ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Chart 12.1 – Examples of health determinants divided by socioeconomic and environmental categories 596 Environmental determinates Water and air pollution, biodiversity, global warming, ozone depletion, housing conditions, transport quality, food safety, waste management, energy policy, urban environment Economic determinates Country economic performance, per capita income, access to health services, employment conditions, housing, security, transportation Social determinates Culture, lifestyles, gender, ethnicity, degree of social inclusion, age, health-related behaviors, living conditions, working conditions, education • Promote community involvement in implementing local actions to increase physical activity. • Conduct evidence-based public campaigns through mass media, social media, and community and social marketing initiatives to inform and motivate adults and youth about the benefits of physical activity and facilitate healthy behaviors. Campaigns should be linked to supportive actions across the community for maximum benefit and impact. Encourage the evaluation of actions aimed at increasing physical activity to contribute to the development of an evidence base for effective and cost-effective actions. 654,655 12.9. Socioeconomic and Environmental Factors and Associated Diseases in Cardiovascular Prevention The main determinants of population health are multiple and classifiable in the fields of biology, environment (physical, social and economic), behaviors (lifestyle) and health care. 656 It is estimated that major, socioeconomic determinants , represent 75%, while genetic, biological and behavioral factors together account for approximately 25% of the population’s health 657,658 (Chart 12.1). The literature reports different models that intend to describe the complex relationship between the multiple factors that influence the socioeconomic determinants of health, one of the most mentioned is the Dahlgren and Whitehead 659 model (Figure 12.4). According to Rose, 660 the socioeconomic determinants underlie the pyramid of health inequalities and, consequently, the right to health cannot be guaranteed only by the health sector, requiring economic and social public policies. 660 Prospective studies have shown that in Brazil and in developed countries, low socioeconomic status defined as low status employment, low educational and income levels, and living in poorer residential areas contribute to increased CV mortality and all-cause death. 664-668 Through a macroeconomic indicator, represented by the Gross Domestic Product per capita (GDPpc) from 1979 to 2010 of municipalities of the State of Rio de Janeiro, the relationship between this indicator and the reduction in Figure 12.4 – Socioeconomic and environmental determinants: Dahlgren and Whitehead model. Source: Carvalho A. 659 CONDI GENERAL ECONOMIC, CULTURAL AND ENVIRON AGRICULTURAL AND FOOD PRODUCTION EDUCATION WORK ENVIRONMENT WORKING AND LIVING CONDITIONS SOCIAL HEALTH SERVICES UNEMPLOYMENT WATER AND SEWER SYSTEM HOUSING AGE, SEX AND HEREDITARY FACTORS SOCIAL AND COMMUNITYNETWORKS INDIVIDUAL MENTAL TIONS LIFESTYLE 865