Cardiovascular Disease in the Nation’s Capital: How Policy and the Built Environment Contribute to Disparities in CVD Risk Factors in Washington, D.C.

  • Phillip Mauller
  • Lauren A. DoamekporEmail author
  • Crystal Reed
  • Kweisi Mfume


On average, Washington D.C. residents experience low levels of cardiovascular disease (CVD) behavioral risk factors compared to the rest of the country. Despite presenting as a city of low risk, CVD mortality is higher than the national average. Driving this inconsistency are vast racial disparities as Black D.C. residents die from CVD at a much higher rate than their White counterparts. A closer examination of the data also reveals significant disparities between White and Black populations with regard to behavioral risk factors. Segregation and the built environments of sections of the city with large Black populations may be contributing to risk factor disparities. We examine factors in those built environments that contribute to disparities and assess the intentionality and effectiveness of policies focused on food access, physical activity, and tobacco use implemented between 2003 and 2014. We found that D.C. enacted few policies intentionally designed to reduce barriers in the physical environment that contributed to disparate outcomes, and the few that were implemented showed mixed results in their levels of effectiveness. Our findings demonstrated that both racial and geographical disparities have persisted for more than a decade and half. It is possible that the formation of intentional policies may help reduce barriers in the physical environment and disparate CVD outcomes.


Cardiovascular disease Risk factors Built environment Policy Health disparities 


Funding Information

This work was supported by the National Institute on Minority Health and Health Disparities of the National Institute of Health under award number 5U54MD00860802.

Compliance with Ethical Standards

The authors have complied with the Principles of the Ethical Practice of Public Health of APHA. This manuscript has not been published nor is it under consideration for publication elsewhere.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Conflict of Interest

The authors declare that they have no conflicts of interest.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health or the National Institute on Minority Health and Health Disparities.


  1. 1.
    CDC National Health Report Highlights [Internet]. Atlanta, GA: Centers for Disease Control. (Accessed 07 Sept. 2017).
  2. 2.
    Heart disease risk factors [Internet]. Atlanta, GA: Centers for Disease Control. (Accessed 07 Sept. 2017).
  3. 3.
    Graham G. Disparities in cardiovascular disease risk in the United States. Curr Cardiol Rev. 2015;11(3):238–45. CrossRefGoogle Scholar
  4. 4.
    Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis 2007;17(1):143–152.Google Scholar
  5. 5.
    Sortable risk factors and health indicators [Internet]. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed 07 Sept. 2017).
  6. 6.
    Malambo P, Kengne AP, De Villiers A, Lambert EV, Puoane T. Built environment, selected risk factors and major cardiovascular disease outcomes: a systematic review. PLoS One. 2016;11:e0166846.
  7. 7.
    Median household income: the 25 most populous metro areas: 2014 and 2015 [Internet]. Washington, DC: United States Census Bureau.
  8. 8.
  9. 9.
    District of Columbia and the United States American Community Survey 5-year Estimates 2011–2015 [Internet]. Washington, DC: Government of the District of Columbia Office of Planning State Data Center. (Accessed 07 Sept. 2017).
  10. 10.
    Census and demographic data by ward. Washington, DC: Washington, D.C. Office of Planning. (Accessed 07 Sept. 2017).
  11. 11.
    Food access research atlas. Washington, DC: United States Department of Agriculture, Economic Research Service. (Updated 18 Oct. 2017. Accessed 20 Oct. 2017).
  12. 12.
    Laska MN, Borradaile KE, Tester J, Foster GD, Gittelsohn J. Healthy food availability in small urban food stores: a comparison of four US cities. Public Health Nutr. 2010;13:1031–5.CrossRefGoogle Scholar
  13. 13.
    Food, environmental, and economic development in the District of Columbia Act of 2010. Washington, DC City Council.
  14. 14.
    Healthy corners [Internet]. Washington, D.C. Department of Health. (Accessed 16 Aug. 2017).
  15. 15.
    Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. Contribution of public parks to physical activity. Am J Public Health. 2007;97(3):509–14.CrossRefGoogle Scholar
  16. 16.
    Behavioral Risk Factor Surveillance System: 2014 Annual Health Report [Internet]. District of Columbia Department of Health. (Published Sept. 2016. Accessed 16 Aug. 2017).
  17. 17.
    Murray TC, Rodgers WM, Fraser SN. Exploring the relationship between socioeconomic status, control beliefs and exercise behavior: a multiple mediator model. J Behav Med. 2012;35(1):63–73.CrossRefGoogle Scholar
  18. 18.
    McGinn AP, Evenson KR, Herring AH, Huston SL, Rodriguez DA. The association of perceived and objectively measured crime with physical activity: a cross-sectional analysis. J Phys Act Health. 2008 Jan;5(1):117–31.CrossRefGoogle Scholar
  19. 19.
    Bennett GG, McNeill LH, Wolin KY, Duncan DT, Puleo E, Emmons KM. Safe to walk? Neighborhood safety and physical activity among public housing residents. PLoS Med. 2007 Oct 23;4:1599–606; discussion 1607. Scholar
  20. 20.
    Perceptions of public safety: report on the 2015 DC Public Safety Survey. Community Preservation and Development Corporation. (Published May, 2016, Accessed 16 Aug. 2017).
  21. 21.
    Obesity in the District of Columbia. Government of the District of Columbia Department of Health. (Published January 2010. Accessed 16 Aug 2017).
  22. 22.
    Lafleur M, Gonzalez E, Schwarte L, Banthia R, Kuo T, Verderber J, et al. Increasing physical activity in under-resourced communities through school-based, joint-use agreements, Los Angeles County, 2010–2012. Prev Chronic Dis. 2013;10:E89. Scholar
  23. 23.
    Current cigarette smoking among adults in the United States [Internet]. Atlanta, GA: Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. (Updated 1 Dec 2016. Accessed 2 Aug. 2017).
  24. 24.
    District of Columbia, Communities putting prevention to work tobacco use. District of Columbia Department of Health. (Published June 2013, Accessed 2 Aug. 2017).
  25. 25.
    Responses to cigarette prices by race/ethnicity, income, and age groups—United States 1976–1993. Morbidity and Mortality Weekly Report. Atlanta, GA: U.S. Centers for Disease Control and Prevention. 31 Jul. 1998 / 47(29);605–9
  26. 26.
    Oredein T, Foulds J. Causes of the decline in cigarette smoking among African American youths from the 1970s to the 1990s. Am J Public Health. 2011;101(10):e4–e14. Scholar
  27. 27.
    Rabius V, Wiatrek D, McAlister AL. African American participation and success in telephone counseling for smoking cessation. Nicotine Tob Res. 2012;14(2):240–2.CrossRefGoogle Scholar
  28. 28.
    Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51(Suppl):S28–40.CrossRefGoogle Scholar
  29. 29.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001 Sep-Oct;116(5):404–16.CrossRefGoogle Scholar
  30. 30.
    Handbury J, Rahkovsky I, Schnell M. Is the focus on food deserts fruitless? Retail access and food purchases across the socioeconomic spectrum. National Bureau of Economic Research. Working Paper No. 21126, April, 2015. (Accessed August 2, 2017).
  31. 31.
    Cummins S, Flint E, Matthews SA. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Aff. 2014;33(2):283–91.CrossRefGoogle Scholar
  32. 32.
    Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73(10):643–60.CrossRefGoogle Scholar
  33. 33.
    Blitstein JL, Snider J, Evans WD. Perceptions of the food shopping environment are associated with greater consumption of fruits and vegetables. Public Health Nutr. 2012;15(6):1124–9.CrossRefGoogle Scholar
  34. 34.
    Haynes-Maslow L, Parsons SE, Wheeler SB, Leone LA. A qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina, 2011. Prev Chronic Dis. 2013;10
  35. 35.
    Cha E, Kim KH, Lerner HM, Dawkins CR, Bello MK, Umpierrez G, et al. Health literacy, self-efficacy, food label use, and diet in young adults. Am J Health Behav. 2014;38(3):331–9.CrossRefGoogle Scholar
  36. 36.
    District of Columbia and the United States American Community Survey 5-year Estimates 2005–2009 [Internet]. Washington, DC: Government of the District of Columbia Office of Planning State Data Center. (Accessed 17, Oct. 2017).
  37. 37.
    Zhang M, Debarchana G. Spatial supermarket redlining and neighborhood vulnerability: a case study of Hartford, Connecticut. Trans GIS. 2016;20(1):79–100. Scholar
  38. 38.
    Cohen L, Davis R, Lee V, Valdovinos E. Addressing the intersection: preventing violence and promoting healthy eating and active living. Prevention Institute. Published May 2010. (Accessed 16 Aug 2017).
  39. 39.
    Cohen DA, Lapham S, Evenson KR, Williamson S, Golinellie D, Ward P, et al. Use of neighborhood parks: does socioeconomic status matter? A four city study. Public Health. 2013;127(4):325–32. Scholar
  40. 40.
    Cohen DA, Marsh T, Williamson S, Derose KP, Martinez H, Setodji C, et al. Parks and physical activity: why are some parks used more than others? Prev Med. 2009;50:S9–S12. Scholar
  41. 41.
    Yerger VB, Malone RE. African American leadership groups: smoking with the enemy. Tob Control. 2002;11(4):336–45. Scholar
  42. 42.
    Kirchner TR, Villanti AC. Tobacco retail outlet advertising practices and proximity to schools, parks and public housing affect Synar underage sales violations in Washington, DC. BMJ. 2011;343:d6269. Scholar
  43. 43.
    DiFranza JR, Wellman RJ, Sargent JD, Weitzman M, Hipple BJ, Winickoff JP. Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality. Pediatrics. 2006;117(6):e1237–48.CrossRefGoogle Scholar
  44. 44.
    Tobacco use among U.S. racial/ethnic minority groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control, Office on Smoking and Health. (Published 1998. Accessed 9 Sept. 2017).
  45. 45.
    Coady MH, Chan CA, Auer K, Farley SM, Kilgore EA, Kansagra SM. Awareness and impact of New York City’s graphic point-of-sale tobacco health warning signs. BMJ Journals Tobacco Control. 2013;22:e51-e56.Google Scholar
  46. 46.
    Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tob Control. 2016;25:ii14–20. Scholar
  47. 47.
    Pearson JL, Abrams DB, Niaura RS, Richardson A, Vallone DM. A ban on menthol cigarettes: impact on public opinion and smokers’ intention to quit. Am J Public Health. 2012;102(11):e107–e114.CrossRefGoogle Scholar
  48. 48.
    Centers for Disease Control and Prevention. Quitting smoking among adults—United States, 2001—2010. Morbidity and Mortality Weekly Report (MMWR). 2011;60(44);1513–1519. (Accessed 9 Sept. 2017).

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Phillip Mauller
    • 1
  • Lauren A. Doamekpor
    • 1
    Email author
  • Crystal Reed
    • 1
  • Kweisi Mfume
    • 1
  1. 1.Health Policy Research Consortium, A CTIS, Inc. ProgramGreenbeltUSA

Personalised recommendations