Rural Florida has higher rates of heart disease than their urban counterparts. Changing that means meeting people where they live.
While heart disease is the most common cause of death, it is also highly preventable. The steps to reduce the rate of heart disease by 80% or more — whether coronary artery disease, heart attack or stroke — is well documented. The American Heart Association offers an eight-point plan called Life’s Essential 8 that anyone can follow to improve their cardiovascular health through a combination of diet, exercise and sleep, along with regular checkups with a doctor.
It’s simple, but not always easy, especially in rural Florida communities that have long had higher rates of heart disease than their urban counterparts. Contributing factors to the disparity include a lack of access to health care and to healthy, affordable ingredients for meals for a variety of geographic and social reasons.
“We can see how a rural environment does not foster some of these (behaviors),” says Dr. Humberto López Castillo, a physician and University of Central Florida assistant professor in the Department of Health Sciences.
The age-adjusted rates of deaths from heart disease are highest in rural Florida counties such as Holmes, which had about 308 deaths per 100,000 — nearly double Florida’s rate of 147 per 100,000. Union, Baker and Okeechobee aren’t far behind Holmes, with 294, 268 and 266 deaths per 100,000, respectively.
Educating communities on interventions such as the Heart Association’s Life's Essential 8 plan is a key step, Castillo says. But he has found that those efforts may be more successful if they’re adapted to the culture and environment where people live. Gender, ethnicity, and socioeconomic status all play a role.
Part of his research on rural-urban heart health disparities has focused on Latino populations in Central Florida. Among a sample of roughly 50 participants, he asked them about the best ways to tackle the Heart Association’s recommendations and to rank them.
His subjects typically listed low-hanging fruit at the top. If you don’t already smoke, for instance, don’t start.
The people teaching them about how to create healthier diets or exercise routines to apply to their daily lives also mattered. In general, they preferred someone non-judgmental who looked like them and shared their culture. When Castillo asked them to close their eyes and imagine a fitness instructor, they often pictured a fit Latino man resembling a familiar singer or star. If it was a cooking instructor, then more often they imagined a Latina woman, and would trust her more if she was maternal and chubby instead of thin.
He also asked them to imagine that money is not a barrier. In that case, participants told him that instead of new meals they would adapt healthier versions of foods they are already familiar with.
“We want someone with our cultural values,” Castillo says. “We still want to eat tacos, but we want to know how to make these tacos healthier.”
The American Heart Association's Life’s Essential 8
1. Eat Better — with whole foods, fruits, vegetables, lean protein, nuts, seeds, and cooking in non-tropical oils such as olive and canola
2. Be More Active — Adults should get 2 and a half hours of moderate or 75 minutes of vigorous physical activity per week; kids, 60 minutes each day
3. Quit Tobacco
4. Get Enough Sleep — 7 to 9 hours for adults and more for children
5. Manage Weight
6. Control Cholesterol
7. Manage Blood Sugar
8. Manage Blood Pressure