Environmental Scans and Women's Cardiovascular Health

Environmental scans benefit several sectors and have implications for planning, decision-making, and policy (Charlton et al., 2019). The healthcare system is not exempt from this benefit. In the pursuit of health equity for women’s cardiovascular health, the Canadian Women’s Heart Health Alliance ATLAS is no exception (Norris et al., 2020). The Canadian Women’s Heart Health Alliance ATALS (ATLAS) is a comprehensive environmental scan created to provide clinicians and policymakers with information supporting the advocacy of equitable care for women with cardiovascular disease (CVD). Although this scan is not specific to my chosen health topic (CVD in Indigenous women), it possesses relevant implications.

The goals of ATLAS include the following:

“Report an environmental scan of the status of women’s heart health and disease in Canada; (2) summarize the existing research on CVD in Canadian women; (3) identify importance of sex- and gender- specific differences and approaches to CV [cardiovascular] care in Canada; (4) identify knowledge gaps to guide future research; and (5) describe a unified approach to CV health promotion, disease management, and research in Canadian women with an ultimate goal of improving CV outcomes” (Norris et al., 2020, p 146).

It achieves this via the following nine chapters:

(1)     Introduction to the ATLAS

(2)     Scope of the problem

(3)     Patient Perspectives

(4)     Sex- and gender- unique disparities: CVD across the lifespan

(5)     Sex- and gender- unique manifestation of CVD

(6)     Sex and gender- specific cardiovascular diagnosis and treatment

(7)     Sex, gender, and the social determinants of health

(8)     Knowledge gaps and status of existing research programs in Canada

(9)     Next steps/recommendations, challenges and opportunities and conclusions (The Canadian Women’s Heart Health Alliance, n.d.)

This compilation is an excellent example of a comprehensive environmental scan. Appraising an environmental scan can be challenging. Prior to the work of Chalton et al. (2021), there was no consensus on the definition. The purpose can be very broad, ranging from environmental scans of health services and programs to environmental scans that inform clinical practice. Through a scoping review, it was put forth that the working definition for the healthcare industry is that an “[environmental scan] is a type of inquiry that involves the collection and synthesis of existing information and/or the pursuit of new evidence to inform decision-making and help shape future response(s) to existing and emerging policy and service delivery issues and opportunities …” (Chalton et al., 2021, p. 7).

Based on this working definition, I believe that ATLAS is an outstanding example of an environmental scan. It is exceptionally comprehensive, which some may see as a negative characteristic. However, for a complex issue such as women’s cardiovascular health where women’s heart disease is under-diagnosed, under-researched, under-supported, and under-treated with many women being unaware of their risk (Heart and Stroke Foundation of Canada, 2018), a comprehensive and powerful environmental scan is necessary. The only critique I would have regarding the report, is that a dedicated analysis (i.e., SWOT, PEST, force-field) may help decision-makers visualize the intersecting effects of factors influencing women’s heart disease from various ecological levels. The ATLAS does discuss these details throughout the scan, but a dedicated section would be beneficial.

References

Charlton, P., Kean, T., Liu, R. H., Nagel, D. A., Azar, R., Doucet, S., Luke, A., Montelpare, W., Mears, K., & Boulos, L. (2021). Use of environmental scans in health services delivery research: a scoping review. BMJ open, 11(11), e050284. https://doi.org/10.1136/bmjopen-2021-050284

Charlton, P., Doucet, S., Azar, R., Nagel, D. A., Boulos, L., Luke, A., Mears, K., Kelly, K. J., & Montelpare, W. J. (2019). The use of the environmental scan in health services delivery research: a scoping review protocol. BMJ open, 9(9), e029805. https://doi.org/10.1136/bmjopen-2019-029805

Heart and Stroke Foundation of Canada. (2018). Ms. Understood: Women’s hearts are victims of a system that is ill-equipped to diagnose, treat and support them. https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx

Norris, C. M., Yip, C. Y. Y., Nerenberg, K. A., Jaffer, S., Grewal, J., Levinsson, A. L. E., & Mulvagh, S. L. (2020). Introducing the Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Diseases in Women. CJC open, 2(3), 145–150. https://doi.org/10.1016/j.cjco.2020.02.004

The Canadian Women’s Heart Health Alliance. (n.d.). CWHHA ATLAS. Canadian Women’s Heart Health Centre. https://cwhhc.ottawaheart.ca/national-alliance/projects-and-initiatives/cwhha-atlas