Promoting cardiovascular health: from individual goals to social environmental change.

A conceptual model of the relationship between well-known individual-level behavioral and biomedical risk factors for heart disease and stroke and community-level social environmental risk factors, which may be less familiar to professionals working in cardiovascular health promotion, is presented. The social environment paradigm holds that programs and interventions should focus "upstream" and attempt to directly modify social environmental conditions in order to positively influence human behaviors, and consequently disability and disease. For each of the "big five" cardiovascular risk factors (poor diet, physical inactivity, cigarette smoking, high blood pressure, and high blood cholesterol), social environmental barriers and promoters are described. This conceptual model should be a useful tool in explaining and justifying the ways in which social environmental change can improve risk factor distributions for entire populations, and subsequently reduce disability and death from heart disease and stroke.