Department of Health and Human Services
Centers for Disease Control and Prevention
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Heart-Healthy and Stroke-Free: A Social Environment Handbook
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Document Format (PDF - 10M).
IntroductionThis handbook is a tool for everyone working to create heart-healthy and stroke-free communities across America. Health advocates are recognizing that creating and sustaining healthy communities requires fundamental social change that goes far beyond the individual patient education approach of many traditional public health programs. However, changing the social environment has proved even more challenging than trying to modify individual lifestyle choices. The first step to improving the social environment is to accurately identify its health-promoting and health-damaging characteristics. In this handbook, public health professionals, advocacy groups, and concerned community and state leaders will find specific ideas and strategies for identifying barriers and promoters for heart-healthy and stroke-free living in local environments. Although many public health tools are available for “community diagnosis,” this handbook is unique because of its particular focus on prevention and treatment of heart disease and stroke. All of the specific examples, tables, and worksheets relate directly to heart disease and stroke risk factors, prevention challenges, and treatment issues. We have attempted to present the information and ideas in the handbook in an accessible, straightforward fashion so that a wide range of users—from motivated school, church, and community leaders to highly trained local public health professionals—will find something useful in these pages. A Paradigm ShiftHealth promotion efforts for heart disease and stroke have traditionally employed a health education approach focused on the major biomedical and behavioral risk factors. These risk factors include hypertension, elevated blood cholesterol, obesity, diabetes, poor diet, physical inactivity, and cigarette smoking. Programs and interventions for these risk factors have been designed and implemented based on a health education paradigm.
Importance of the Social EnvironmentIn recent years, growing awareness of the importance of social environmental and policy changes in promoting heart-healthy and stroke-free communities has resulted in activities and interventions focused on community-level change at the Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA). These new activities require a conceptual model that links individual risk factors and behaviors for heart disease and stroke with their corresponding promoters and barriers in the social environment. We have outlined a conceptual model that connects individual goals for heart and stroke health promotion with population goals and have identified both barriers and promoters for each goal (see the tables below). We have highlighted “the big five” heart disease and stroke risk factors: hypertension, dyslipidemia, tobacco use, poor nutrition, and physical inactivity. However, a number of other well-known risk factors certainly could be added to this conceptual model, including diabetes, depression, and stress.
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| Source | Description and Web Address |
|---|---|
| Centers for Disease Control and Prevention | The Heart Disease Prevention: What You Can Do Web page provides fact sheets on many risk factors. Links to official guidelines and reports for blood pressure, cholesterol, obesity, physical activity, tobacco use, and diet. |
| American Heart Association | The Health Tools Web page provides links to information sheets
on heart disease and stroke risk factors, treatments and tests, and
disease conditions. There are several interactive features,
including a risk assessment tool, family tree, cholesterol and blood
pressure tracker, and an exercise diary. http://www.americanheart.org/presenter.jhtml?identifier=3006028* |
| American Stroke Association | The How Cardiovascular and Stroke Risks Relate: Converging Risk
Factors Web page provides an overview of many risk factors that are
common to both stroke and heart disease, such as blood pressure,
cholesterol, and physical activity. Links to additional detailed
information are provided. http://www.strokeassociation.org/presenter.jhtml?identifier=3027394* |
*Links to non–Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.
Furthermore, efforts to create and strengthen social environmental promoters of normal blood pressure through healthy food and recreational environments will be more successful when coupled with efforts to reduce barriers such as lack of access to medical care or medications, lack of time for healthy food preparation, and inadequate family incomes.
Health professionals must recognize that some of the most serious social environmental barriers to good health—such as racism, poor economic conditions, and advertising of harmful products—arise from social conflicts among different interest groups in society. These barriers must be tackled; they are not insurmountable. However, successful approaches will require reaching out beyond the health promotion community to form broad coalitions of public agencies, nonprofit groups, concerned citizens, and policy makers.
The pathways by which social environmental change can affect individuals, their behaviors, and their biology are not obvious to everyone. Advocates for cardiovascular health promotion are often required to explain and justify proposed public policies, environmental changes, regulations, and community-level interventions to organizational leaders in the public and private sectors. The conceptual model presented here should be a useful tool in explaining and justifying the ways in which social environmental change can improve risk factor distributions for entire populations, and subsequently reduce disability and death from heart disease and stroke.
| Blood Cholesterol Goals | ||
|---|---|---|
| Individual | Population and Social Environment | |
| Goals | High-risk individuals Lower blood cholesterol. Low-risk individuals |
High-risk population Increase % of people whose blood cholesterol is normalized.
Low-risk population |
| Promoters | Physical activity Healthy diet Good medical care Medication Adequate health insurance |
Healthy food environments Healthy recreational environments Good family incomes Good working conditions Health promotion and education Healthy cultural food practices Wellness programs at work and school |
| Barriers | Lack of medical care Cost of medication Lack of social support Cost of healthy foods Food preferences Obesity Genetics |
Lack of access to medical care Lack of access to medications Lack of grocery stores Grocery stores with limited selections Large number of fast food restaurants Poor economic conditions Time pressure |
| Nutrition Goals | ||
|---|---|---|
| Individual | Population and Social Environment | |
| Goals | Consume a heart-healthy diet. | Increase % of population that consumes a heart-healthy diet. |
| Promoters | Adequate income Healthy food availability Time for meal preparation Knowledge Preferences for healthy food |
Healthy food environments Good family incomes Good working conditions Nutrition and diet education Healthy cultural food practices Wellness programs at work and school |
| Barriers | Lack of social support Cost of healthy foods Restaurant portion sizes Preferences for unhealthy food |
Lack of grocery stores Grocery stores with limited selection Large number of fast food restaurants Poor economic conditions Time pressure |
| Tobacco Goals | ||
|---|---|---|
| Individual | Population and Social Environment | |
| Goals | High-risk individuals Stop using tobacco. Low-risk individuals |
High-risk populations Increase % of tobacco users who quit. Low-risk populations |
| Promoters | Social support Desire to quit Negative health effects Physical activity Aversion to tobacco |
No-smoking policies High tobacco cost and taxes Higher insurance costs for smokers Cessation classes/programs No tobacco sales to minors Wellness programs at work and school |
| Barriers | Lack of social support Lack of desire to quit Lack of knowledge of cessation strategies Depression Family tobacco use Psychosocial stress Peer pressure |
Location of tobacco vendors Lack of public policy Economic dependence on tobacco Advertising/marketing High smoking rates Tobacco vending machines Tobacco use in public places |
| Physical Activity Goals | ||
|---|---|---|
| Individual | Population and Social Environment | |
| Goals | Participate in regular physical activity. | Increase % of people who participate in regular physical activity. |
| Promoters | Good overall health Time for physical activity Knowledge Enjoyment of physical activity |
Good family incomes Good working conditions Healthy recreational environment Organized activities Recreational programs Pedestrian-friendly development |
| Barriers | Lack of facilities Cost of clothes and equipment Cost of facilities Lack of social support Aversion to physical activity Depression |
Climate Lack of safety/hazards Social conflict Time for physical activity Economic constraints Family constraints |
| Blood Pressure Goals | ||
|---|---|---|
| Individual | Population and Social Environment | |
| Goals | High-risk individuals (including
those with borderline high blood pressure) Reduce blood pressure. Low-risk individuals |
High-risk population (including
those with borderline high blood pressure) Increase % of population whose blood pressure is normalized.
Low-risk population |
| Promoters | Physical activity Healthy diet Good medical care Medication Adequate health insurance Control of diabetes Weight loss |
Good family incomes Good working conditions Stable employment Healthy food environments Healthy recreational environments Health promotion and education Wellness programs at work and school |
| Barriers | Physical inactivity High-salt, high-fat diet Diabetes Obesity Psychosocial stress Lack of medical care Cost of medication Lack of social support Tobacco use |
Lack of access to medical care Lack of access to medications Lack of access to recreational facilities Unstable local economy High rate of unemployment Social stressors (e.g., racial discrimination) Social conflict leading to stress |
To obtain free copies of the Heart-Healthy and Stroke-Free: A Social Environment Handbook, please email cdcinfo@cdc.gov, or write to:
National Center for Chronic Disease Prevention and Health Promotion
Division for Heart Disease and Stroke Prevention
4770 Buford Highway NE
MS K-47
Atlanta, GA 30341-3737
Date last reviewed:
08/29/2008
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion
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Individual
Versus Population Goals
