Social Determinants

Social Determinants of Health: Race and Hypertensive Heart Disease
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Both African-American men and women are at a higher risk of hypertensive heart disease compared to white men (Rehkopf & Adler, 2011). Nonetheless, hypertensive heart disease is preceded by other comorbid conditions that are varied on the basis of race as shown in table 1 below. Morbidity disparities, based on race, in hypertensive heart disease and related conditions, is indicated below:

Morbid disparity based on Race (Saab et al., 2015)
This occurrence is further indicated by the Johns Hopkins Medicine (2007) who reported a higher heart failure rate among the African-Americans at 4.6 cases per 1,000 per year compared to all other races that report as low as 1 case of heart failure per 1,000 per year. This variation in morbidity has been observed over a long time and genetics and environmental factors have been deemed to be modulatory factors (John Hopkins Medicine, 2007). In the early twentieth century (around the 1920s), the African Americans did not have higher incidences of morbidity, but as they continued to settle in the United States and face racial discrimination marked by limited resources, they could not access healthy foods and high-quality treatment (Saab et al., 2015). Thereby, addressing the modifiable environmental, behavioral, cultural, and socioeconomic factors, could help to reduce the rate of hypertensive heart diseases (Husaini et al., 2011). Zoning laws place the African American at a disadvantage because he or she is exposed to obesogenic foods and crowded neighborhoods that limit his or her willingness to engage in physical activity (Lee et al.

, 2013).
On a different note, nonetheless, whereas the evidence presented above highlights the modulatory role of the environment and socio-economic status, Frierson et al. (2013); Lee et al. (2013); Davis, Gebreab, Quarells, and Gibbons (2014) indicate otherwise. Therefore, the environment, largely regulated by healthcare policies, and cultural beliefs need to be investigated to understand the link between race and hypertensive heart disease. An individual is predisposed to a certain risk factor that is favored by one’s racial disposition to cause disease.

References
Davis, S. K., Gebreab, S., Quarells, R., & Gibbons, G. H. (2014). Social Determinants of Cardiovascular Health among Black and White Women Residing in Stroke Belt and Buckle Regions of the South. Ethnicity & Disease, 24(2), 133–143.
Frierson, G. M., Howard, E. N., DeFina, L. F., Powell-Wiley, T. M., & Willis, B. L. (2013). Effect of Race and Socioeconomic Status on Cardiovascular Risk Factor Burden: The Cooper Center Longitudinal Study. Ethnicity & Disease, 23(1), 35–42.
John Hopkins Medicine. (2007). Who gets heart failure? Race takes back seat to diabetes and high blood pressure. Retrieved from https://www.hopkinsmedicine.org/news/media/releases/who_gets_heart_failure_race_takes_back_seat_to_diabetes_and_high_blood_pressure.
Husaini, B. A., Mensah, G. A., Sawyer, D., Cain, V. A., Samad, Z., Hull, P. C., … Sampson, U. K. A. (2011). Race, Gender, and Age Differences in Heart Failure-Related Hospitalizations in a Southern State: Implications for Prevention. Circulation. Heart Failure, 4(2), 161–169. http://doi.org/10.1161/CIRCHEARTFAILURE.110.958306
Lee, H., Kershaw, K. N., Hicken, M. T., Abdou, C. M., Williams, E. S., Rivera-O’Reilly, N., & Jackson, J. S. (2013). Cardiovascular Disease Among Black Americans: Comparisons Between the U.S. Virgin Islands and the 50 U.S. States. Public Health Reports, 128(3), 170–178.
Rehkopf, D. H., & Adler, N. (2011). Review of social determinants of health for public health departments. Oakland, CA: Public Health Institute and Bay Area Regional Health Inequities Initiative.
Saab, K. R., Kendrick, J., Yracheta, J. M., Lanaspa, M. A., Pollard, M., & Johnson, R. J. (2015). New Insights on the Risk for Cardiovascular Disease in African Americans: The Role of Added Sugars. Journal of the American Society of Nephrology : JASN, 26(2), 247–257. http://doi.org/10.1681/ASN.2014040393.