Cincinnati.com – The Enquirer
‘A public health crisis’: How access to food, care shape region’s high blood pressure woes
Brooks Sutherland, Cincinnati Enquirer – November 11, 2022
When Dr. Benjamin Peterson advises patients seeking help controlling their blood pressure, he typically starts by talking with them about their diet, detailing why certain foods exacerbate preexisting health problems.
“The advent of a lot of processed foods is worsening a situation that’s already there,” the St. Elizabeth’s cardiologist told The Enquirer. “There’s definitely a lot of genetics involved (in high blood pressure) but the American diet and processed foods really accelerate that.”
“I would say it’s a public health crisis,” he later added.
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Fried foods, fast food and processed foods can lead to unhealthy outcomes. But Peterson acknowledges that the choice of what we eat, our smoking habits and the amount of exercise we engage in aren’t always direct lines to good health. Other factors can be at play.
“I tell (my patients) try to quit smoking, try to do their best with diet and exercise,” the doctor said, “but even if they make big improvements in their lifestyle, I don’t want them to be too hard on themselves if their blood pressure doesn’t come down a whole lot. It’s still a huge benefit to them to try to eat healthy, that’s still going to help them add longevity even if their blood pressure didn’t come down a whole bunch.”
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Traditional public health advice centers around choice. If an individual improves lifestyle choices, mainly diet, exercise, and smoking habits, their health outcomes will also improve. But what happens when healthy choices aren’t always an option? Location, access, genetics, health inequities, and community resources are factors experts have begun to focus on through years as peer-reviewed studies have pointed to the importance of location. And locally in the Cincinnati region, Lauren Bartoszek, senior manager of population health strategies at the Health Collaborative, wants health organizations to partner to think boldly about how important location is to health inequities.
“As a community, it’s really important for us to redefine what we mean by lifestyle,” said Lauren Bartoszek, senior manager of population health strategies at the Health Collaborative, the coordinating body of the region’s 40 hospitals. “Historically, the frame that was taken was around lifestyle being purely a choice. But what we’ve come to learn over the last handful of years … is that lifestyle is really a result of conditions. You don’t really have a say in your community, whether or not more or less fast food restaurants are there. You are living somewhere based on your economic and financial ability to live there.”
A health problem in Cincinnati made worse by societal, other barriers
Heart problems are common in the Cincinnati region, but they’re worse among Black residents here (as they are elsewhere in America).
High blood pressure occurs when arteries that give blood to the body get stiffer and then don’t respond as well to the pressures of the heart, making the heart work harder to get blood out to the rest of the body. The leading contributor to cardiovascular disease is untreated high blood pressure, according to the Mayo Clinic.
In the Cincinnati region, 4 in 10 residents report having high blood pressure, according to a survey conducted by Interact for Health. Three in 10 report needing treatment for hypertension, the Health Collaborative found in its annual Community Health Needs Assessment. Regional death rates due to high blood pressure are 15% higher among Black residents and cardiovascular-related health conditions rank first among health conditions in the region, Interact’s survey found.
The causes of high blood pressure begin with diet and exercise but can extend to smoking and even environmental factors such as weather, experts have found. The risks are significant, particularly when untreated.
“One of the biggest issues is there’s really no symptoms until something untoward happens,” said Dr. John Szawaluk, a cardiologist at the Christ Hospital. “Hypertension is a huge risk factor for heart attack, stroke, heart failure, kidney dysfunction, renal failure. So, a lot of times, someone who is not getting regular medical care does not know they have high blood pressure. It’s not diagnosed until one of these things rears its head.”
Because of that unpredictability, health organizations have taken it upon themselves to reach out to vulnerable communities and provide free health screenings, follow-ups, and dietary advice. Organizations such as Interact for Health use data to map out inequities and coordinate plans to aggressively attack disparities. That work is being done specifically in Cincinnati, where Black majority neighborhoods account for the city’s 10 highest rates of high blood pressure.
“(African Americans) get it at a younger age, and they’re more likely to suffer from complications,” Dr. Meron Hirpa, a physician at the Cincinnati Health Department, said while detailing why innovative approaches must be used to reach more communities.
The inequities extend to other health factors that contribute to high blood pressure as well. In Cincinnati, seven of the 10 highest neighborhood smoking rates are also Black majority, according to an Enquirer analysis of CDC data.
“A lot of it exists because we haven’t reckoned with these broader environmental factors that lead to disparities in health based on where you’re born and where you live,” said Kate Schroder, president and chief executive officer of Interact for Health. “There’s factors around access to healthy food, around the amount of tree cover and green space and how it impacts your health. If you have a higher rate of pollution in your neighborhood, water quality, poverty.”
Hypertension’s grip in a region with many health resources
The top cause of death in the Cincinnati region is heart disease. That isn’t atypical as heart disease is also the top cause of death in the nation. But contributing factors to heart disease such as smoking, hypertension, and obesity are above national averages. That troubles Bartoszek considering the area.
“The most fascinating part, fascinating in a negative way unfortunately, is we have one of the most dense regions for health care resources,” she said. “If you were to add up things like hospitals and things like (federally qualified health centers), clinics, health departments and social service agency organizations like nonprofits, the resources are there but we continue to rank pretty poorly in our health. At the end of the day, something’s not working.”
One major factor Bartoszek and other contributors to the report identified is that the structure of the Cincinnati region doesn’t always support a healthy lifestyle. The community must take a harder look at some of these deep-rooted issues, she argued.
“We’re thinking about that from the ability of different sectors to collaborate with one another,” she said. “We think about of that from the structural divide between systems, from clinical to social service. That ability of somebody to have a really strong care coordination and to get from their doctor to the food pantry or from their clinician’s office to their work through transportation. All of those things really go into the infrastructure of our region. And it’s lacking. There’s problems.”