How healthcare providers can combat disparities in heart health right now

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Inequality and discrimination have a powerful impact on health – the results can be seen in higher rates of mortality and morbidity among Black Americans. For example, the life expectancy gap between Black and white Americans is nearly six years as of 2021 – 70.8 years compared to 76.4 years.

This disparity is especially significant when it comes to heart health. Research shows Black Americans have higher age-adjusted heart disease death rates than white Americans, American Indians and Alaskan Natives (AIANs), Hispanic Americans and Asian Americans. Black people in the U.S. also have disproportionately high rates of hypertension, which affects more than half of Black adults.

Several factors contribute to this imbalance, but one significant cause healthcare providers can help address is unequal access to medical services. In particular, the lack of cultural competency and even racism Black Americans experience in the healthcare system may dissuade them from seeking lifesaving medical services. By working to deliver care in a more equitable manner, healthcare providers can help bridge the racial gap in heart disease prevention and treatment.

Racial inequalities in heart health

Black communities are more likely to face barriers to care. This can leave them at a greater risk for heart disease and allow serious health conditions to go untreated.

Black people with atrial fibrillation are one-third as likely to know they have the condition as white people, due in part to lack of access to proper monitoring for conditions like hypertension and diabetes, which increase the risk of AFib. Black Americans are also more than twice as likely to develop peripheral arterial disease (PAD), and two to four times more likely to undergo amputation after being diagnosed.

Research suggests heart disease could be better managed in Black patients who visit Black physicians. Such patients are more likely to develop a relationship with their doctor and engage in health promoting preventive care. Another study conducted by NYU Grossman School of Medicine and NYU Langone Health reported patients with hypertension and symptoms of cardiovascular disease were more likely to follow medication guidelines if they were treated by doctors of the same race. It's even been found that Black people may live longer in areas with more Black primary care physicians.

Despite the benefits, while Black Americans represent 13% of the population, only 3% of cardiologists are Black. This is even lower than the rate of Black physicians, which is about 5.7%.

How physicians can address disparities in care

Diversifying the medical field is one of the most significant ways we can address unconscious bias and systemic discrimination in healthcare, and it’s critical to ramp up recruitment and retention of underrepresented groups in the medical field. Early outreach, mentoring and tutoring will help Black students successfully pursue careers in health.

But more immediately, healthcare providers can take steps today to ensure they are prepared to care for all patients equitably. One study found 10.6% of Black patients reported experiencing discrimination or unfair judgment while seeking healthcare in 2020, which reveals healthcare providers, like all people, are guided by implicit biases. To ensure compassionate, unbiased care, physicians should understand the impact of race on health and be able to communicate effectively with patients from different backgrounds. Cultural competency education should be required in medical school and continue with regular training for practicing professionals. Studies have found strategies like stereotype replacement, counter-stereotype imaging, individuation, perspective taking and increasing interracial contact can help reduce prejudices.

For many Black Americans, anticipated costs are a barrier to getting care, so another way to make healthcare more accessible is to ensure patients understand the best places to seek treatment depending on their needs. Healthcare providers can help educate the communities they serve about the services provided at primary care facilities, urgent care facilities and emergency rooms and the costs associated with each. For example, a greater emphasis on primary care can help reduce unnecessary specialist visits and reduce healthcare costs overall.

Healthcare providers can also implement outreach initiatives and chronic disease management programs to help advance knowledge about heart health in affected communities. One such approach involves the integration of community health workers into healthcare delivery. Research has found CHW interventions have been effective in improving high blood pressure control, reducing cardiovascular risk factors and managing diabetes, among other benefits.

No one initiative can solve the problem of systemic inequalities in heart health, but with regular training and education, practices can make great strides in reducing disparities right now.

Nancy K. Klotz, MD, MBA, FACP, is chief medical officer at New York-based Brighton Health Plan Solutions, where she is responsible for clinical strategy across the company’s various business segments.