Health and Healthcare Systems

How can we overcome the racial barriers to global health parity?

Artists Aziz Asmr and Anis Hamdoun pose next to a graffiti of George Floyd in Idlib, Syria June 1, 2020.

A memorial to George Floyd in Idlib, Syria Image: MOHAMAD JAMALO via REUTERS

Bertram L. Scott
Chairman, American Heart Association
Nancy Brown
Chief Executive Officer, American Heart Association
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Systemic Racism

  • The pandemic has laid bare longstanding racial health inequalities.
  • A host of factors lie behind these disparities.
  • Targeted funding and communications can help us begin to address these issues.

From Louisville to London, the call for social justice has reached fever pitch worldwide as multicultural voices decry police brutality and the disparities that imperil Black lives. Amid the mainly peaceful protests, colonial monuments are falling and global consciousness is rising — even in Idlib, Syria, where a mural on a bombed building memorializes George Floyd.

Sadly, Floyd, who died in police custody on the streets of Minneapolis in May, is one of many. Breonna Taylor, Ahmaud Arbery and others met the same fate, capturing global headlines and our collective conscience. Then there are the lesser-known victims like Collins Khosa of Alexandra, South Africa, who was allegedly beaten to death by police and security officers for consuming a beer in his yard during the COVID-19 lockdown.

The American Heart Association denounces senseless acts of racial violence and destruction in communities of colour that are already contending with socioeconomic factors that compromise health and shorten lives. We are taking a stand for social justice — because it is the right thing to do, and because there is scientific evidence supporting the link between social injustice and health inequity.

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The racially disproportionate impact of heart disease, stroke, diabetes and other chronic conditions is well documented. Black and brown people are also more likely to be uninsured and to suffer negative effects on their physical and mental health due to socioeconomic inequities. Nowhere is this more apparent than in Chicago, where residents of the predominantly Black neighbourhood of Englewood live an average 30 years less than residents of the predominantly white neighbourhood Streeterville, just 10 miles away.

With ZIP codes more influential than genetic codes in determining health and longevity, it is vital to lead sustainable change in underserved urban, rural and indigenous communities. That is especially important today, with COVID-19 continuing its course, claiming more than 690,000 lives globally and more than 158,000 in the US at time of writing.

The pandemic has laid bare longstanding inequities. With 44 states and the District of Columbia publicly reporting full or partial COVID-19 death data by race, mortality among Black Americans is more than double the rate of Hispanics, 2.3 times as high as whites and Asians, 1.7 times as high as Pacific Islanders and 1.4 times as high as indigenous people.

COVID-19 deaths per 100,000 people by race, as of July 21 2020
COVID-19 deaths per 100,000 people by race, as of July 21 2020 Image: APM Research Lab

Population density plays a big part and — even as rural hot spots emerge — more populous communities report higher rates of infection. The most effective tool for controlling disease spread is social distancing, which presents a challenge for low-income families, many of whom live in crowded neighbourhoods with multiple generations under one roof.

Addressing the social determinants of health

The American Heart Association has long fought against health disparities, establishing the AHA Office of Health Equity to champion and oversee initiatives.

We are investing in organizations overcoming the barriers of social determinants of health and wellbeing through the AHA Social Impact Fund and the newly established Bernard J. Tyson Impact fund.

To date, the Association has invested $4.5 million in 34 organizations that are breaking down barriers to healthy living across Boston, New York City, Chicago, Flint, Michigan, San Francisco and Oakland, California. In turn, that funding has inspired an additional $15.9 million from other investors.

Among the investees is Forty Acres Fresh Market, founded in response to the scarcity of fresh and healthy foods on Chicago’s West Side. The nonprofit delivers about three dozen boxes of fruits and vegetables to underserved communities, as well as areas with high concentrations of people who are vulnerable to COVID-19.

Many more Social Impact Fund grant recipients are stepping in to support fragile communities and fill voids left by government agencies that have scaled back or eliminated services. Their collective efforts are essential to sustain communities as we await a COVID-19 vaccine and effective treatments.

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Engaging communities of colour in clinical trials

CenterWatch, the leading global clinical trials repository, currently lists 442 COVID-19 studies currently recruiting patient participants. The Association has awarded $2.9 million to 16 scientific teams fast-tracking studies on the heart and brain impact of the virus.

Active recruitment from communities of colour is vital to developing targeted therapies for COVID-19 and other conditions, and to fulfilling the promise of personalized medicine.

At issue is the historically low Black and Hispanic participation in clinical research, which can result from a lack of awareness, cultural beliefs and distrust of the medical establishment. For some, suspicion is based on historical injustices such as the infamous Tuskegee Study of Untreated Syphilis in the Negro Male — conducted by the US government without informed patient consent from 1932 to 1972.

Today, patient protections are in place, including institutional review boards and ethics review committees that oversee the trial process. Informed consent ensures patients understand and agree to the potential risks and benefits of participating in studies.

Empowered beyond the pandemic

The Association will be investing in research, raising awareness and addressing social determinants of health long after the pandemic has passed.

We are continuing our policy advocacy to ensure equitable access to testing, care, financial support, healthy foods and physical activity.

In tandem, Community Impact teams in Puget Sound, Denver, Chicago, Nashville, Jackson, Baltimore and beyond are partnering with local stakeholders to reduce the burden of chronic disease.

The American Heart Association has championed health parity for all people for nearly a century, and we are redoubling our commitment to overcoming racial and socioeconomic barriers to well-being.

We must stand together as a relentless force for a world of longer, healthier lives. That is our mission, and our contribution to a more equitable society.

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