Douglass: Strides made in CV health equity, but much more needs to be accomplished
Click Here to Manage Email Alerts
Paul L. Douglass, MD, MACC, FSCAI, has long been an advocate for working toward eliminating disparities in CV care and achieving health equity in cardiology.
When Douglass, a clinical and interventional cardiologist at Wellstar Health System in the greater Atlanta area, and a member of the Cardiology Today Editorial Board, raised the issue as president of the Association of Black Cardiologists in 1994, “it was considered almost impolite conversation,” he told Healio in 2011. But today, achieving health equity is a major part of the mission of many cardiology societies.
For those efforts throughout the years, Douglass, who serves as chair of the American College of Cardiology’s Health Equity Task Force and as a member of the American Heart Association’s Heart Failure Systems of Care Advisory Group, received the Pamela S. Douglas Distinguished Award for Leadership in Diversity and Inclusion at the ACC Scientific Session Together with World Congress of Cardiology earlier this month.
Douglass spoke to Healio during the meeting about receiving the award, the achievements in health equity over time and the goals that remain, and the challenges that face patients from traditionally underrepresented backgrounds in achieving CV health.
Healio: What was your reaction when you heard that you won the award?
Douglass: I was thrilled for a number of reasons. No. 1, when these types of awards are created, it raises awareness of the importance of health equity. I was happy that this type of work is being recognized and that people are finding some value in what we are doing in terms of trying to achieve health equity. The fact that the College has established this award is heartwarming and speaks to the importance of this initiative and to the mission and vision of the College.
No. 2, I was thrilled because the award is named after Pamela S. Douglas, MD, MACC, FASE, FAHA, Ursula Geller Professor of Research in Cardiovascular Diseases at Duke University and past president of the ACC, who has been a real stalwart in the work on eliminating disparities, especially as it relates to gender bias. She has been a dear friend over the years and a real partner in the work on health equity. Being able to receive an award from the College that bears her name was especially significant to me.
Healio: How would you characterize the progress that the cardiology community has made on health equity in recent years?
Douglass: We have been talking about this for decades. It is a work in progress. This is an evolutionary process. We are not going to solve this problem overnight. It took centuries to get where we are. But the College has stepped up and provides the platform for us to be successful on many fronts. The fact that the College is now providing human resources and financial resources behind this initiative speaks to the evolution of our seriousness of trying to achieve health equity and the value that it will bring to CV medicine and society as a whole. We have always been great conveners of progressive medical thought. We have been thought leaders in the field of medicine. This is another demonstration of the ACC leading the way and defining this as a very serious problem that requires robust effort.
Healio: What are some of the goals that still need to be met in terms of health equity?
Douglass: In terms of our task force, we have established three goals that we think are imperative. We are well on our way toward trying to achieve those goals. The first goal is to create a culture in CV medicine that is welcoming, that speaks to health equity as an environment. An environment where all groups are welcomed and feel comfortable in the CV space, and feel that they and their contributions are valued irrespective of gender, ethnicity, race, place of birth or sexual orientation. We are trying to create a culture within cardiology that makes people feel valued.
The second goal involves collaboration. We are going to partner with people who share our values, so that we can achieve health equity. We know that we can’t do this by ourselves, and it will be essential to have strong strategic partners who share our vision and will help us to overcome those social determinants of health that require a multipronged approach.
The third goal is to have health equity in everything that the ACC does. That includes our programming, our educational opportunities and what is reflected in the guidelines. Our task is that as we create all of these things, we use them as tools to help people understand that health equity is important. As we approach clinical problems, we identify opportunities to extend health equity in a way that is beneficial toward achieving social justice. That is extremely important. As mentioned earlier, partnering with other institutions, particularly the American Board of Internal Medicine, is important so that as we construct questions to assess competency among cardiologists, we emphasize that having those cultural competencies and those skills that see things through a health equity lens is important. Once we have those things, and people are reminded daily in everything they do about the importance of health equity, we create a better world.
Healio: What have been some of the greatest accomplishments so far in the achievement of health equity in the cardiology community?
Douglass: The greatest accomplishment, reflected at this year's ACC Scientific Session, is the Health Equity Hub. It is a visual demonstration of the commitment of the College toward achieving and supporting health equity.
Our most important achievement to date is that when we look at the strategic plan of the College, part of that strategic plan is achieving the goals of the Health Equity Task Force. We are incorporated into the DNA of the strategic efforts the College is going to make in terms of enhancing the care and transforming CV medicine, not only in the United States but globally.
Healio: Are there any upcoming projects related to health equity that you think might have the potential to make an impact?
Douglass: We have got all kinds of projects. One we are counting on making a significant impact is the Health Equity Summit, held April 2-3 in Washington, D.C. We have invited all of the medical stakeholders to the table. We are going to have a program that will start in the National Museum of African American History and Culture that helps to highlight that many of the disparities in health care that we see are rooted in structural and systemic problems that revolve around racism. Having the origination of that meeting at the National Museum will help to highlight the fact that if we are going to be successful, we will have to dismantle the systemic and structural problems that allow these disparities to exist and persist. The next day, we will have the scientific portion of the meeting to discuss where we have been, where are now, and what solutions should we be working toward to dismantle the inequities in our society. We are extremely excited about the potential for this, in having all of the right stakeholders, in coming up with a roadmap that is going to plot our future and help to define the work of the Task Force to help us continue to move this forward.
Healio: What are some of the biggest challenges currently facing patients from historically underrepresented backgrounds?
Douglass: The biggest challenges are that we continue to be confronted with the impact of social determinants of health. We keep looking at this from our clinical standpoint. When looking at CV outcomes, only 20% of them are dependent upon what happens in a clinical encounter. Eighty percent of your clinical outcome is determined by where you live, work and pray; whether you have access to quality health care; whether you have transportation; whether you have food security; whether you have housing security; and whether you have the wherewithal to afford the strategies and interventions that have been offered to you. Those are much more significant barriers to care and have a much greater impact on people’s inability to achieve their best CV outcome. Our biggest challenge is being able to dismantle those barriers. It will require a huge collaboration from many aspects of our community, not only from the medical side but from the governmental and regulatory side creating opportunities for people to have access to healthy foods and environments. That work is a daunting task, but with great collaborators and partners, I think we can get it done.
For more information:
Paul L. Douglass, MD, MACC, FSCAI, can be reached at paul.douglass@wellstar.org.
Collapse
Healio Interviews
Read more about
Click Here to Manage Email Alerts