The aim of this essay is to discuss the implications of socioeconomic and psychosocial factors in the prevention of Coronary Heart Disease, also medically known as CHD.
I will discuss the three levels of disease prevention strategies and risk factors for CHD and link these to a particular life style and social class.
Coronary heart disease is preventable yet kills more than 70,000 people and 110,000 people have a heart attack in England every year. Around 2 million people suffer from angina in the UK. Such statistics mean CHD is the biggest killer in the country (Department of Health. 2010).
Coronary heart disease seems to affect people in some sections of society more than in others. It is more common in lower socioeconomic groups, the premature death rate for men living in Scotland is 69% higher than those living in the South East of England and 97% higher for women, the death rates from coronary heart disease are 2.9 times more higher in the most deprived areas of Britain compared to the most least deprived areas, there is also a variation in coronary heart disease risk between manual and non manual workers and a difference in smoking rates between theses groups. (Scarborough et al., pages 39-41).
Four different types of psychosocial factor have been found to be most consistently associated with an increased risk of coronary heart disease , (The British Heart Foundation, 2010), these are; work stress, lack of social support, depression which includes anxiety and personality especially if hostile in nature. As yet there does not seem to be any estimations of the numbers of deaths from coronary heart disease heart disease which are due to poor psychosocial well-being or of the numbers of deaths which could be avoided if psychosocial well-being was increased.
The three levels of disease prevention strategies in CHD are, Primary, The aim to prevent the onset of disease in educating people about their own lifestyles, for instance, losing weight, taking up exercise and giving up smoking.
Secondary, Strategies that aim to detect all people with established coronary heart disease and offer them advice and treatment to reduce their risks. Identify all people at significant risk of CHD but who have not developed symptoms and offer them advice and treatment Tertiary, People with suspected CHD are to be offered investigations and treatments that will both relieve their symptoms and reduce the risk of subsequent cardiac problems.
Primary Prevention & Risks Of CHD
To help with the primary prevention of the disease the it is suggested that we smoke less, eat more healthily and exercise more.
Smoking increases the risk of CHD. The long-term risk of smoking to individuals has been quantified in a 50-year cohort study of British doctors (Doll et al, BMJ 1994). The study found that mortality from CHD was around 60% higher in smokers (and 80% higher in heavy smokers) than in non-smokers. Observing deaths in smokers and non-smokers over a 50-year period, the study concluded about half of all regular smokers will eventually be killed by their habit.
There is a strong association between cigarette smoking and socio-economic position. Cigarette smoking is more prevalent among manual social groups than among non-manual groups, and is lowest among higher managerial and professional classes.
In 2006, 29% of men and 27% of women in manual households smoked compared to 18% of men and 16% of women in non-manual households (Melissa Davy, 2007)
A poor diet is another risk associated with CHD. Eating at least five portions of fruit and vegetables a day, fish twice a week and cutting down on saturated fat, salt and alcohol will help reduce the risk of CHD
A health survey carried out by the National office of statistics in England (Doyle M, Hosfield N, 2001), suggests that more fruit and vegetables were consumed by those in the highest income sectors. The survey found that the number of people eating five portions of fruit and vegetables a day was over 50% higher in the highest income sector than the lowest income sectors
People who are physically active have a lower risk of CHD. To produce the maximum benefit the activity needs to be regular and aerobic. Aerobic activity involves using the large muscle groups in the arms, legs and back steadily and rhythmically so that breathing and heart rate are significantly increased.
Current government guidelines recommend that for general health, adults should accumulate a total of at least 30 minutes of moderate intensity activity on five or more days of the of the week. (Department of Health)
Evidence shows that manual workers are over two and a half times less likely to participate in sport than professionals. Women are also less likely to participate in sport than men.
Some factors relating to inequalities in levels of physical activity in relation to social class could be a relatively low level of knowledge about the benefits of physical activity, low levels of motivation to be physically active, a shortage of affordable facilities in areas of disadvantage and the lack of parental/family support, for example, financial, transport and general encouragement.
Those of higher social class have the financial means to join a health centre, more family support or child care, transportation and they can choose the best facilities to suit their individual fitness needs.
Recent research from the World Health Organization highlighted the importance of physical inactivity as a major risk factor for CHD. It is claimed, that on estimation, over 20% of CHD in the worlds population was due to physical inactivity.
The Government acknowledges that working in jobs which make very high demands, or in which people have little or no control, increases the risk of coronary heart disease and premature death. Inadequate social support or lack of social networks can also have a harmful effect on health and on the chances of recovering from disease.
The majority of Coronary heart disease can be prevented; our understanding of the disease is continually improving yet death rates from the disease remains high. With all the information that is available about the disease perhaps we have the moral duty to inform and teach ourselves more about it to protect ourselves against the effects of coronary heart disease.
The Department of Health has developed national service frameworks (NSF's) for the management of CHD NSFs are long term strategies for improving specific areas of care. They set measurable goals within set time frames. The NSF for CHD was launched in March 2000 and sets standards for improved prevention, diagnosis and treatment, and goals aimed at securing fair access to high quality services.
Department of Health. 2010. Coronary heart disease. (Online). Available at http://www.dh.gov.uk/en/Healthcare/Coronaryheartdisease/index.htm (Accessed 10 January 2010).
Scarborough P, Allender S, Peto V, and Rayner M (2008). pages 39-41 Regional and social differences in Coronary Heart Disease 2008. British Heart Foundation, London.
The British Heart Foundation 2010. Psychosocial well-being. (Online). Available at http://www.heartstats.org/topic.asp?id=880 (Accessed 11 January 2010).
Doll R, Peto R, Wheatley K, Gray R, Sutherland I. 1994. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 309. Available at; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC437139/?tool=pubmed (Accessed 11 January 2010).
Melissa Davy, 2007, Socio-economic inequalities in smoking: an examination of generational trends in Great Britain (Online). Available at http://www.statistics.gov.uk/articles/hsq/HSQ34_Smoking.pdf. Accessed 12 January 2010.
Department of Health (2000) National Service Framework (NSF) for coronary heart disease. (Online). Available at www.dh.gov.uk/policyandguidance/healthandsocialcaretopics.
Doyle M, Hosfield N. Health Survey for England 2001: Fruit and vegetable consumption. The Stationery Office, London, 2003.
Eviedence in summary of government enitatives on reducing CHD in socially and physically effected people.