Cardiovascular Disease and Women in Urban Informal Communities: A Detailed Overview

 Introduction

Cardiovascular disease (CVD) is the leading cause of death and disability globally (H. Vorster, 2002a), with a significant burden of impact being felt in low- and middle-income countries (LMICs) (Niyibizi et al., 2022). Women in urban informal settings, often characterized by poor living conditions, limited access to general healthcare, and socioeconomic dynamics, are particularly vulnerable (Niyibizi et al., 2022). Urban informal settlements, often called slums, are inhabited by millions of women globally (Rossier et al., 2014), making this population critical to addressing global CVD inequalities (Wekesah et al., 2019).

Prevalence and Burden

CVD includes a range of disorders affecting the heart and blood vessels (Niyibizi et al., 2022), which include coronary artery disease, hypertension, stroke, and heart failure (H. H. Vorster et al., n.d.). Women in urban informal communities face an increased risk of CVD due to a combination of environmental, behavioral, and systemic factors (Valson & Raman Kutty, 2018). Some of these factors include but are not limited to high incidences of risk factors, most studies show that women in these locations have higher rates of hypertension, obesity, diabetes, and smoking compared to women in formal urban settings or rural areas (), premature mortality, it is found that CVD-related deaths often happen earlier among women in urban informal settlements, with limited interventions available to address prevention and management (Boateng et al., 2017).

Main Risk Factors

Lifestyle-related factors include unhealthy diets. In urban informal settlements, access to affordable, nutritious food is limited, leading to diets high in salt, sugar, and trans fats (H. Vorster, 2002b). Poor physical activity caused by unsafe environments, lack of recreational spaces, and time constraints due to work and caregiving responsibilities, which hinder physical activity (Mberu et al., 2015). Smoking tobacco and alcohol use due to factors like economic stress and cultural shifts increase substance use among women in urban informal communities (Wekesah et al., 2020). Socioeconomic Stress characterized by chronic stress from poverty, gender inequality, and informal labor negatively impacts cardiovascular health through hormonal pathways, for example, elevated cortisol levels (Ndejjo et al., 2023). Low levels of education about health aggravate the inability to identify and manage risk factors (Soura et al., 2014). Environmental Factors like exposure to air pollution, including particulate matter and household air pollution from cooking with biomass fuels, contribute significantly to CVD risk (Cornell et al., 2009; Heitzinger et al., 2014). Urban informal settlements often lack infrastructure for clean water and sanitation (Joshi et al., 2014) which indirectly affects cardiovascular health through infectious diseases and chronic inflammation (Doulougou et al., 2014). Healthcare Barriers are one major hindrance (Nakkash et al., 2003) where we find that women in informal communities face significant barriers to healthcare (Cornell et al., 2009), including cost, distance, and cultural norms that deprioritize women’s health (Egbujie et al., 2016). Limited or lack of awareness of CVD symptoms in women (), which are often atypical like fatigue, shortness of breath, and nausea) compared to men (Joshi et al., 2014). Compromised healthcare quality is another major factor (Tshabangu & Coopoo, 2001) where we find that the informal settlements are often underserved by trained healthcare professionals, leading to delayed or inadequate treatment (Sriskantharajah & Kai, 2007).

Gender-Specific Challenges

The biological differences where it is the case that women’s hormonal changes, particularly during pregnancy, menopause, and with conditions like preeclampsia or gestational diabetes, increase their long-term CVD risk (H. Vorster, 2002). Socio-cultural norms make women in many informal communities prioritize family needs over their health (Wekesah et al., 2020) which, in so many instances, delays their medical consultations (Mberu et al., 2015). Gender-based violence and stress further exacerbate cardiovascular risks (Tshabangu & Coopoo, 2001), and on the other hand, we have the risk factor where the intersectionality of roles leaves women often bearing the dual burden of caregiving and earning income in these communities, leading to chronic stress and limited time for self-care (Wekesah et al., 2019).

Implications of CVD on Women in Urban Informal Communities

CVD has several impacts on the lives of urban women, they are faced with challenges and economic Impacts where the economic burden of CVD treatment disproportionately affects women, who often earn less and lack financial independence (Egbujie et al., 2016). Disability or death from CVD can destabilize families reliant on women’s income and caregiving roles and reduced productivity (Joshi et al., 2014). On the aspect of Community Health (Joshi et al., 2014), the health of women directly impacts the well-being of children and families, creating a generational cycle of poor health outcomes (Heitzinger et al., 2014).

Interventions and Solutions

On the prevention of CVD, there is need to have community-based education in the form of programs tailored to increase awareness about CVD risk factors, healthy living, and symptom recognition among women (Egbujie et al., 2016). Setting up nutrition initiatives aimed at subsidizing healthy food options and promoting urban gardening to improve dietary habits is an important intervention (Ndejjo et al., 2023). The community needs to be aware of the importance of physical activity programs, creating safe spaces and time-efficient exercise options for women (Sriskantharajah & Kai, 2007).

Changes at the policy level are vital where there is integration of CVD prevention into primary healthcare services and maternal health programs (Wekesah et al., 2019) and providing financial assistance or subsidized care for CVD treatment in underserved areas (de-Graft Aikins et al., 2020).

On the other hand, environmental Improvements need to be put into consideration (Boateng et al., 2017), through the reduction of air pollution and improving access to clean energy solutions for cooking and heating (Boateng et al., 2017), developing infrastructure for clean water, sanitation, and safe housing, health System Strengthening, training community health workers to deliver gender-sensitive CVD care and screenings and establishing mobile clinics to serve informal settlements with basic diagnostic and treatment services (Valson & Raman Kutty, 2018; H. H. Vorster et al., n.d.).

Women empowerment is a vital tool (Egbujie et al., 2016; Valson & Raman Kutty, 2018) this is characterized by supporting women’s cooperatives and income-generating activities to reduce economic stress (de-Graft Aikins et al., 2020). And lastly, strengthening laws and policies to address gender inequality and domestic violence, indirectly improves cardiovascular outcomes (H. H. Vorster et al., n.d.).

Conclusion

Cardiovascular disease in women living in urban informal communities is a multifaceted issue requiring holistic interventions (Egbujie et al., 2016) through addressing the social determinants of health, improving access to quality care, and empowering women which are essential to reducing the CVD burden (Peterson & Wellman, 2019). Collaborative efforts between governments, non-governmental organizations, and communities can significantly improve cardiovascular health outcomes and overall well-being for this vulnerable population (Egbujie et al., 2016).

 

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