How to heal millions of hearts?

High blood pressure in mid-life is common and dangerous for your heart. Based on World Health Organisation data, an estimated 33 million working age adults in Europe have early stage hypertension.  The condition becomes chronic if left uncontrolled, taking 8 million lives and $150 million in health care costs each year. It is a contributing factor to the development of cardiovascular and kidney disease, and dementia. However high blood pressure is highly controllable and preventable through nutrition, exercise and stress/energy management, medication and regular, accurate BP measurement. So why does it persist?

Hypertension - a systemic challenge

Hypertension is a complex, dynamic problem with interconnected factors, happening both inside the body and external to it. It is often symptomless. Diagnosis takes time, access and effort to do accurately. The risk factors are well known and addressable, yet the condition at scale persists. There are a number of stakeholders addressing hypertension in different ways however there is a lack of clarity around accountability, e.g. physicians, charities, individuals.

The Oxford University 'Map the System' challenge provided me with an opportunity to apply systems thinking, a method to understand how things within a whole influence each other, to the global hypertension epidemic. Over 8 weeks this involved:

1. Conducting 'lived experience' interviews with 7x 40-60 year olds hypertensives living in different global regions
2. Interviewing 7x hypertension/ heart health medical and NGO experts
3. Identifying thematic factors - events, patterns structures, mental models - that contribute to rising rates of HBP
4. Organising thematic factors into causal loops
5. Gathering examples of existing solutions for early stage hypertension prevention and management via desk research
6. Distilling gaps and levers of change

‍

Systems map - the deep structure of hypertension prevalence and persistence

‍

The challenge landscape

Systems analysis of hypertension, with focus on the early stage and working age adult experience, resulted in two connected deep structural loops, comprising six thematic factors:

• Modern way of living/ Western culture
• Social system
• Inside the body/mind
• Conventional medical system
• Patient’s information needs
• Behaviour design

The upstream loop represents everyday working life, while the downstream loop represents the patient experience, with an inefficient body/mind being the connecting variable. The upstream loop describes external pressures within modern western culture that impact our internal physical/mental wellbeing leading up to and through working age life. The downstream loop describes the common pattern that unfolds following hypertension diagnosis, and which was evident in the lived experience interviews. This loop involves the primary care/ medical system, information awareness and quality specific to hypertension condition and self management, and behaviour change dynamics. Both loops reinforce an underlying mental model of learned helplessness and low self-efficacy in that domain.

‍

Curious to know more? Contact monicatodd@alumni.ie.edu to view and discuss the full report. Our hope is that this systems analysis inspires multiple stakeholders in the hypertension ecosystem to see new opportunities for, and their role in, creating positive change towards reducing high blood pressure at scale.