The American Nations model: An analytical tool for understanding the influence of U.S. regional cultures on health and the social and political determinants of health.

Cardiovascular disease (CVD) represents a significant health crisis, leading to premature morbidity and mortality, that is largely preventable. A decade ago, the World Health Organization formally acknowledged the powerful role culture plays in health and well-being, a key factor in preventing CVD, prompting increased attention on how shared values, norms, symbols, ethics and life practices effect the decisions and behaviors of patients, populations and practitioners alike. Cultural contexts affect human behaviors and health outcomes, and the United States (U.S.) is divided between dominant regional cultures. The American Nations model, informed by the work of cultural geographers, historians, and anthropologists, provides an analytical framework for understanding regional cultural contexts within the U.S. This model has been used to demonstrate significant regional differences in health outcomes, wellbeing, lifestyle behaviors, lifespan, and social vulnerability, with communitarian cultures consistently outperforming individualistic cultures across a broad range of phenomena. This model has significant implications for how a nation approaches health and health care, shifting from the traditional, national level one-size-fits-all paradigm to one that considers distinct regional differences based on historical settlement patterns. In this context, the American Nations model can help improve the effectiveness of health interventions by supporting a better understanding of cultural differences and the dominant U.S. cultural landscapes.