Changing our understanding of chronic disease
RESEARCH LEADERSHIP by UC Berkeley Chancellor's Professor of Public Health and Diversity and Health Disparities faculty member Mahasin Mujahid has focused the attention of the American Heart Association on the influence of neighborhood conditions on cardiovascular health. In a 2017 scientific statement endorsed by the American College of Cardiology, Mujahid and a group of researchers representing the American Heart Association reviewed the state of cardiovascular health in African Americans. Findings show that African American men are more than twice as likely to die from coronary heart disease compared to white men1 and African American women are more than twice as likely to experience sudden cardiac death compared to white women.2 While these disparities can be partially explained by the higher prevalence of traditional cardiovascular risk factors among African Americans including hypertension, diabetes mellitus, and obesity, the researchers argue that disparities can also be explained by external sources of stress and adverse social determinants of risk.
Racial discrimination is a unique source of stress reported by African Americans and has been associated with hypertension, weight gain, adverse birth outcomes and persistent inflammation.3 African Americans are disproportionately exposed to adverse social determinants of health. Environments without health promoting resources is an important dimension of that risk. This includes places where access to supermarkets and healthier food options is limited,4 where advertising overwhelmingly promotes high-calorie low-nutrition foods and beverages,5 and where there is limited access to safe places for physical activity.6
Mujahid’s own research findings show the significant influence of neighborhood conditions on cardiovascular risk factors. Losing a neighborhood supermarket worsens the health of diabetic patients with poor baseline A1c measures;7 increasing individual and neighborhood-level safety over time is associated with decreasing BMI;8 higher neighborhood all-crime rates increase high stress among African American and Latina women;9 and neighborhood context may increase the risk of cardiovascular disease and contribute to racial/ethnic differences in health.10
If unfavorable neighborhood conditions increase the risk associated with poor cardiovascular health, then creating favorable conditions is a group- or place-level strategy for reducing cardiovascular disease. Furthermore, these advances will improve the context for biomedical interventions such as evidence-based therapies and clinic-based tools including screening and risk prediction,11 thus incentivizing healthcare providers and insurance companies to support neighborhood-level improvements in the name of health.