk factors such as hypertension, hyperlipidaemia, and diabetes. The likelihood of developing heart conditions is increased by about 20% for overweight people.

Cigarette smoking is a habit that has been determined to increase the potential heart disease conditions and stroke. Smoking has been established to cause an increase in blood pressure, decrease in exercise tolerance as well as fasten the blood clotting process (Dinas, Koutedakis & Flouris, 2013). Atherosclerosis is also hastened by cigarette smoking. The first four years marking the start of the second millennium also marked the death of 443,000 early deaths connected with CVDs and which can be directly linked to cigarette smoking. A smoker is between twice and four times more likely to develop heart conditions as opposed to a non-smoker.

Most of the risk factors mentioned above are highly interconnected in an intricate web or chain. However, one may develop or increase the effects of one of them at any given time. For this reason, any factor among cigarette smoking, hypertension, high cholesterol, diabetes, poor eating habits, lack of exercises, and overweight/obesity can spell the danger of the development of heart malady or stroke.

The above discussion indicated that there is a great challenge facing the American population concerning the control of cardiovascular disease through the manipulation of factors that can highly enhance the conquering of these heart conditions. The fact that most of the health enhancing factors are under the total control of the at-risk population is what makes the Healthy People 2020 initiative to highly focus on them. According to Healthy People 2020, the risk that the American citizen faces of developing and maybe dying from heart diseases, stroke, or any other cardiovascular disease can be highly reduced in case more efforts are put into the control of Americans’ diet and physical activity. Furthermore, efforts should be put in controlling high blood pressure, cholesterol, diabetes, and Americans encouraged quitting smoking.









Healthy People 2020 Aims and Commitments

Healthy People 2020 is an initiative by multiple organizations and individuals aimed towards the achievement of longer, more fulfilling healthy lives by all Americans (Healthy People 2020, 2017). This initiative was officially launched in 2010 and thus aimed to work for the next 10 years to meet this objective. The scientific data that Healthy People 2020 operates on, however, is informed by three decades of research and monitoring of progress in the public health sector. These data is helpful in terms of encouraging collaborations in multiple facets of society and different sectors and individuals. Moreover, Healthy People 2020 aims at influencing Americans towards making more informed health decisions. The Healthy People 2020 initiative also constantly assesses the impact of preventive measures in order to gauge their performance.

Healthy People 2020 aims at increasing the quantity and quality of life enjoyed by Americans, and for this reason, their vision is a society where all people live long, healthy lives. The main objectives of the programme, as indicated on their website, include: ensuring that the American citizen attains a high quality, extended lifespan free of preventable diseases, injuries, disability, and early death (Healthy People 2020, 2017). As the benefits in the health sector are unequally distributed, the Healthy People 2020 initiative aims at levelling the playing ground and ensuring health equity. The initiative aims at eliminating disparities in the health sector and ensuring the health of all groups indiscriminately. The initiative also aims at the development of social and physical environments that promote and encourage the good health for all American citizens. Most of the preventable conditions that affect most Americans occur mainly due to choices and lifestyles which may have been encountered in earlier life stages. For this reason, Healthy People 2020 aims at encouraging healthy development and healthy choices across all life stages.

Narrowing down to the issue on heart disease and stroke, the Healthy People 2020 aims at achieving the following. Top on the list is the increasing of the overall cardiovascular health of the US population (Healthy People 2020, 2017). Next, the initiative aims at reducing deaths emanating from coronary heart disease and strokes. Furthermore, the Healthy People 2020 initiative also has the objective of increasing the population of US citizens who regularly get their blood sugar checked, thus in every 2 years they could be able to monitor their blood pressure levels and indicate whether it is normal or high (Healthy People 2020, 2017). The other main objectives are to ensure that the population of individuals who have their cholesterol levels high, hypertension, diabetes, or are obese is reduced.

Interventions Aimed towards the Deterrence of Heart Disease and Stroke

In line with the Healthy People 2020 objectives, many interventions have been put in place to alleviate the heart disease and stroke problem in the US population. Two of these interventions are the health promotion and risk reduction in the general population, and the integrated programs approach, as discussed below.

Health Promotion and Risk Reduction in the General Population

Measures are being put in place to reduce the risk of developing heart related conditions in many parts of the US. These health promotion interventions are encouraging the abstinence from tobacco and cigarette use cessation, engaging in regular physical activity and generally maintaining a healthy cardiovascular (CV) lifestyle.

The target population for this intervention is mainly the young people, as data analysis suggests that low-risk and healthier CV profiles in midlives have a high correlation to better lifestyles later on in life (Greenlund, Keenan, Clayton, Pandey & Hong, 2012). The control of risk factors, however, is also recommended for older high risk individuals.

These risk factor controls and risk reduction are being advocated for both within the medical setting and the community setting. The overall impact of this intervention indicates positive results in terms of improving the overall CV health of both the young and the elderly.



Integrated Programs

The integrated programs, mainly being carried out in Alaska, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mississippi, and New York involve the effective management of multiple conditions concurrently(Greenlund, Keenan, Clayton, Pandey & Hong, 2012). These programs are aimed at preventing and managing chronic conditions that Americans may be facing. As some of the CVDs are highly correlated with other conditions, such as diabetes, health care providers from different sectors have teamed up to effectively manage these different yet highly connected conditions together.

Apart from the integration of different chronic disease sectors, this intervention is also aiming at integrating efforts both by the community and the medical community in combating heart disease and stroke. A Planned Care Model programme is being used by the combined effort of over 40 private non-profit clinics and 95 sites across Kansas (Greenlund, Keenan, Clayton, Pandey & Hong, 2012). To ensure that all the necessary information regarding Cardiovascular Diseases in the US is collected and analysed, a robust data collection system has also been put in place to support comprehensive program evaluations.

The impact of this intervention is that the number of diabetes patients who have hit their blood sugar targets has been increasing constantly over the last couple of years. By combating diabetes, the CDC hopes that they would also impact on CVDs as these two conditions are highly connected. Treating them as non-separate issues and dealing with them in an integrated manner would thus lead to better results as opposed to dealing with each one independently.

The Role of Health Educators

Health education is an important aspect in dealing with CVD as most of these diseases are preventable. Thus, health educators play a very crucial role in alleviating the CVD problem. The National Commission for Health Education Credentialing (NCHEC) has outlined 7 areas of tasks and proficiencies that any HE specialist requires to take care of and possess respectively. These are evaluating the prerequisites, assets, and capability for health education, forecasting for health education, executing of health education, steering an appraisal and research-related to health education, overseeing and supervising health education, aiding as a health education reserve persons, and eventually collaborating and backing for health and health education.

The interventions mentioned above were conducted in line with the seven responsibilities. For instance, in the engagement of community health workers and the implementations of the self-measured blood pressure monitoring interventions, the assessment of the needs was a necessary step. The Healthy People 2020 experts must have noticed the need for community health workers to interact with the community directly in order to achieve better health education and thus healthy lives for that section of society. The determination of the needs and assets required in order to better the health education delivered to the target population must have been reached through a thorough analysis of already available data about the community.

After determining the needs and assets available for delivering health education, the next step was the planning on how these community health workers would engage in the actual education efforts on the ground. This was done through the identification of the target populations. The actual implementation of the healthcare education then follows. The actual implementation is the backbone of this entire process and thus needs to be conducted thoroughly, with checks and monitoring plans to ensure that the actual goals which were determined in the previous step are being met. The evaluation of the impact of the health care education is the basis for determining the effectiveness of a certain strategy. It is the evaluation of these impacts that led the Healthy People 2020 to arrive at the conclusions that both the engagement of community health workers and the use of self-measured blood pressure readings were effective in combating heart ailment and stroke.



Conclusion

In conclusion, heart disease and stroke account for the biggest percentage of deaths in the US today. Ironically, these conditions are amongst the most preventable in public health. The formation of the Healthy People 2020 strategy was aimed at dealing with such highly preventable diseases and premature death of most Americans. In doing so, the American citizen would be guaranteed a longer, more fulfilling and healthy live. This article dealt with the issue of heart disease and stroke, delving into some of the deliberate interventions that have been established to alleviate the issue and save the American citizen not only from premature death but also from the loss of potential revenue. The interventions discussed in this paper were the health promotion and risk reduction in the general population and the use of an integrated systems approach in dealing CVDs. The risk factors and the health enhancing factors connected to heart disease and stroke were also highlighted.

References

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