The POWER of equity

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Publication Date: 
Wed, 2010-03-31

Poverty, low educational attainment, access to healthy foods, and neighbourhood and work place characteristics are underlying factors that increase the risk of heart disease among individuals, increase the rates of heart disease in the population and contribute to continued CVD-related health inequities among those with heart disease. Focusing efforts upstream through community and cross sectoral collaboration can help address the root causes of these health inequities and reduce the burden of heart disease in the population. Because women are more likely to live in low-income households than men, to be most effective, these efforts will need to address the factors that lead to increased rates of poverty among women.

Prevention (primary and secondary) is key to reducing the burden of illness due to CVD.

The prevalence of behavioural risk factors for heart disease remain high in Ontario — smoking, physical inactivity, obesity, and poor diets — in the general population and among people with heart disease. Primary prevention, or reducing risk among those who do not yet have CVD, is key to reducing illness burden. Secondary prevention will reduce CVD-related illness and death among women and men with heart disease. Prevention interventions need to address the social determinants of health, be gender sensitive and target those who are socioeconomically disadvantaged and therefore at greatest risk. Increased emphasis on prevention and integrated approaches at the population, community and clinical levels are essential to reduce the burden of illness due to CVD in Ontario.

Close the gender gap in care for CVD.

Gender gaps in CVD care have narrowed because of an increased awareness of the importance of heart disease to women and a recognition of the gender disparities in care that exist, combined with activities to close these gaps including gender-specific guidelines. While we did find some gender gaps in clinical care, there were a number of indicators where care for women and men was similar and where there were disparities, many of these were modest. Nevertheless women were still less likely to receive care from a cardiologist, undergo diagnostic testing and they were more likely to be readmitted to hospital after an admission for a heart attack. Of greater concern, women with heart disease consistently reported worse functional status and higher rates of disability than men. Women were more likely to report activity limitations, mobility problems, activities prevented by pain, and disability. Gender sensitive models of care focussed on disability prevention and improved functional status can improve the quality of life of women with heart disease.

Comprehensive patient-centred chronic disease management can improve quality and outcomes of care for CVD.

CVD is a chronic disease requiring coordination across settings of care, including physician care and hospital care. Individuals with CVD often have other chronic conditions such as diabetes and hypertension, because of similar risk factors for these conditions and because CVD and other chronic diseases are more prevalent with increasing age. We found high rates of emergency department use and hospital readmission in women and men with heart failure. Effective interventions that prevent both emergency department use and hospital readmissions would reduce the burden on hospitals and free much needed resources. The implementation of a coordinated, comprehensive, patient-centred, chronic disease prevention and management strategy — one that addresses the needs of at-risk populations — may be the key to improving quality and outcomes of care for CVD.

Province-wide, integrated, organized models of care delivery can improve health outcomes and reduce inequities in care.

We found sizable regional variations in care probably due to differences in human resources, capacity and practice patterns. Province-wide, integrated, organized models of care delivery can improve health outcomes and reduce inequities in care. The Ontario Stroke System—which targets activities across the continuum of stroke care from prevention, prehospital care, acute care and rehabilitation and community reintegration—provides an example for such a model that could be applied to other types of CVD.

Improve quality, availability and timeliness of data to assess CVD and CVD care in the province.

While data quality and availability to assess CVD care in the province has improved, there is still much to be done to improve the quality, availability and timeliness of data. Specifically, medication data on those under age 65, data on management of CVD in ambulatory care settings, and datasets that capture clinical factors are needed. Additionally, data on ethnicity would allow us to assess disease burden as well as access, quality, and outcomes of care to Ontario’s diverse communities.


Naushaba Degani is Project Director of the POWER Study.

Arlene S. Bierman, a general internist, geriatrician, and health services researacher is Principal Investigator for the POWER study.

To download the entire CVD chapter or the Chapter Highlights go to

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