





































       V39 N4 / 2024 

©2024 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     53

ABSTRACT 
The purpose of this article is to examine the influence of 
social determinants of health on the global health problem 
of cardiovascular disease (CVD), particularly focused on the 
Americas. CVD, encompassing conditions such as coronary 
heart disease, heart failure, and cerebral vascular disease, is 
identified as the leading cause of mortality worldwide, with 
low- and middle-income countries bearing the brunt of its 
burden. The article discusses how factors such as economic 
status, education, physical environment, food supply, sub-
stance addiction, and health care accessibility contribute 
to the prevalence of CVD. Additionally, it explores current 
public health policies addressing CVD and provides rec-
ommendations for enhancing these policies to alleviate 
the burden of the disease. The recommendations include 
implementing tobacco control policies, raising the legal age 
for purchasing tobacco products, and advocating for com-
prehensive health care services. The article concludes by 
emphasizing the importance of tailored interventions, evi-
dence-based policies, and evaluation strategies in combat-
ing CVD and improving public health outcomes.

PUBLIC HEALTH POLICIES AND CARDIOVASCULAR 
DISEASE
An effective public health policy assists in creating support-
ive environments that are important in ensuring that people 
live in a healthy social, emotional, spiritual, physical, and 
ecological environment that is safe and enjoyable for the 
greater community. This is achievable if public health poli-
cies are developed and established to improve the determi-
nants of health and the subsequent factors that contribute 
to the overall health status of the individual and commu-
nity. Over time, public health policies should be reviewed 
to assess their impact on health and, if these policies have 
a negative impact on health, strategies should be imple-
mented to amend and resolve them.1

Historical Perspective
Cardiovascular disease (CVD) is a common theme of public 
health policy. In the Americas, both country-specific strat-
egies and regional approaches have been adapted to maxi-
mize the effectiveness of the various policies in tackling the 
ever-present issue of CVD. During 2007, on a daily average, 
more than 2,200 Americans died of CVD.2 Despite this dis-
tressing statistic, there has been a notable decline in CVD 
mortality rates since their peak in the mid-1960s, reflecting 
sustained progress over decades.3 This decline, particularly 
noticeable from 1980 to 2000, is attributed to reductions in 
major CVD risk factors achieved through the implemen-
tation of public policies, education campaigns, and evi-
dence-based medical treatments.4

 Despite initial optimism for sustainable progress, public 
policy aimed at addressing CVD encountered a critical 
challenge in 2020. Mortality rates among adults contin-
ued to rise beyond the early years of the COVID-19 pan-
demic, persisting into 2022 despite the stabilization of the 
public health emergency. This marked a notable reversal of 
almost a decade’s worth of progress in reducing CVD mor-
tality rates in the United States. Although the exact reasons 
behind these adverse trends remain unclear, factors such 
as higher occupational exposure to COVID-19, increased 
financial instability, heightened stress levels, and reduced 
access to quality health care during the pandemic likely 
played significant roles.5

 Moving forward, CVD policies should prioritize a com-
prehensive approach addressing traditional risk factors and 
emerging challenges exacerbated by local or global health 
crises. This includes enhancing public awareness, ensur-
ing equitable access to preventive services, and strength-
ening health care infrastructure. These efforts should align 
with the concerns raised by the American Heart Association 
regarding projected increases in CVD and associated risk 
factors in the United States by 2050. High blood pressure 
prevalence is expected to rise significantly, from 51.2% to 
61.0%, leading to over 184 million people diagnosed with 
CVD, up from 128 million in 2020. CVD, excluding high 

Alan Silburn, MPH, BP, BN, FAWM / Western Sydney University, Campbelltown, Australia

Cardiovascular Disease in the Americas: Social Determinants,  
Public Health Policies, and Recommendations (Part 2)

SCIENCE SERIES

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AMWAJournal.org     54Cardiovascular Disease in the Americas (Part 2)

blood pressure, is expected to increase from 11.3% to 15.0%, 
affecting 45 million adults, up from 28 million. Stroke cases 
will nearly double, reaching approximately 20 million adults 
from 10 million currently. Obesity rates are forecasted to 
increase from 43.1% to 60.6%, impacting over 180 million 
individuals. Meanwhile, diabetes prevalence will rise from 
16.3% to 26.8%, affecting more than 80 million people.6

The United States’ Approach
The US Department of Health and Human Services’ A Public 
Health Action Plan to Prevent Heart Disease and Stroke 
employs a comprehensive 6-fold array of intervention 
approaches to reduce the burden of CVD.7 The plan includes 
policy and environmental changes to address the funda-
mental social and environmental conditions that contribute 
to the early development of CVD. Additionally, it promotes 
population-wide behavioral changes to mitigate the effects of 
adverse social and environmental conditions. Another focus 
is on detecting and controlling risk factors such as smoking 
and dietary habits that lead to CVD. The plan also includes 
emergency care and acute case management for patients, fol-
lowed by rehabilitation services to help patients regain their 
quality of life, and concludes with end-of-life care.7

 Although the Public Health Action Plan to Prevent Heart 
Disease and Stroke demonstrates considerable strengths 
with its diverse approaches to managing CVD progression, 
it falls short in addressing the causes of CVD.7 This plan 
lacks a clear strategy to identify and mitigate the root causes 
of the disease. Additionally, it does not adequately account 
for the necessity of cultural sensitivity and the demographic 
differences across the United States, which are crucial 
for the successful implementation of a population-wide 
approach.
 In response to these shortcomings, the US Department 
of Health and Human Services has shifted its focus toward 
effective public health policies aimed at reducing the 
burden of CVD. This shift is embodied in the Healthy People 
2020 strategy. The initiative is dedicated to enhancing future 
cardiovascular health and quality of life by emphasizing the 
prevention, detection, and treatment of risk factors associ-
ated with CVD.8

Reducing CVD Through Tobacco Control Policies
The reduction in cardiovascular risk factors such as tobacco 
smoking is easily targetable by public policy and poses the 
greatest population health gain in reducing the burden of 
CVD. This is evident as the implementation of tobacco con-
trol policies has a dramatic impact on the accessibility, pro-
motion, and distribution of tobacco products and can lead 
to a reduction in overall exposure.9 Not only is tobacco a 
leading cause of CVD, tobacco smoking also has a causality 

link to many other diseases and adverse health effects that 
contribute to premature mortality rates around the world. 
For example, since the implementation of comprehensive 
tobacco control efforts in the United States, it is estimated 
that 8 million fewer premature deaths related to smoking 
have occurred. This remarkable achievement underscores 
the life-saving impact of robust antitobacco policies.9

 Similarly, in the Americas region, the Pan American 
Health Organization9 reports substantial progress follow-
ing the adoption of the Framework Convention on Tobacco 
Control. The Americas have made significant strides in 
implementing various tobacco control measures, such as 
creating smoke-free environments, mandating graphic 
health warnings on tobacco products, and banning tobacco 
advertising, promotion, and sponsorship. The effectiveness 
of these measures is evident in the continuous decline in 
CVD mortality rates across all measurable countries in the 
Americas.3

 Furthermore, the introduction or increase of taxes on 
tobacco products has proven to be a highly effective tobacco 
control intervention. A substantial body of evidence conclu-
sively demonstrates that higher taxes on tobacco products 
lead to a significant decrease in tobacco consumption. By 
making tobacco products less affordable, higher taxes dis-
courage initiation, promote cessation, and ultimately con-
tribute to the overall decline in smoking rates and related 
health issues. This evidence-based strategy is a critical com-
ponent of comprehensive tobacco control programs, offer-
ing a powerful tool to reduce the burden of tobacco-related 
diseases and deaths.3,10

RECOMMENDATIONS FOR ACTION
In the United States, tobacco products are taxed in 2 ways: 
per unit (ie, per pack of cigarettes) and the ad valorem tax, 
which is based on a constant fraction of the wholesale or 
retail price.11 Therefore, a policy recommendation can be 
made to call upon the local, state, and federal governments 
to increase the tax applied to tobacco-related products to 
discourage the population’s continued consumption.
 A second policy recommendation is that the legal age for 
purchasing tobacco-related products be raised to increase 
the level of difficulty for the adolescent population to obtain 
tobacco products. By raising the minimum age to purchase 
tobacco products to 21 years, tobacco sales would decrease 
by approximately 2% but could have a substantial impact on 
the prevalence of adolescent tobacco use and dependency 
by limiting its accessibility,12 thus potentially reducing 
future CVD incidences.
 A final policy recommendation is a call to action by 
the Food and Drug Administration in the United States to 
implement the complete abolition of tobacco product sales. 

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AMWAJournal.org     55Cardiovascular Disease in the Americas (Part 2)

Cigarettes are addictive by design and termed as a defec-
tive product, meaning that they are unreasonably danger-
ous, because it is the leading cause of death for more than 
half of its long-term consumers.13 Not only is the death of 
millions of people around the world an issue, but tobacco 
smoking also enforces an enormous financial burden on the 
economy due to the subsequent health care costs and loss 
of labor productivity.13 It is an assumption that if the United 
States were to implement a complete abolition of tobacco 
product sales, the remaining countries of the Americas 
region would in time follow suit.

INSIGHTS FOR HEALTH EDUCATION SPECIALISTS 
AND PROMOTION PROFESSIONALS
This article offers a wealth of insights that can significantly 
benefit certified health education specialists (CHES), health 
education, and health promotion professionals in their 
efforts to design, implement, and evaluate interventions 
aimed at controlling or delaying the onset of chronic dis-
eases, with a specific focus on CVD. The following sections 
highlight the ways in which this research can be instrumen-
tal in their respective roles.

Designing Effective Interventions
One critical aspect explored in this article is the substantial 
impact of social determinants of health on the prevalence 
of CVD. This understanding is paramount for CHES and 
health education professionals when devising interventions. 
Armed with this knowledge, they can tailor their programs 
to address specific determinants, such as economic factors, 
education, food supply, substance addiction, and health 
care accessibility. By targeting these determinants, they can 
design interventions that are more effective in preventing 
CVD within the Americas.
 As underscored in this research, the prevalence of CVD 
and its determinants exhibit significant variations across 
countries and regions. This highlights the necessity for tai-
lored intervention strategies. CHES and health promotion 
professionals can draw from this article to design interven-
tions that are culturally and regionally appropriate, increas-
ing the likelihood of their success.

Implementing Evidence-Based Interventions
This article provides valuable policy recommendations, par-
ticularly in the context of tobacco control, a major contributor 
to CVD. CHES and health education professionals can lever-
age these recommendations as a foundation for developing 
and advocating for policies within their respective regions 
or communities. The implementation of such policies can 
significantly contribute to reducing the incidence of CVD by 
addressing a significant risk factor. This knowledge can guide 

professionals in implementing effective tobacco control 
interventions. Strategies like establishing smoke-free envi-
ronments, promoting graphic health warnings, and advocat-
ing for bans on tobacco advertising can be instrumental in 
reducing tobacco use and its associated health risks.

Evaluating Intervention Success
The tangible impact of tobacco control policies on CVD 
mortality rates was discussed. CHES and health promo-
tion professionals can use this as a model for evaluating 
the effectiveness of their interventions. By tracking changes 
in CVD rates and other relevant health indicators, they 
can assess the success of their programs. For profession-
als involved in advocating and implementing policies, this 
research emphasizes the critical importance of evaluating 
policy outcomes. By examining the effects of tobacco con-
trol policies on CVD mortality, CHES and health promotion 
specialists can demonstrate the success of their efforts and 
make necessary refinements to their strategies.
 In summary, this article serves as an invaluable resource 
for CHES and Health Education and Health Promotion pro-
fessionals by offering comprehensive insights into the social 
determinants of CVD, the impact of public health policies, 
and policy recommendations. These insights can guide the 
design, implementation, and evaluation of interventions 
aimed at controlling or delaying the onset of chronic dis-
eases. In doing so, they contribute to the improvement of 
health outcomes and the reduction of health disparities 
within communities and regions.

CONCLUSIONS
CVD is the leading cause of morbidity and mortality 
that affects the worldwide population.14 Currently, CVD 
accounts for 31% of the overall global deaths; however, as 
research suggests, low- and middle-income countries have 
a higher susceptibility to CVD, accounting for 80% of these 
deaths.15 The global health problem of CVD is influenced 
by the social determinants of health such as the economy, 
physical environment, education, food supply, substance 
addiction, and the accessibility of appropriate health care 
services. Therefore, it is a consideration that a multitude 
of public health policies are necessary for the effective 
response to the broad burden of CVD among the population 
of the Americas.
 Moreover, the insights provided in this article are invalu-
able to medical communicators. By understanding the com-
plex interplay of social determinants and CVD, medical 
communicators can craft more precise, impactful messages 
that resonate with diverse populations. This information 
enables them to highlight the importance of tailored inter-
ventions and evidence-based policies in combating CVD. 

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AMWAJournal.org     56Cardiovascular Disease in the Americas (Part 2)

Medical communicators can also leverage these findings to 
advocate for specific public health policies, such as tobacco 
control measures, that have proven effective in reducing 
CVD prevalence.9 By disseminating this crucial information 
clearly and persuasively, medical communicators play a 
vital role in educating the public, influencing health behav-
iors, and ultimately contributing to improved public health 
outcomes.

AUTHOR STATEMENT
This study did not require ethical approval as it involved a 
retrospective analysis of publicly available and anonymized 
data, with no direct involvement of human subjects.

Author declaration and disclosures: All individuals listed 
as authors participated sufficiently in the intellectual content, 
writing, and data analysis of the manuscript to assume public 
responsibility for the content therein; that all authors reviewed 
the final version prior to submission; and that any financial or 
personal relationships that might bias or be seen to bias their 
contributions to the work have been disclosed.

Author contact: alan.silburn@health.nsw.gov.au

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