The development of a successful framework for managing heart disease in any community requires an effective understanding of the demographics and the challenges that groups face in support of developing strategies to improve outcomes. In particular, heart disease is a challenging condition that must be considered and evaluated in order to reduce risks and improve outcomes for community members. The following discussion will evaluate heart disease in Baltimore, MD in order to identify different strategies that might be useful in expanding knowledge and information regarding this condition to prevent serious complications.
Part 1: Community/State Demographics
Baltimore, Maryland is a very diverse community with many different health concerns and a strong necessity to facilitate health promotion activities. Heart disease is a number one killer throughout the United States and carries a high degree of risk for many communities, including the Baltimore area. With the 2012 Census, the city of Baltimore had approximately 621,342 residents, of which 52.9 percent are females and 63.6 percent are African Americans (US Census Bureau, 2012). Whites make up 31.5 percent of the population and only 4.3 percent are of Hispanic or Latino origin (US Census Bureau, 2012). Almost 80 percent of this population has a high school diploma and 26 percent has earned a Bachelor’s degree or higher, with 50% owning their own homes (US Census Bureau, 2012). The median household income for 2007-2011 was $40,100 and 22.4 percent of the population is below the poverty level (US Census Bureau, 2012).
In the State of Maryland, there are 5,884,563 residents, with females comprising 51.6 percent of the population, while 61.1 percent are White, 30 percent are African American, and 8.4 percent are Hispanic or Latino (US Census Bureau, 2012). Within the State, 88.2 percent of the population has earned a high school diploma and 36.1 percent has earned a Bachelor’s Degree or higher, with a home ownership rate of 68.7 percent (US Census Bureau, 2012). Finally, the median household income for the State is $35,751 and 9 percent of the population lives below the poverty line (US Census Bureau, 2012). Based on these statistics, the City of Baltimore faces greater socioeconomic challenges than those of the State of Maryland, including the potential for greater health disparities. Therefore, it is important to identify these disparities and to address cardiovascular disease within the City as a serious health issue and a formidable threat to this population.
Part 2: Health Status
The Baltimore City Health Department routinely provides reports regarding the health status of its local residents and identifies specific health disparities that require further consideration. Although some areas have experienced slight improvement, there continue to be many health disparities that must be addressed to improve outcomes throughout the city (Baltimore City Health Department, 2010). In general, the city fares worse than the State of Maryland in such areas as heart disease and infant mortality; therefore, the City must utilize its available resources in order to accomplish improved health outcomes throughout this community (Baltimore City Health Department, 2010).
Within Baltimore County, cardiovascular disease claims approximately2,000 lives annually; therefore, this community must identify methods to better manage existing disparities and to encourage greater compliance to improve health and wellbeing (Baltimore City Health Department, 2009). An agenda was established by the City Health Department in an effort to reduce the risks associated with cardiovascular disease and included such topics as reducing salt intake, expanding blood pressure screenings, enhancing health education by using Faith-based approaches, and smoking cessation efforts (Baltimore City Health Department, 2009). These efforts demonstrate the important impact of health promotion for this population group in order to reduce disparities and to improve outcomes (Baltimore City Health Department, 2009).
Within the City of Baltimore, there were approximately 200 deaths per 100,000 members of the population as a result of coronary heart disease in 2008, which is 53 deaths above the state average (Maryland Department of Health & Mental Hygiene, 2009).These findings suggest that Baltimore residents do not manage their overall cardiovascular health and face critical challenges that require additional education and guidance from community members (Maryland Department of Health & Mental Hygiene, 2009).Within the City of Baltimore, evidence also demonstrates that African Americans experience higher rates of death as a result of cardiovascular disease as compared to other population groups, thereby mandating additional education and prevention efforts within this community (Johns Hopkins Urban Health Institute). Furthermore, African Americans within the city have a higher rate of obesity than Whites (Johns Hopkins Urban Health Institute). These statistics provide further evidence that cardiovascular disease in Baltimore is higher in some population groups than in others, supporting the belief that these groups experience greater health disparities (Johns Hopkins Urban Health Institute).
In an examination of statistics evaluating specific neighborhoods of Baltimore, every single neighborhood that was evaluated, from wealthiest to poorest, reported heart disease as the leading cause of death (The Baltimore Sun, 2011). Therefore, it is important to identify different methods to promote the expanded delivery of healthcare services and health promotion activities to improve outcomes for this population group (The Baltimore Sun, 2011). In addition, it is important to recognize the value of surveys and discussion groups to identify health disparities in order to improve outcomes and to reflect on existing frameworks to achieve greater results. According to a study conducted by the National Heart, Lung, and Blood Institute (NHLBI) in public housing units in Baltimore, “Public housing residents had a preexisting knowledge and awareness of heart healthy lifestyles and CVD risk factors…One cardiovascular risk behavior, cigarette smoking, is pervasive among the demographic groups probed (excluding teen females) and accordingly smoking cessation is a critical element of any community outreach strategy that would be developed. Stress, from environmental and personal stimuli, is also cited by participants as a major barrier to improving health, including young adults ages 15–18. In fact, many participants cite stress as a primary risk factor for heart disease and a barrier to heart disease prevention” (NHLBI, p. 2). Based upon these indicators, it is necessary to evaluate the conditions that are evident within this community in an effort to improve knowledge and prevention strategies to reduce cardiovascular risks (NHLBI). The efforts that are made to conduct interventions throughout Baltimore are likely to be effective in providing knowledge and information to local residents who might improve their own health outcomes in the process.
One of the most staggering discrepancies in Baltimore regarding the health of its population is life expectancy, which differs by 20 years in some communities (Cohn and Marton, 2012). For example, the Roland Park community has a much higher life expectancy rate and a higher median income at $90,000, while Upton has a much lower life expectancy rate and a lower median income at $13,000 (Cohn and Marton, 2012). Nonetheless, heart disease is the number one killer in both communities; however, prevention and awareness of the disease vary dramatically (Cohn and Marton, 2012). These findings suggest that the residents of Baltimore in throughout all communities must be aware of the risks associated with heart disease, but that those in lower income communities must be provided with greater interventions in order to improve their cardiovascular health and wellbeing over time (Cohn and Marton, 2012). It is important to recognize these disparities and how to overcome the discrepancies in the health of Baltimore residents so that the risks associated with heart attack, stroke, and other conditions are reduced as best as possible (Cohn and Marton, 2012). In addition, this population group must be provided with the appropriate level of access to healthcare screenings and services in an effort to produce successful outcomes for individuals and families who are at the greatest risk for cardiovascular disease (Cohn and Marton, 2012).
Finally, the development of a successful approach to prevent heart disease and improve disease management to prevent high mortality rates requires an effective understanding of the disparities that exist throughout Baltimore, particularly those that occur across minority groups. Since there are significant discrepancies in Baltimore in regards to specific populations, it is important to evaluate these differences and to take the steps that are necessary to provide local residents across different communities with the tools and resources that are required to improve their health and reduce their risk of heart disease through healthy lifestyle choices and other factors that will improve their health and wellbeing in different ways.
The disparities in health in Baltimore are best represented by the development of strategic approaches in community –based settings in order to gather data and to develop specific frameworks that will generate healthier outcomes for this group. Within this context, it is important to recognize the value of interventions that provide education and support to those persons at risk for cardiovascular disease in order to improve outcomes and create new opportunities for expanded health. With a diverse range of life expectancy within the City of Baltimore, it is more important than ever to recognize the different concerns associated with lower income communities and how this impacts health over the long term. From this perspective, it is likely that organizations that work collaboratively towards a set of common goals and objectives will achieve greater than anticipated outcomes in different ways to reduce their risk of heart attack, stroke, and other cardiovascular concerns. For the residents of Baltimore, it is more important than ever to provide them with a framework for the achievement of successful outcomes and the development of healthier lifestyle choices to improve general health and wellbeing over time.
Baltimore City Health Department (2009). Agenda to reduce cardiovascular disease disparities in Baltimore City. Retrieved from http://www.baltimorehealth.org/info/Keep%20the%20Beat%20-%20Baltimore%27s%20Cardiovascular%20Disease%20Agenda.pdf
Baltimore City Health Department (2010). 2010 Baltimore City health disparities report card. Retrieved from http://baltimorehealth.org/info/2010_05_25_HDR-FINAL.pdf
The Baltimore Sun (2011). Mapping the health of Baltimore’s neighborhoods. Retrieved from http://data.baltimoresun.com/baltimore-healthy-neighborhoods/
Cohn, M., and Marton, A. (2012). City health data illustrates chasm between rich and poor neighborhoods. The Baltimore Sun, retrieved from http://articles.baltimoresun.com/2012-07-12/news/bal-baltimore-health-data-map-illustrates-chasm-between-rich-and-poor-neighborhoods-20120712_1_life-expectancy-city-health-heart-disease
Johns Hopkins Urban Health Institute. Health disparities in Baltimore City: is geography destiny? Retrieved from http://urbanhealth.jhu.edu/media/reports/healthdis_baltimore.pdf
Maryland Department of Health & Mental Hygiene (2009). The Maryland burden of heart disease and stroke. Retrieved from http://phpa.dhmh.maryland.gov/cdp/pdf/Report-Heart-Stroke.pdf
National Heart, Lung, and Blood Institute (NHLBI). Cardiovascular health small group
discussion in Baltimore City public housing: consumer assessment for community-based outreach and education. Retrieved from http://www.nhlbi.nih.gov/health/prof/heart/other/smallgroup.pdf
United States Census Bureau (2012). Baltimore city, Maryland. Retrieved from http://quickfacts.census.gov/qfd/states/24/24510.html