Public Health Community Advisory – Advances in public health and medicine have increased life expectancy for all Americans, with the average lifespan exceeding 70 years for all races and both genders. However, stark health disparities continue to exist, with low-income populations and minorities experiencing higher rates of illness and death at earlier ages. Cardiovascular disease (CVD) is no exception! (1) The evidence is vast, and the take-home message is that low-income populations and certain minority groups have earlier onset of CVD and earlier death with advanced disease. The causes of this heartbreaking reality are many and are rooted in biological, psychosocial, environmental, and behavioral issues. Public health programs have been implemented nationwide to modify known risk factors, with a focus on tobacco cessation, increased physical activity, healthier diets low in saturated fats, and preventive screening. However, progress in reducing CVD health disparities among low-income and minority populations has been minimal.
Another heartbreaking reality is that successful public health programs often rely on social infrastructure, community norms, policies, and resources for “public” compliance. A substantial body of literature explores environmental contributors to improved health outcomes (2). These contributors include access to affordable and nutritious foods, safe neighborhoods and parks for physical activity, and access to health screening. However, “cultural norms” and “community priorities” may also perpetuate disparities in CVD outcomes. People who live in lower-income neighborhoods pay what has been referred to in the literature as the “poverty tax,” in which the cost of living a healthy lifestyle is often too expensive to embrace. For instance, healthier options in a grocery store are often more expensive than unhealthy foods. Lean 99% fat-free ground turkey costs on average $6.00 per pound, whereas 75% or 85% fat-free ground turkey costs on average $3.00 per pound. Fresh produce and organic foods tend to be more expensive than canned or frozen produce and nonorganic options. To further complicate the issue, many low-income neighborhoods are considered “food deserts,” in which residents must travel miles outside of the immediate neighborhood to access affordable, nutritious foods, with transportation being a limiting factor. In turn, these same neighborhoods are often infiltrated with fast-food outlets that offer cheap, calorie-dense foods, and with corner liquor stores. In regard to exercise, many low-income neighborhoods have poorly maintained sidewalks (if they have sidewalks at all), low street lighting, and no biking or walking trails, creating barriers to safe exercise and travel. This combination—lack of healthy foods and limited safe, alternative modes of transportation—further impacts the problem and contributes to disparities in CVD outcomes.
However, this heartbreaking, complicated public health issue is not hopeless! Public health programs are essential to improving the health outcomes of lower-income communities that experience disproportionate rates of CVD illness and death. Smoking cessation, alcohol cessation, and healthy lifestyles (diet and exercise) programs offer important behavioral modification models. However, these public health models must always take into consideration the complexity of the issues and address the factors that limit “public” compliance. Public health practitioners are unique in that we are often at the front lines of the issue and can identify the needs of the community. Collectively we have a powerful voice, and advocacy represents a feasible solution to improving health disparities not only with CVD but also across many health outcomes. Our ability to implement public health initiatives, combined with local, state, and national advocacy, can help promote factors that encourage public compliance (i.e., smoke-free environments, zoning laws for fast food, patrolled parks, etc.). Only with the unleashing of our collective and synergistic power can we truly begin to heal the heartbreaking realities of CVD disparities.
1. Global atlas on cardiovascular disease prevention and control: Policies, strategies, and interventions. 2011. WHO; World Heart Federation; World Stroke Organization, retrieved from http://www.who.int/cardiovascular_diseases/en/
2. Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences. Chapter 4: Food access and its relationship to diet and health outcomes. Retrieved from: United States Department of Agriculturehttp://www.ers.usda.gov/Publications/AP/AP036/AP036d.pdf
3. Using Healthy Eating and Active Living Initiatives to Reduce Health Disparities, February 2008; a report for the Disparity Reducing Advances (DRA) Project, Institute for Alternative Futures.http://www.altfutures.com/draproject/pdfs/Report_08_01_Using_Healthy_Eating_and_Active_Living_Initiatives__to_Reduce_Health_Disparities.pdf
4. Cardiovascular Disease Mortality and Risk Factors by Nebraska’s Local Public Health Department Regions. 2005. Nebraska Health and Human Services System. http://dhhs.ne.gov/publichealth/Documents/lphdfullreport.pdf
This article was written by Renaisa S. Anthony, MD, MPH, deputy director and assistant professor, UNMC COPH Center for Reducing Health Disparities, and by Sondra Manske, MPH, CHES, health disparities research specialist, UNMC COPH Center for Reducing Health Disparities.