Heart of the Matter: The Social Justice Fight Against Heart Disease CENTER FOR POLICY ANALYSIS AND RESEARCH Health Equity JULY 2022
John R. Lewis Social Justice Fellow, Cameryn Blackmore
1 Audre Lorde can be quoted as saying “caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
2 Introduction
In Black communities, the disease is more pronounced. Black people ages 18-49 are 2 times more likely to die from heart disease than white people (CDC, 2017). Common conditions such as hypertension (high blood pressure), obesity and diabetes—prevalently experienced in Black communities—increase the risk of heart disease and stroke. For Black Americans, heart disease is a social justice issue that must be prioritized within the legislative agenda through collaborative partnerships with relevant stakeholders (e.g., government agencies, nonprofit organizations). There must also be a concerted effort to promote policies that increase healthcare resources within the Black community. Centering Black health is critical to radically transforming our communities. Achieving health equity can be accomplish through eliminating systematic racism and addressing the social determinants of health.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
Author and activist, Audre Lorde, declared self-preservation as an important feature for political warfare.1 Centering Black health is critical to radically transforming our communities. Achieving health equity can be accomplish through eliminating systematic racism and addressing the social determinants of health. “Self-preservation is an important feature for political warfare.”
In that same year, 693,021 Americans died of heart disease (CDC, 2022). The nation has spent astronomical amounts of money each year fighting heart disease. According to the Centers for Disease Control (2022), during the 2016-2017 fiscal year the United States spent $363 billion fighting heart disease.
Magnitude of Heart Disease in the Black Community
Heart disease is often increased by other health ailments, such as hypertension and diabetes. For Black Americans, these health conditions are likely to develop during young adult and middle-aged years, but typically do not affect white Americans until their sixties (CDC, 2017). These health ailments contribute to the increased risk of mortality for Black Americans, making the fight against conditions leading to heart disease critical for healthcare professionals.
Heart disease is the leading cause of death in the United States, even after the COVID-19 pandemic which claimed nearly 460,000 lives in 2021 (Centers for Disease Control, 2022).
In 2021 Black Americans over the age of 18 represented 13% of diagnosed cases of diabetes, while white Americans represented 8% (U.S. Department of Health and Human Services, 2021). Unmanaged diabetes can lead to heart disease through the buildup of sugars in the blood (Nall, 2021). Type 2 diabetes is the most common type of diabetes, and strongly linked with obesity (Nall, 2021). Combating diabetes can occur through physical activity and diet adjustments. However, Type 1 diabetes can be diagnosed in childhood and comes from an insulin deficiency.
Hypertension (high blood pressure) is another health ailment that increases the likelihood of heart disease in Black Americans. According to the American Heart Association (2022), Black adults are disproportionately affected by high blood pressure, with 55% of Black adults having high blood pressure. Physical activity and diet can also lower high blood pressure like lowering the effect of diabetes through addressing obesity.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
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Health scholars have focused on societal factors that increase the possibility of Black people experiencing heart health complications. These factors are referred to as social determinants of health, pointing to non-medical forces that contribute to the health condition of a population. The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work, and age.”
The social determinants of health that often lead to an increase of heart disease within the Black com munity include lack of healthcare, unhealthy diet, lack of physical activity, and the lack of infrastructure within communities (e.g., walking paths or sidewalks). Effects of Systemic Racism and the Social Determinants of Health
According to Dingake (2017), income inequality is one of the most prominent factors that impacts the social determinants of health. In healthcare, income inequality is illustrated best through access to employer sponsored healthcare benefits (Javed et al., 2022). For example, Black people made up 23% of service industry jobs in 2018 (United States Bureau of Labor Statistics, 2019). These jobs were less likely to include employer sponsored healthcare benefits, increasing the likelihood that the overrepresentation of Black people in the service industry are lacking healthcare coverage.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
Further, non-frontline Black workers were more likely to experience job loss, increasing the likelihood that displaced workers went without crucial healthcare access (Gemelas et al., 2022). Systemic racism in healthcare is also a contributing factor of heart disease among Black Americans. Before Brown v. Board of Education (1954), segregation in healthcare was legal. Though illegal today, segregation continues to exist within healthcare facilities, especially in the Midwest and northeastern regions (Gay, Hammer, & Ruel, 2020). The Lown Institute discovered high levels of segregation within hospitals in cities like Chicago, Philadelphia, and Detroit, with hospitals serving either predominately Black patients or predominately white patients (Garber, 2021). Medical deserts also create barriers to healthcare access within the country. Medical deserts, much like food deserts, are created when a geographical area is lacking medical facilities and resources (Gay et al., 2020). For Black people who do have access to medical facilities, many are still concerned about how they will be treated during interactions with medical practitioners. Though illegal today, segregation continues to exist healthcarewithinfacilities.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
Dr. Monica Webb Hopper et al. (2019) conducted a study in Cleveland, Ohio titled, Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research, which found low trust in healthcare facilities and workers amongst Black citizens of the city. The study revealed that Black citizens: experienced negative current and past encounters in healthcare, believed doctors and nurses lacked compassion towards them, and believed doctors offered different treatment plans based upon their neighborhood and insurance plans (Hooper et al., 2019).
The fight against heart disease in the Black community should have a two-prong approach that addresses internal care within the healthcare industry, as well as external societal factors that contribute to heart disease.
RecommendationsPolicy
Provide early intervention programming: Community-based programs should add early intervention efforts to prevent health aliments in Black Americans earlier in life. Since Black Americans are more likely to be diagnosed with high blood pressure, diabetes, and obesity earlier during their lifespans, communities should prioritize programs for youth that address these health ailments during childhood. Educating Black youth about proper diets and exercise early in life will encourage proper lifestyle habits that can reduce heart disease.
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These findings demonstrate the insidious existing implicit bias towards Black patients, making Black Americans more likely to receive inadequate quality care (Matthew, 2015). These findings also support feelings of distrust and treatment disparities expressed by Black citizens regarding treatment at medical facilities. Though it is important for Black citizens to advocate on behalf of their own care, doctors and nurses must uphold their professional and ethical duty to provide their patients with the highest quality of care regardless of race, ethnicity, or any other factor.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
2 From Status of State Medicaid Expansion Decisions: Interactive Map. The southern states that have not adopted and implemented Medicaid expansion are Texas, Mississippi, Alabama, Tennessee, Georgia, North Carolina, South Carolina, and Florida.
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Expand preventative programs: The Centers for Disease Control Division for Heart Disease and Stroke Prevention has existing programs designed to aid in the fight against heart disease. The CDC’s WISEWOMAN program, for example, has had success with lowering complications due to heart disease. This program was created to be a program of last resort for women ages 40 to 64 who were uninsured or underinsured. The WISEWOMAN program is culturally competent and is implemented differently based on geographical location. These programs often address the social determinants of health while addressing the health needs of women qualified to participate. Lowering the age of participation for uninsured women in this program will ensure Black women that have been diagnosed with high blood pressure and other contributing health aliments will have access to care earlier in their lifespans. Increase access to community resources: Communities with significant number of Black citizens should receive additional resources to battle the social determinants of health that can lead to heart disease. Eliminating food deserts through acquiring grocery chains and building community gardens will ensure Black Americans have access to healthy food as opposed to the limited nutritional options offered at neighborhood corner stores. In addition, building and expanding community recreational centers, healthcare clinics, and employment programs will ensure Black citizens are in positions of social mobility and have access to fitness gyms and healthcare and employment opportunities. Increase access to affordable healthcare and Medicaid expansion: Removing barriers to healthcare access cannot be achieved without increasing access to healthcare benefits. According to the Kaiser Family Foundation (2022), many southern states have elected not to expand access to the Medicaid program by lowering the income threshold for their citizens.2 Medicaid expansion within these states would make millions of citizens in those states eligible for Medicaid benefits that would provide healthcare access. Medicaid expansion is a solution for those citizens who are considered the uninsured working poor but making more than the income threshold for Medicaid benefits.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
Increase diversity in research and healthcare workers: The pipeline to the medical field should begin earlier with public education creating programs to introduce youth into the field. Higher educational programs, especially medical schools, should create special educational programming to ensure Black people are on the proper pre-med and medical tracks. This will create an increased generational effect within the medical field. In addition, research trials must eliminate barriers, such as cost, to ensure Black citizens are included in clinical trials.
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Source: From Status of State Medicaid Expansion Decisions: Interactive Map. The southern states that have not adopted and implemented Medicaid expansion are Texas, Mississippi, Alabama, Tennessee, Georgia, North Carolina, South Carolina, and Florida.
Promote Racial Competency Training and Oversight: Healthcare facilities, pharmaceutical companies, researchers, and other healthcare providers should have mandated ongoing racial competency trainings to center knowledge of the Black community within the field. In addition to training, every healthcare facility and provider should receive oversight and have transparent policies and practices for Black citizens to report incidents of low-quality care.
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
Addressing societal factors related to heart disease in the Black community is imperative and requires the support of policymakers, workers within the public and private sectors, and healthcare professionals. Ensuring Black citizens are properly insured and eliminating their experience of systematic racism within healthcare facilities would begin the end of generations of health disparities in the United States. The heart of the matter for this country rests in lowering the number of Black citi zens living with and succumbing to heart disease.
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The heart of the matter for this country rests in lowering the number of Black citizens living with and succumbing to heart disease.
Conclusion
CPAR | Heart of the Matter: The Social Justice Fight Against Heart Disease
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racism and COVID-19. American Sociological Association, 19(3), 523-230. Gemelas, J. et al. (2022). Inequities in employment by race, ethnicity, and sector during COVID19. Journal of Racial and Ethnic Health Disparities, 9(1), 350-355. Hopper Webb, M. et al. (2019). Understanding multilevel factors related to urban community trust in healthcare and research. International Journal of Environmental Research and Public Health, 16(18), 3280.
World Health Organization (n.d.). Social determinants of https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1.health.
Javed et al. (2022). Race, racism, and cardiovascular health: Applying a social determinants of health framework to racial/ethnic disparities in cardiovascular disease. American Heart Association Journal, 15(1). Kaiser Family Foundation. (2022). Status of state medicaid expansion decisions: Interactive Unitedhttps://www.medicalnewstoday.com/articles/323627.Nalls,NewMatthew,https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/.map.D.(2015).Justmedicine:AcureforracialinequalityinAmericanHealthCare.YorkUniversityPress.R.(2021).Anoverviewofdiabetestypesandtreatment.MedicalNewsToday.StatesBureauofLaborStatistics(2019).Laborforcecharacteristicsbyraceand ethnicity, 2018. https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm.
health: Creating equal opportunities for health. Centershttps://www.cdc.gov/vitalsigns/aahealth/index.html.ofDiseaseControl.(2022).Provisionalmortalitydata
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Centers of Disease Control. (n.d.). WISEWOMAN program.
References American Heart Association. (2022). High blood pressure among Black https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/high-blood-prespeople. sure-and-african-americans.
United States Department of Health and Human Services Office of Minority Health. (2021). Diabetes and African Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=18.
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