Socio-ecological model - South Asian Cardiovascular Health

Socio-ecological model is crucial in studying different association between study subject and health outcome. South Asians are more likely than other ethnicity groups, to be diagnosed and die from various types of cardiovascular diseases, in North America and rest of the world. South Asians generally tend to have a higher risk of developing heart disease, diabetes, and other cardiometabolic conditions at a younger age than most of the general population. (Das A., 2016).

A multilevel framework provides us with an opportunity to ask questions that extend our analytic lens beyond individual experience to a fuller appreciation of the levels of influence that plausibly shape the health of populations, all to the end of understanding what might indeed matter most and what might be helpful to levers of power in our goal to improve population health. (Thongs, G., 2015)

In terms of health indicators, South Asians are over-represented with an abnormal ratio between apolipoprotein B and apolipoprotein A1, hypertension, glucose intolerance, type 2 diabetes mellitus, increased BMI, body fat percentage, abdominal and visceral adiposity. (T. Tharmaratnam, 2018). These risk factors are strong precursors to various cardiovascular diseases globally.

This unusual phenomena of high CVD risk in South Asians is explained by the combination of both genetic and environmental factors, mostly notably in genetic biomarkers, cultural beliefs, diet, lack of physical activity and unhealthy habits such as smoking and alcohol consumption. Nevertheless, this model is important for researchers to gain an insight, and investigate in how can we use different research studies to study different variables that might have been neglected over past few decades.

One interesting insight is that despite that South Asian is categorised as one ethnic group, this group is highly diverse with background from 7 countries (~2 Billion people) from India, Pakistan, Sri Lanka, Bangladesh, Nepal and Bhutan. There are diverse cultural beliefs, dietary restrictions and genetic composure within this group that would represent different tendency of risk factors to be diagnosed with different type of CVDs. By analysing the ecological model to study high risk of CVDs amongst South Asians, Researchers could work on different public policies to improve cultural-competency in health programs directed to different ethnicities. Sometimes, an universal program might not be sufficient to address various differences in an intra-group perspective, I hope to use different types of multi-level models in my future thesis studies, especially in the field of South Asian Health.

Figure 1: Ceasar, Joniqua & Ayers, Colby & Andrews, Marcus & Claudel, Sophie & Tamura, Kosuke & Das, Sandeep & Lemos, James & Neeland, Ian & Powell-Wiley, Tiffany. (2020). Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS ONE. 15. 10.1371/journal.pone.0230041.

Figure 2: Kaplan GA. What’s wrong with social epidemiology and how can we make it better? Epidemiol Rev., 2004; 26: 124-35.

Reference

Ceasar, Joniqua & Ayers, Colby & Andrews, Marcus & Claudel, Sophie & Tamura, Kosuke & Das, Sandeep & Lemos, James & Neeland, Ian & Powell-Wiley, Tiffany. (2020). Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS ONE. 15. 10.1371/journal.pone.0230041.

Thongs, G., & Gahman, L. (2015). In the Caribbean, colonialism and inequality mean hurricanes hit harder. Retrieved October 23, 2017, from http://theconversation.com/in-the-caribbean-colonialism-and-inequality-mean-hurricanes-hit-harder-84106

Das A, Ambale-Venkatesh B, Lima JA, Freedman JE, Spahillari A, Das R, et al. Cardiometabolic disease in south Asians: a global health concern in an expanding population. Nutr Metab Cardiovasc Dis. 2017;27(1):32–40. https://doi.org/10.1016/j.numecd.2016.08.001.

Tharmaratnam, T., Iskandar, M. A., Doherty, S., D’Urzo, K. A., Kopalakrishnan, S., Tabobondung, T. C., Gopee-Ramanan, P., Sivagurunathan, S., & Sivananthan, N. (2018). The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians. Frontiers in Cardiovascular Medicine, 5. https://www.frontiersin.org/article/10.3389/fcvm.2018.00165

Makshood, M., Post, W. S., & Kanaya, A. M. (2019). Lipids in South Asians: Epidemiology and Management. Current cardiovascular risk reports, 13(8), 24. https://doi.org/10.1007/s12170-019-0618-9

Palaniappan, L., Garg, A., Enas, E., Lewis, H., Bari, S., Gulati, M., Flores, C., Mathur, A., Molina, C., Narula, J., Rahman, S., Leng, J., & Gany, F. (2018). South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. Journal of community health, 43(6), 1100–1114. https://doi.org/10.1007/s10900-018-0527-8

R. Jiwani, S. Gerry, D. Patel. A review of culturally tailored interventions to reduce cardiovascular disease in South Asians. (June, 2018.). www.oatext.com. Retrieved June 11, 2022, from https://www.oatext.com/a-review-of-culturally-tailored-interventions-to-reduce-cardiovascular-disease-in-south-asians.php#Article