Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

Abstract

Conditions in the social and physical environment influence population health and risk for CVD, including hypertension. These environmental conditions are influenced by the decisions of public officials, community leaders, and service providers. Examining the frames that local decision makers bring to understanding hypertension can provide important insights into the decisions that they make about strategies for addressing this problem in their jurisdiction. The goal of this study was to examine the frames that local decision makers in Quibdó, Colombia, bring to understanding hypertension risk, and in particular, whether and how they use frames that encompass associations between living conditions and hypertension risk. Data for this qualitative study were collected using a stratified sampling strategy. Semi-structured interviews were conducted in 2012 with 13 local decision makers and analyzed using a framework approach. Participants linked the structural conditions experienced in Quibdó, including displacement, limited economic opportunities, and the infrastructure of the city, to hypertension risk through multiple pathways, including behavioral risk factors for hypertension and physiologic responses to stress. They described the social patterning of these factors across socioeconomic, racial/ethnic, and gender hierarchies. Although several conditions associated with hypertension risk are widely distributed in the city's population, social processes of marginalization and stratification create additional disadvantages for those on the lower rungs of the social hierarchy.

Asociación entre marcadores de posición social y adherencia al tratamiento de la hipertensión arterial en Colombia

“…Por otro lado, por sí mismos han jugado un papel determinante sobre el estado de salud de las minorías étnicas en Colombia. En un estudio cualitativo llevado a cabo en la ciudad de Quibdó, una región con alta concentración de afrocolombianos en Colombia ratifica lo descrito, dado que muestran que factores estructurales como el desempleo o la inseguridad pueden determinar el riesgo de HTA y generar disparidades en salud 40 .…”

Establishing a local coalition for addressing social determinants of hypertension in Quibdó (Colombia): a description and reflection on the process

“…A qualitative study carried out in Quibdó in 2012 identified forced displacement, unemployment, and unplanned urban space as social determinants of hypertension (20). Participants in that study described those determinants influence urban living conditions for Quibdó’s residents (e.g.…”

“…CHRG convened a meeting with representatives of organizations identified through the above process that expressed interest in joining the coalition. Findings from the qualitative study (20) described above were presented and discussed, with 12 organizations subsequently committing to participate in the coalition to address SDH in Quibdó. Of these, eight represented community groups, three were governmental, and one was academic.…”

“…Due to armed conflict in the area, large numbers of displaced individuals have moved into the city. City officials, organizations and community members struggle to address the many pressing social and economic challenges associated with displacement, with limited resources (20). The immediacy of the needs of displaced persons, for example, and the limited resources available to organizations whose focus is on providing services to those groups, create particular challenges to organizations’ ability to maintain active participation in coalition efforts.…”

Socioeconomic position and quality of life among Colombian hypertensive patients: The mediating effect of perceived stress

“…Its occurrence globally is increasing, and projections estimate a 30% increase in its prevalence by 2025 ( Kearney et al, 2005 ). Low and middle-income countries like Colombia are at higher risk for hypertension ( Sánchez et al, 2009 ), possibly due to factors such as socio-economic inequalities, poor environmental conditions, increasing trends in unhealthy behaviors, and excessive body weight, aging population, and deficient primary health care strategies ( Lucumi et al, 2016 , 2017 ; Sánchez et al, 2009 ; Sarki et al, 2015 ). In Latin America countries, hypertension prevalences are high, being the countries with the highest prevalence: Brazil (25–35%), Paraguay (34%), Chile (33.7%), Uruguay and Venezuela (33%) ( Sánchez et al, 2009 ).…”