Heart-Healthy and Stroke-Free: A Social Environment Handbook

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Chapter Four: Social Environment—Quality of Life

Chapters Introduction Chapter 1: Getting Started Chapter 2: Preventive and Medical Services Chapter 3: Heart-Healthy Living Chapter 4: Quality of Life Chapter 5: Direct Observations and Windshield Surveys Chapter 6: Photography and Videography Chapter 7: Key Informant Interviews Chapter 8: Library Resources and Newspapers Chapter 9: Searching the Internet Chapter 10: Worksheets Chapter 11: Heart Disease and Stroke Resources

Quality of life refers very broadly to the social, economic, and environmental dimensions of life that contribute to happiness and an overall sense of health and well-being. Quality of life for individuals is influenced by a wide range of socioeconomic and social environmental conditions. Adverse social and economic circumstances contribute to higher rates of heart disease and stroke for both individuals and communities. Creating and sustaining heart-healthy and stroke-free communities will need to occur in the context of creating opportunities for good quality of life for community residents.

Housing Quality

Quality of housing can be considered and measured along a number of dimensions that focus on both the physical characteristics and condition of the building, and on the social dimensions of the household and living arrangements. Specific dimensions of housing quality can influence heart disease and stroke prevention as well as quality of life for heart attack and stroke survivors. These dimensions include: availability of kitchen and facilities, source of heating in winter (indoor air quality), availability of air conditioning in summer (potential for heat stress, especially for the elderly), geographic proximity to other housing units, number of rooms per person (crowding), and handicapped accessibility both inside and outside.

Employment and Income

Families and individuals depend on stable employment and adequate incomes to maintain independent living and well-being. Self-sustaining households are the bedrock of any local community’s economy. In areas where unemployment and underemployment (i.e., a preponderance of low-paying jobs with few benefits or opportunities for advancement) are high, the resulting economic instability creates negative ripples that affect every aspect of the social fabric and well-being of the community.

Health promotion and disease prevention are extremely difficult to achieve in conditions of economic deprivation and poverty, because struggling to satisfy the basic necessities of life overwhelms more positive pursuits. In contrast, in prosperous, economically stable or growing communities, individuals and families enjoy the peace of mind and positive orientation toward the future that can permit them to actively engage in healthy living and wellness.

Educational Opportunities

Opportunities for education and intellectual growth at every life stage are critically important for the development and maintenance of heart-healthy and stroke-free communities. At a fundamental economic level, education provides training for employment and helps to create economic opportunities in a community. Educational institutions, from day care centers to universities and specialized vocational training centers, are often major sources of employment and benefits, especially in smaller towns and rural areas. At the individual level, adult educational attainment strongly influences many risk factors for heart disease and stroke, with better educated people being less likely to smoke, be obese, be physically inactive, or have high blood pressure, high cholesterol, or diabetes.

Social Support and Social Cohesion

Social support (at the individual and family levels) and social cohesion (at the neighborhood and community levels) are also important for the development of heart-healthy and stroke-free communities. Social support from family and friends helps to prevent depression, can help to improve blood pressure and lower blood cholesterol, and can improve success rates for people attempting to quit smoking cigarettes, start an exercise program, or lose weight.

For patients who are recovering from a heart attack or stroke, social support is vital in helping to improve long-term health outcomes. People who lack social support and become (or remain) socially isolated after a heart attack or stroke are more likely to suffer a second acute event. Furthermore, patients who are socially isolated may have much more difficulty with transportation and accessing medical care and needed medications, further worsening their conditions.

Environmental Quality

Environmental quality can influence heart disease and stroke prevention both directly and indirectly. Air pollution may be the most important direct environmental risk factor for heart disease and stroke. High levels of air pollution, particularly carbon monoxide and particulate matter, can exacerbate illness for people already suffering from heart disease, stroke, and chronic obstructive pulmonary disease, which can eventually lead to heart failure. At the community level, high levels of air pollution may be caused by motor vehicle exhaust, industrial smokestack outputs, or typically a combination of both sources. Natural sources of air pollution include dust from agricultural and deforested lands.

Indirect effects of environmental quality on prevention of heart disease and stroke can occur via recognized risk factors such as physical inactivity and poor diet. To the degree that high levels of pollution and low environmental quality inhibit community residents from engaging in healthy outdoor activities, risk for heart disease and stroke would be expected to increase.

Personal and Public Safety

In communities where residents do not feel safe from crime and other hazards, health promotion and community cohesion are negatively affected. In high-crime areas, residents may be much less likely to engage in healthy outdoor recreational activities, to participate in social and community events, and even to attend religious services and participate in civic groups. Lower social cohesion and higher levels of social isolation and depression may result. Elderly residents who live alone may be particularly vulnerable to these negative impacts of low public safety. Heart-healthy and stroke-free communities must be communities in which all residents feel safe to leave their homes and participate in social life.

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Planning Worksheet for Quality of Life
Choose Your Questions and Practical Methods

Use this planning worksheet and the tables in Chapter Three to help choose the most important questions for your community. Write each question in the left-hand column. Then, focus on one or more dimensions of quality of life. Next, choose one or more practical methods. You can photocopy the blank planning worksheet in Chapter 10.

SAMPLE

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Results Worksheet for Quality of Life
Using During and After Your Fieldwork

Complete one Results Worksheet for each of your questions. Write the question at the top of the worksheet. Then, for each practical method, record your findings under “Assets and Strengths” and “Needs and Challenges.” You can photocopy the blank Results Worksheet in Chapter 10.

SAMPLE

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Summary Worksheet for Quality of Life
What Are Your Most Important Results?

Condense the findings recorded on your Results Worksheets to highlight the most important assets, strengths, needs, and challenges.  You can photocopy the blank Summary Worksheet in Chapter 10.

SAMPLE

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Date last reviewed: 07/09/2007
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion