Final Blog Post – Grace Weatherbee

Cardiovascular disease has caused the most deaths, for both men and women, globally than any other disease.  Every year, millions of people die from cardiovascular diseases, and these numbers are continuing to rise.  Despite these high rates, a majority of these deaths could have been prevented.  The major risk factors for cardiovascular diseases are controllable, and these include physical inactivity, poor diet, and alcohol and tobacco use.  Aside from genetic predispositions, many cardiovascular diseases can be avoided, but an outrageous amount of people around the world continue to suffer from these diseases.   Cardiovascular disease is a major problem for my selected country, which is New Zealand, and women are especially at risk in this culture.  This is due to the common misconception that men are more susceptible to contracting cardiovascular diseases.  Another factor that puts women in New Zealand at risk is the fact that women tend to remain undiagnosed for cardiovascular diseases when compared to men.  In New Zealand, cardiovascular disease is the leading cause of death for women, and the rates are not predicted to decrease.  In fact, the rates are actually predicted to increase in the Maori, and the current rate is already 67% higher than the top 10 OECD country average (Nolte et al, 2008).  There are a number of reasons why cardiovascular disease continues to be a large problem for New Zealand, and the epidemiological approach is the best perspective to use when looking at this issue.

The epidemiological theory focuses on the social, biological, and cultural factors that affect how individuals within a community experience a certain disease (Joralemon 1999).  This approach is interested in how the disease started, as well as how the disease can be treated and prevented.  This approach focuses on a particular disease at the population level rather than the individual level, and uses statistical data to find patterns to help them determine the cause of a disease (Trostle et al, 1996).  Another aspect of epidemiological theory is that it looks at the intersection between physical health and social aspects of human behavior (Dunn et al, 1986).  The epidemiological approach usually looks at communicable diseases, but I feel that this theory can be used to understand how cardiovascular disease began in New Zealand and how the disease is being treated.

There are several social, political, and cultural determinants that affect how the people of New Zealand experience cardiovascular disease.  The two most influential social factors that affect the prevalence of cardiovascular disease in New Zealand are ethnicity and socioeconomic status (Chan et al, 2008).  This study is the first in New Zealand to examine the effects of social factors on rates of cardiovascular disease.  The entire population of New Zealand was used for the study, which was 4,191,388 people in total.  The data was collected through hospital discharge and procedural codes from national collections to determine which patients had cardiovascular disease.  Patients with two or more prescriptions to control angina (chest pain) were included in the criteria for cardiovascular disease as well. Out of the entire population, 281,333 participants had some form of cardiovascular disease.  Additionally, it is important to note that a majority of the population that were affected by cardiovascular disease were of Maori decent when compared to all other ethnic groups.  There are a few possible explanations to why the Maori have higher rates of cardiovascular disease, and the most probable is lifestyle choices.  As I discussed in a previous post, the Maori have begun incorporating unhealthy European inspired foods into their diet, which has greatly contributed to the prevalence of cardiovascular disease among this ethnic group.  Additionally, the fact that the Maori have higher rates of cardiovascular disease is also related to socioeconomic status.  The majority of the Maori have a lower socioeconomic status in the community when compared to other ethnic groups.  Socioeconomic status is a social determinant of cardiovascular disease because a lower status usually means that an individual or household does not make as much money, and therefore may not be able to afford quality health care.  Additionally, those in lower socioeconomic status may have more stress related illnesses than those in a higher socioeconomic status, and this can contribute to the onset of cardiovascular disease.

There are several political determinants that affect the prevalence of cardiovascular disease in New Zealand.  The most influential political factors are health policies related to social and economic policies including housing, income distribution, and urban planning (National Health Committee, 1998).  This report talks about how many of the health policies in place have not been examined for their effects on public health, and therefore, they may be doing the public more harm than good.  Many of the health policies in place are not helping to promote healthy lifestyle choices, which are contributing to the high rates of cardiovascular disease.  Because the influence of socioeconomic status on cardiovascular disease is so strong, health policies need to attempt to reduce the large inequalities within the population to address this problem.  Another political determinant of cardiovascular disease is access to healthcare.  Although there are many programs in place, many Pacific Islanders and Maori are not aware of the health care programs that are available to them (Paterson et al, 2004).  This may be partly the fault of the government and health services providers because there is a lack of communication with the public about those services.  Simply having a better knowledge of the health services available will improve health outcomes related to cardiovascular disease.

Culture is defined as a set of accepted guidelines, both implicit and explicit, which individuals inherit as a result of membership in a certain group.  Culture is complex because it is always changing, and every individual within a specific culture experiences it differently.  The individuals within a culture shape that culture, and are also shaped by that culture.  Most cultural groups are based on ethnic backgrounds, but this is not always the case.  Cultural groups can also be based on religion, location, age, or social class.  Additionally, a single person may be a member within several different cultural groups at one time.   Therefore, cultural determinants of cardiovascular disease can include a wide variety of examples, and may not apply to the entire group.  The cultural determinants of cardiovascular disease in New Zealand are primarily related to attitudes and beliefs about health and treatment of certain diseases.  Many of the natives of New Zealand practice holistic health treatments, and do not view disease as only a physical problem or ailment.  The Maori believe that several illnesses or diseases can result from unresolved emotional, mental, or spiritual problems (Public Health Commission, 1994).  Because their views on health and illness are different from the mainstream Western perspective, the treatments used for physical ailments, cardiovascular related illnesses included, are not the same.  As a result, many of the victims of cardiovascular disease remain untreated.  As I discussed in a previous post, many people in New Zealand smoke, which is a risk factor for cardiovascular disease.  Several programs have been implemented to attempt to lower the rate of smoking among this group, but different beliefs and cultural barriers have prevented this from happening.  The Maori and Pacific Islanders believe that nicotine replacement is more harmful than smoking, which is why many people continue to smoke.  Additionally, they believe that if an individual wants to stop smoking, than they should do so without the help of nicotine replacements or other programs.  Both of these cultural factors contribute to the high rates of smoking among New Zealanders, which in turn affects the prevalence of cardiovascular disease.

As I mentioned previously, one of the main goals of the epidemiological theory is to determine how a disease can be treated and prevented.  Using the perspective of the epidemiological theory, there are several solutions that can be applied to reduce the rates of cardiovascular disease in New Zealand.  Although looking at statistical data for patterns in cardiovascular disease will not identify a single cause, it does tell us what the controllable risk factors in this community are.  I mentioned that smoking is a big problem in New Zealand, and this is one aspect that the community can work on that may help reduce the prevalence of cardiovascular disease.  Developing programs to help eradicate smoking that are culturally sensitive to the customs and beliefs of the Maori will help reduce the problem of cardiovascular disease.  An additional risk factor for cardiovascular disease is poor diet.  Because the Maori have incorporated unhealthy foods into their diet, the rates of cardiovascular disease have increased.  Targeting the habit of consuming unhealthy foods through education programs and promoting healthier food choices may be a solution that can lower the rates of cardiovascular disease in New Zealand as well.  A final risk factor for cardiovascular disease is physical inactivity.  Many of the Maori and Pacific Islanders work long hours for their jobs, and this promotes physical inactivity.  Workplace programs that facilitate being physically active may help lower the rates of cardiovascular disease at the population level.  Encouraging activity at the workplace as much as possible, as well as in the home will greatly reduce the rates of cardiovascular disease.

In conclusion, cardiovascular disease continues to be a major health issue in New Zealand, and there are several social, political, and cultural determinants that contribute to the problem.  Using the epidemiological theory helps to determine patterns in statistical data to help determine both the causes and possible solutions to the rates of cardiovascular disease.  The most prominent social determinants of cardiovascular disease include socioeconomic status and ethnicity, with the Maori being the most at risk.  Political determinants of cardiovascular disease in New Zealand include a lack of communication about health services available, as well as a lack of knowledge about the effectiveness of health policies in place.  Finally, cultural determinants that affect the prevalence of cardiovascular disease focus on attitudes and beliefs about the causes of health issues.  The Maori belief that physical ailments are related to unresolved emotional, mental, or spiritual problems is part of the reason why many victims of cardiovascular disease go untreated.  Using the epidemiological perspective, I have identified several possible solutions to the problem of cardiovascular disease in New Zealand as well.  Developing culturally sensitive programs to help reduce the amount of smokers may help to prevent cardiovascular disease in the future.  Additionally, promoting healthier food choices and education programs about healthy eating may also prevent cardiovascular disease.  Lastly, promoting physical activity, in the workplace especially, may help the majority of the population who work long hours to be more active, which can also help reduce the rates of cardiovascular disease in the future.  A combination of all of these factors will be the most effective in reducing the rates of cardiovascular disease in New Zealand.  Cardiovascular disease is not only a major problem for New Zealand, but it remains to be a global issue as well.  It is crucial to educate the population about ways to prevent cardiovascular diseases.  In addition with awareness programs, it is important to implement treatment and prevention programs that target the causes and risk factors of cardiovascular disease.  It is terrible to see how one of the top killers in the world today is largely preventable.  In order to protect the health of our population, it is necessary to focus on preventive measures to control the rates of cardiovascular disease.

References

Joralemon, Donald. Exploring medical anthropology. USA: Allyn and Bacon, 1999.

Dunn, Frederick L., and Craig R. Janes. “Introduction: medical anthropology and epidemiology.” Anthropology and epidemiology. Springer Netherlands, 1986. 3-34.

Trostle, James A., and Johannes Sommerfeld. “Medical anthropology and epidemiology.” Annual Review of Anthropology (1996): 253-274.

Chan, W., et al. “Ethnic and socioeconomic disparities in the prevalence of cardiovascular disease in New Zealand.” New Zealand Medical Journal (2008).

National Health Committee. “The social, cultural and economic determinants of health in New Zealand: action to improve health.” (1998).

The health of Pacific islands people in New Zealand. Public Health Commission, 1994.

Hay, David Russell. Cardiovascular disease in New Zealand, 2004: A summary of recent statistical information. National Heart Foundation of New Zealand, 2002.

 

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