Heart Disease and Stroke in Brookhaven
Joanne Lauten
Chamberlain College of Nursing
NR443 Community Health Nursing

Heart Disease and Stroke in Brookhaven
Public health is a dynamic field of medicine that is concerned primarily with improving the health of populations rather than just the health of individuals. Nies defines public health nursing as; “preserving the health of the community and surrounding population by focusing on health promotion and maintenance” (Nies & Mcewen, 2007). Community Health Nurses are aware that stroke is one of the world’s leading preventable causes of death. According to the Center for Disease Control (CDC) every forty seconds someone in the United States has a stroke, making it the fourth leading cause of death in the United States (Centers for Disease Control , 2012).
Community
Brookhaven is one of ten towns in Suffolk County, New York, and the largest town in New York State. Its south coastline is Great South Bay, and the Atlantic Ocean on the north. A large part of Fire Island and the Great South Bay are in the town. It has a large hill, known as "Bald Hill", in the hamlet of Farmingville, which marks where the glacier which formed Long Island stopped. At the top of Bald Hill is a Vietnam Veterans Memorial. Brookhaven National Laboratory is also located within the town.
Demographic Data Epidemiologic Data
According to the U. S. Census Bureau, Brookhaven’s total population is 490,016. The median age is 35 years, compared to the state’s median age, which is 35.9 years. The U.S. Census Bureau lists the following racial percentages: Whites 88.4%, Hispanic/Latino 8.4 %, Asian 2.9%, African American 4.33%. Per Capita income for the town of Brookhaven is listed by the U.S.Census Bureau as being $24,191, well below the national income of $35,575, as of 2010. As of January 2011, the cost of living index in Brookhaven was 153.1, which is very high, the U.S. average only being 100. The poverty level of Brookhaven is 8.9% below the national average of 12.5% (United States Census Bureau, 2011). In 2006 the mean price of a home was $450,000. In 2011 the prices have dropped to $250,000; the mean property tax is $6,800. (Brookhaven Town, 2011). According to the local precinct, the murder rate is above the national average, but all other crimes are in line with the national average (Sufflok County Police Government, 2011).
According to the World Health Organization, chronic diseases are responsible for 63% of all deaths in the world, with cardiovascular disease as the leading cause of death. The following information will target the population of Brookhaven Township within the approximate mean age of 35. According to the Suffolk County Health Department; AIDS, cancer, cardio-vascular disease, and diabetes are the four leading causes of death, with heart disease and stroke being number one. African American men are more likely to die from heart disease, as compared to non-Hispanic men. Asian/Pacific adults are less likely than white adults to have heart disease, and are less likely to die from heart disease compared to non-Hispanic whites. (Suffolk County Government, 2011). As for obesity, 27.6% of males in the county are obese with a BMI of 29 or greater. Of these, 15.5 % of them smoke, 8.9 % are type II diabetics, and 1,419 die of a cancer related diagnosis. (NYS Department of Health, 2011).
In 2009, heart disease accounted for 1,554 male deaths and there were 179 deaths from stroke. Currently, the obesity rate is 23.4% and the rate of diabetes is 8.9% in the town of Brookhaven. (NYS Department of Health, 2011). While the number of deaths from stroke may seem small, when you add up the risk factors of diabetes and obesity the numbers appear much larger.
Wind Shield Survey Nies and Mcewen describe a windshield survey as: a visual assessment of a community (Neis & Mcewan, 2007). Following those guidelines, a windshield survey was conducted in the Farmingville area of Brookhaven during the day and evening. The majority of the homes are single family with approximately a ¼ acre of land. In the four mile radius covered, 30 homes were for sale, and 10 were boarded up due to foreclosure. Most of the homes were well manicured; however, some appeared overgrown, with garbage at the curb. There are no sidewalks in this community, the property extends to the curb. Multiple little strip malls line the main thoroughfare, with small “mom and pop” stores, such as a bodega, and taco take out store. The area also has two McDonalds, one Burger King and a Rib King store. Stop and Shop and Bravo are the local supermarkets. There are two elementary schools with playgrounds attached to the building, one middle school, and a high school, with a track that is community accessible, as well as a community college. A large university and two private colleges are within a 10 mile radius. . Farmingville is in the proximity of four hospitals, one run by the state, another by catholic charities, and the last two are private. All have emergency rooms and two have clinics. There is also a local Medicaid run health care clinic within the community. The local Catholic Church has a soccer field on the grounds and a food pantry and mass is said in English and Spanish. There are also several small evangelist churches within the town, mostly as little store fronts. The majority of the people travel by car; however a bicycle is the second mode of transportation. The main street has a bus route and the train station is a bike ride away. The majority of the men appear to be about 25-30 years old, with several congregating on the corners awaiting work in the morning. In the evening, these same men can be seen carrying large laundry bags while on a bicycle to a laundromat . The few children that were seen were playing soccer at the local church. Of over 100 people tallied, 75 were Hispanic, 5 white, and the remainder were Asian.
Problem
The area of concern for this region is heart disease and stroke. Due to the poor economic status, high rate of illegal immigrants, the availability of ethnic fast food, and lack of exercise, the area has many risk factors. Steps should be taken to reduce the risk factors, such as hypertension and high cholesterol, which in turn would reduce the mortality rate from heart disease and stroke. Focus area 12, Heart disease and Stroke of the Healthy People 2020 document contains several objectives that relate to the prevention of this focus. Objectives 5-17 aim to reduce the risk factors of hypertension, cholesterol, poor diet, obesity, and lack of exercise. With the implementation of community education on risk factors and prevention, we should see a drop in the mortality rate for heart disease and stroke.
Historical Significance The first studies of cardiovascular health were performed by Jerry Morris using occupational health data (Ashton, 2000). Dr. Henry Blackburn, professor of the University Of Minnesota School Of Public Health, and professor Ancel Keys a medical scientist defined a direct relationship between a diet high in cholesterol and heart disease (Epstein, 1996). The Suffolk County Health Department discloses that there has been a 22% rise in cardiovascular deaths in the county before 2005. (Suffolk County Government, 2011). The increase in the rate of cardiovascular disease is most likely due to a rise in the unemployment rate, and increase in poor dietary habits. That being said, the rate of cardiovascular deaths has decreased in the last few years due to increased interventions by state designated stroke facilities.
Natural History of the Disease
The term "heart disease" is often used interchangeably with "cardiovascular disease." Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack or stroke. The multiple risk factors make it difficult to wrap parameters around this disease. A stroke is the sudden interruption of blood flow to part of the brain, causing death of brain cells and destroying or impairing body function controlled by that part of the brain. Heart disease happens when your arteries become narrowed through the process, called Arteriosclerosis. When this occurs, the blood and oxygen supply to the heart muscle is restricted, causing heart muscle to die. Heart disease and stroke are not diseases that can be transmitted; rather they are caused by our own lack of knowledge and lifestyles. Heart disease is linked to heredity, poor nutrition, foods that are high in saturated fats, smoking, obesity, lack of physical activity and stress.
Summary
The economic burden of cardiovascular disease and stroke cost the United States between 30 and 40 billion dollars a year, yet they are among the most preventable . Public health strategies and policies that promote healthy living, encourage healthy environments, and promote control of blood pressure and cholesterol levels are vital to improving the public's health and saving lives.

References
Ashton, J. (2000). Professor J N “Jerry” Morris. Journal of Epidemiaology and Community Health, 881.
Brookhaven Town. (2011, May 12). Boorkaven town. Retrieved from vital statiscs: http://www.brookhaven.org
Centers for Disease Control . (2012, April 23). Centers for Disease Control and Prevention. Retrieved from Stroke Awareness: http://www.cdc.gov/Features/HighBloodPressure/
Epstein, F. (1996). Cardiovascular Disease Epidemiology /A Journey From the Past Into the Future . Circulation, AHA Jouranal, 1775.
Nies, M., & Mcewen, M. (2007). Community/ Pulbic Helath Nursing. In M. Nies, & M. Mcewen, Community/ Pulbic Helath Nursing (p. 3). St Louis : Sauders, Elsevier.
NYS Department of Health. (2011, November). New York Stae Department of Health. Retrieved from Suffolk County Indicators For Tracking Public Health Priority Areas: http://www.health.ny.gov/prevention/prevention_agenda/indicators/county/suffolk.htm
NYS Department of Health. (2011, November). Vital Statistics. Retrieved from NYS Community Health Data Set: http://www.health.ny.gov/statistics/chac/chai/
Sufflok County Police Government. (2011, December 10). Suffolk County Govrnment. Retrieved from Public Safety: http://www.suffolkcountyny.gov/Community/PublicSafety.aspx
Suffolk County Government. (2011, June 10). Suffolk County Govrnment. Retrieved from Health Disparities: http://www.suffolkcountyny.gov/Departments/HealthServices/HealthCommissioner/OfficeofMinorityHealth/HealthDisparities.aspx
United States Census Bureau. (2011, September 27). The United States Censusu Bureau. Retrieved from The 2012 Statistical Abstract: http://www.census.gov/compendia/statab/cats/income_expenditures_poverty_wealth.html

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