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Evidence based report on cities and their effects on health
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4000 word report on Health in the City (optional module for MSc Public Health (grade B: 60/100)
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Cardiovascular Diseases in the Bronx Hispanics CommunityIntroduction
Cardiovascular diseases (CVDs) are the name given to several conditions affecting the heart
and blood vessels including hypertension, coronary heart disease, angina, stroke, and heart
attacks (NHS England, 2022). CVDs are the leading cause of death globally (World Health
Organisation,2021). In 2019, deaths due to CVDs amounted to 32% of all global fatalities,
with 85% due to heart attacks and stroke (World Health Organisation, 2021). In the United
States of America (USA), approximately 650,000 people die from heart disease annually
(Centre for Disease Control and Prevention, 2022). CVDs are the leading cause of death for
people of most ethnic and racial groups, including Hispanics, in the USA (Centre for Disease
Control and Prevention, 2022). Early detection of CVD and addressing behavioural risk
factors are some interventions that can aid/assist in preventing CVDs (World Health
Organisation, 2021).
This report will provide an evidence-based background on CVD in the Bronx, New York
Hispanic population. It will include epidemiological data on CVDs concerning the chosen
population produced at a local level to identify the socio-demographics. This will be followed
by exploring the context and background of the health issue by identifying social health
determinants (using epidemiological evidence) such as economic stability, education,
healthcare quality and spatial environment that impact the health of Hispanics living in the
Bronx. Following on from this, the report will identify and critically review previous and
current interventions in place for CVD. The final part of the report will suggest
recommendations to address CVD in the Bronx and address the rationale behind the
recommendations provided.
Rationale and City Context of Human Health
The Urban health advantage suggests that cities provide better access to education,
healthcare, better economic opportunities and greater availability of food, however, cities
typically have severe deprivation, a mix of good and poor working living conditions and
1
, good and poor housing. The urban health penalty approach states that cities can expose
residents to unhealthy environments due to their built-up nature and concentrate poor people
which leads to a disproportionate burden of poor health (Vlahov et al, 2005).
The Sick City Hypothesis proposes the idea that population health in cities is relatively poor
which supports the ‘urban health penalty’ concept (Rodwin, 2001). Cities encourage the rapid
spread of infectious diseases due to the high population density as a vector for transmission
of disease (Rodwin, 2001). The Big Cities Health Inventory in the United States conducted a
study in 1997 and found health indicators and infection rates to be worse in urban settings
than in the United States as a whole (Rodwin, 2001). The evidence from this research
emphasises the ‘Urban Health Penalty’ which suggest that urban environments and urban
lifestyles have negative effects on human health (McDonald et al, 2020). Other evidence that
supports the Sick City Hypothesis is the project Megapoles. The Project Megapoles
compared age – specific mortality of capitals against national rates and found that mortality
rates in infants were 7% higher in city settings (Rodwin, 2001). However, data from
European capitals make it difficult to generalise its support for the sick city hypothesis.
Cities usually attract migrants looking to improve their quality of life; however, this is not
usually the case. For example, in the Bronx, over 50% of residents speak Spanish as their
primary language which could create barriers in access to healthcare and perception of health
issues creating health inequalities amongst populations.
The Bronx and CVD amongst the Hispanics
The Bronx is the only mainland borough in the northernmost part of New York City. It
encompasses 42 square miles and has a population of approximately 1.4 million making it
one
of the most populous boroughs in the United States (Hermalyn and Ultan, 2017). The
Harlem River separates the Bronx from Manhattan and is bordered by Westchester County to
the north, the east river to the south, Long Island Sound to the east and the Hudson River to
the west (Hermalyn and Ultan, 2017). The Bronx is connected to other New York boroughs
by several bridges, railroad tunnels and highways which by the 1980s were the most heavily
travelled than any other part of America (Hermalyn and Ultan, 2017).
The Bronx consists of 12 community districts. Hispanics account for over 50% of the
population in the Bronx. Each district is dominated by a Hispanic population except for
Williamsbridge and Baychester, which has a majority African American population (NYC
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