Disease prevention strategies and risk factors for CHD

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The aim of this essay is to discuss the implications of socioeconomic and psychosocial factors in the prevention of Coronary Heart Disease (CHD). I will discuss the three levels of disease prevention strategies and risk factors for CHD and link these to a particular life style and social class.

CHD is preventable yet kills more than 110,000 people in England each year. Statistics state that CHD is the biggest killer in the country. (department of Health).

The three levels of disease prevention strategies in CHD are:-

Primary - The aim to prevent the onset of disease in educating people about their own lifestyles, for instance, losing weight, taking up exercise and giving up smoking.

Secondary - Strategies that aim to detect all people with established CHD and offer them advice and treatment to reduce their risks. Identify all people at significant risk of CHD but who have not developed symptoms and offer them advice and treatment

Tertiary - People with suspected CHD are to be offered investigations and treatments that will both relieve their symptoms and reduce the risk of subsequent cardiac problems.

You are more likely to develop CHD if you have a poor diet, physically inactive or smoke. (British Heart Foundation)


A poor diet is another risk associated with CHD. Eating at least five portions of fruit and vegetables a day, fish twice a week and cutting down on saturated fat, salt and alcohol will help reduce the risk of CHD.

The Low Income Diet and Nutrition Survey (LIDNS) was carried out by the Food Standards Agency, to provide evidence on the eating habits, nourishment and nutrition related health of people on low incomes. It found that those on low incomes were less likely to eat wholemeal bread and vegetables, eat more processed meats, whole milk and sugar. For men and women, consumption of pasta, pizza, burgers and kebabs decreased with increasing age.

Men and women with a lower level of educational achievement tended to have a less healthy diet than men and women with more education. Men and women with less

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Education ate fewer vegetables and more chips, fried and roast potatoes. Less educated women also consumed less fruit and fruit juice. (Food Standards Agency)

It would suggest that low income families are restricted on the food they buy because of the price of processed foods, compared to fresh fruit, vegetables, meat and fish. Higher income families have the finances to buy healthier foods.

Regardless of income people know what a healthy diet is, but low income families or less educated families might not understand the effects on their general health and CHD with eating fatty and processed foods.


Smoking is an important cause of CHD. The British Doctors Cohort Study found, that mortality from CHD was 50% higher in smokers (and over 75% higher in heavy smokers) than in non-smokers (heart stats.org).

There is a strong link between cigarette smoking and socio - economic groups. Smoking has been identified as the single biggest cause of inequality in death rates between rich and poor in the UK. People in poorer social groups who smoke, start smoking at an earlier age: of these in managerial and professional households, 31% started smoking before they were 16, compared with 45% of those in routine and manual households. (ASH).

Laws preventing smoking in public places and banning tobacco advertising along with the NHS stop smoking services, has helped reduce the number of people who smoke.

It is unsure why the financially worse off still continue to smoke, even though the price of cigarettes has risen dramatically. It could be stress, unhappiness or that they feel they do not have much else in their lives. People less educated might not fully understand the complications of smoking. It just could be that it is highly addictive and they may not have the will power to give up.

The financially better off and well educated could also experience the same dilemmas as the financially worse off but perhaps they have more control of their lives and a better understanding of the implications.

Physical Inactivity

People who are physically active are half as likely to get CHD as those who are inactive.

Current government guidelines recommend that for general health, adults should accumulate a total of at least 30 minutes of moderate intensity activity on five or more

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days of the of the week. (Department of Health )

Too many people are not active enough to benefit their health. With adults- six out of ten men and seven out of ten women are not active enough. Among children, four out of ten boys and five out of ten girls are not meeting the recommended one hour of exercise a day.

Rates of inactivity are higher among older people, some ethnic minority communities and people in rented council accommodation.

Evidence shows that manual workers are over two and a half times less likely to participate in sport than professionals. Women are also less likely to participate in sport than men.

Some factors relating to inequalities in levels of physical activity in relation to social class could be a relatively low level of knowledge about the benefits of physical activity, low levels of motivation to be physically active, a shortage of affordable facilities in areas of disadvantage and the lack of parental/family support, for example, financial, transport and general encouragement.

Those of higher social class have the financial means to join a health centre, more family support or child care, transportation and they can choose the best facilities to suit their individual fitness needs.


The health department has made substantial progress in the prevention, diagnosis and treatment of Coronary Heart Disease with the launch of the Coronary Heart Disease National Service Framework (CHD NSF).

They are trying to meet the NSF standards and there is a new direction for health services set out in the white paper our health, our care, our say. More new cardiothoracic centres and catheter laboratories have opened around the country, helping provide more care closer to home. A reduction in waiting times and a focus on the inequalities agenda to make sure the improvement in CHD services benefit all parts of the community.

The National Fruit Scheme is aimed at giving all four to six year olds in infant and nursery schools a free piece of fruit each day, to help improve children’s health and nutrition.

The Local Exercise Action Pilots (LEAP) tested different community approaches to increasing physical activity in deprived areas. One of the pilots focuses on free

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Swimming for young people.

The Government set up a comprehensive NHS stop smoking service. Services are now available across the NHS in England, providing counselling and support to smokers wanting to quit, complementing the use of stop smoking aids Nicotine Replacement Therapy (NRT) and Bupropion (Zyban).

With advertisement and the overall focus on health care it is hoped to nurture a population that is more engaged in protecting its own health, enjoying healthier lifestyles and reducing their risk of preventable diseases.

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