CHAPTER 107: SOCIAL DETERMINANTS OF CARDIOVASCULAR DISEASE

Summary

This chapter discusses the social determinants of cardiovascular disease (CVD) that operate at the population level. Although every individual is affected by the society in which they live, some are more burdened than others by social and economic disadvantages, which in turn can result in health disparities. The major social determinants of health include socioeconomic status, race/ethnicity, sex, the environment, and access to care. Whilst on a global level, CVD is considered a disease of affluence, a contrasting gradient of CVD prevalence exists within developed societies (see accompanying Hurst’s Central Illustration); thus, as countries develop economically, the disadvantaged socioeconomic position progressively becomes a systematic risk factor for CVD. Racial and ethnic minority populations are disproportionally burdened with cardiovascular risk factors and CVD; socioeconomic status explains some portion of observed health disparities, but does not account for all of it. Scientific evidence also shows that, compared with men, women receive less treatment for both cardiovascular risk factors and CVD, and have increased mortality after myocardial infarction. The environment in which an individual lives impacts on cardiovascular health: lack of social relationships, living in disadvantaged neighborhoods, and work stress are all associated with increased risk of CVD. Finally, reduced access to care is also associated with increased CVD risk. Policy initiatives are critical to improving health outcomes and reducing health disparities.