AHA issues call to action to address systemic racism in US
In an American Heart Association presidential advisory, the association issued a call to action with steps to be taken to address structural racism as a driver of health disparities.
The AHA statement outlined the existing barriers to equitable care for traditionally underrepresented groups in the U.S. and its current activity to address them and proposed a five-faceted strategy for eliminating systemic racism in the future.
“As a leader in dismantling structural racism, we look inward to address our own shortcomings, strengthen our own business practices and advance inclusive policies and practices regarding science, public and professional education and advocacy,” Bertram “Bert” L. Scott, chairman of the board of the AHA, said during a press conference. “What that means is financial investment and community-led solutions are critical to address the need for equitable health. At the ZIP code level, we intend to raise and spend substantial funding for local entrepreneurs and targeted communities through the American Heart Association’s Social Impact Fund and the associated Bernard J. Tyson Social Impact Fund. We will also activate the millions of AHA volunteers and staff to partner with our communities to identify and address the barriers to equitable health for all.”
The press conference was conducted as part of the AHA 2020 Scientific Sessions. On Saturday, 10 a.m. EST, the conference will have a session on structural racism as a public health crisis, a collaboration between the AHA and the Association of Black Cardiologists.
‘Wellness is our destination’
According to the presidential advisory, the COVID-19 pandemic in addition to the police-related deaths of George Floyd, Breonna Taylor and others are reminders that structural racism persists, restricts opportunities and may stand as a health burden for Black, American Indian/Alaska Native, Pacific Islander and Hispanic/Latino individuals.
“Your ZIP code should not be a better predictor of your longevity than your genetic code,” Regina Benjamin, MD, MBA, an AHA board member, the former U.S. surgeon general and a member of the writing committee for the advisory, said during a press briefing. “While I do believe that awareness will help foster change, it is change in individual cultural attitudes, support for change and public understanding of that change that needs to occur, and the American Heart Association stands committed to help make that change happen.
“We need allies,” she said. “Replace the ‘I’ in illness with ‘We’ to get to wellness. Wellness is our destination. The board of directors for the American Heart Association invites other like-minded organizations to join us in this important journey.”
Strategy to address systemic racism
In the advisory, the AHA detailed a five-facet strategy for addressing systemic racism:
No. 1, to eliminate structural racism and its negative effects, adversely affected communities must be transformed. This may involve promoting optimal health in historically marginalized groups and improving conditions that affect health in workplaces, neighborhoods and schools, according to the statement.
Moreover, the COVID-19 pandemic may have exposed and exacerbated existing racial and ethnic disparities in health.
According to the statement, morbidity and mortality rate in patients with COVID-19 was found to be disproportionately increased among Black, American Indian/Alaska Native, Pacific Islander and Hispanic/Latino individuals compared with white individuals.
“They not only make up a higher proportion of essential workers, who are preferentially exposed to this easily transmitted virus, but they also have a higher prevalence of underlying medical conditions that raise the risk for severe reactions, hospitalization and death attributable to COVID-19,” Keith Churchwell, MD, FAHA, president of Yale New Haven Hospital, an AHA board member and the chair of the advisory writing committee, and colleagues wrote.
No. 2, policies must be implemented that dismantle residential segregation and its economic, educational, employment and environmental consequences.
As Healio previously reported, there are many correlations between homelessness, low-quality housing and neighborhood environment with the prevalence of CVD and its risk factors.
No. 3, future policies must eliminate inequities in access to and quality of health care.
“In the health care setting, racial disparities are striking with regard to how often Black patients do not receive lifesaving care, thereby impacting who lives and who dies after cardiac arrest,” the authors wrote. “In addition, Black and Hispanic/Latino patients experience significantly lower survival to hospital discharge than white patients even when controlling for socioeconomic status.”
According to the statement, despite greater health insurance coverage since the 2010 Affordable Care Act was passed, individuals who are American Indian/Alaska Native (22%), Hispanic/Latino (19%) and Black (12%) are still more likely to be uninsured compared with white (8%) and Asian (7%) individuals.
No. 4, the need to foster allyship between racial and ethnic groups is key in addressing systemic racism.
According to the advisory, many U.S. adults are unaware of racial and ethnic health disparities and the role that structural racism plays in their existence.
“Awareness should foster changes in individual cultural attitudes, political support for change and public empathy that change needs to occur, all contributing to increased allyship,” the committee wrote. “In the absence of this transformation, the demographic shift in the racial and ethnic profile of the United States, in individual states, cities and counties, will continue to have a profound impact on attitudes about inequities. Sustainable changes in attitudes need to accompany these demographic shifts.”
No. 5, research on racism must investigate the effects of structural, interpersonal, cultural and anti-Black racism, and their impact on health outcomes and disparities.
“The majority of studies that examine discrimination study the singular measure of interpersonal discrimination and its relationship with CVD risk factors and outcomes,” the committee wrote. “Future research needs to examine the intersectionality of multiple domains of discrimination and their combined effect on health disparities, in particular, cardiovascular health and well-being. We must also study the intersection between structural racism and other measures of social determinants of health and chronic and acute stressors.”
Moreover, future interventions should examine how positive psychosocial assets such as optimism, resilience and purpose in life may moderate negative effects of discrimination and potentially improve CV health, according to the statement.
“A lot of things have changed in the past 100 years since the American Heart Association first set out to save lives from heart disease and stroke,” Mitchell S.V. Elkind, MS, FAHA, FAAN, president of the AHA, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians and Surgeons and attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center, said during the press conference. “But unfortunately, the pervasive existence of inequities among historically marginalized communities has not, and lives are needlessly being lost because of this.
“Recently, we expanded our focus beyond heart disease and stroke to develop a mission statement and goals, positioning the organization as an advocate for improving the overall health of all people. This goal continues to shape our work on a daily basis, but today we go beyond words to take immediate and ongoing action to accelerate social equity,” Elkind said during the press briefing. “Every person must have the same opportunity for a full healthy life. With this advisory, the American Heart Association reiterates our unequivocal support of anti-racist principles that negatively impact the lives of so many and structural racism as a major cause of poor health and premature death.”
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