Structural Racism Major Cause of Poor Health

Structural racism is a major cause of poor health and premature death from heart disease and stroke, according to a new American Heart Association Presidential Advisory, “Call to Action: Structural Racism as a Fundamental Driver of Health Disparities,” published in the Association’s flagship journal Circulation. The advisory reviews the historical context, current state and potential solutions to address structural racism in the U.S., and outlines steps the Association is taking to address and mitigate the root causes of health care disparities.

“With this advisory, the American Heart Association reiterates its unequivocal support of antiracist principles. We are going beyond words to take immediate and ongoing action to accelerate social equity. Every person must have the same opportunity for a full, healthy life,” said Mitchell S. V. Elkind, M.D., M.S., FAAN, FAHA, president of the American Heart Association, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians and Surgeons and attending neurologist at New York-Presbyterian/Columbia University Irving Medical Center in York City. “The American Heart Association will work with allies to removing barriers to provide an equal playing field — lives are at stake. The people of historically marginalized communities deserve nothing less — and society must demand it.”

The Association is focusing more aggressively on overcoming societal barriers created by structural racism because they contributes significantly to the disproportionate burden of cardiovascular risk factors (including high blood pressure, obesity and Type 2 diabetes) in Black, Asian, American Indian/Alaska Native, and Hispanic/Latino people compared with white people in the U.S..

While overall death rates from heart disease and stroke declined over the past two decades until a recent plateau, these gains were not equitably shared among people who are from the Black, Asian, American Indian/Alaska Native or Hispanic/Latino communities.

* Black Americans continue to experience the highest death rates due to heart disease and stroke.

* Black Americans experience a nearly 30% higher death rate from cardiovascular disease (CVD) and a 45% higher death rate from stroke compared with non-Hispanic white Americans.

* Black and Hispanic/Latino patients experience significantly lower survival to hospital discharge than white patients even when controlling for socioeconomic status.

The new Presidential Advisory highlights three key points:

* Structural racism is a current and pervasive problem, influenced by history and not merely an issue of the past.

* Structural racism is real and produces adverse effects, whether it is blatant to others or perceived only or primarily by those impacted.

* The task of dismantling the impact of structural racism on economic, social and health inequities is a shared responsibility that must belong to all of society.

“Structural racism, by definition, is not a personal action or behavior or belief, it’s not something that a few people or institutions choose to practice,” said Keith Churchwell, M.D., FAHA, chair of the Advisory writing committee and president of Yale New Haven Hospital in New Haven, Conn. “Structural racism is an embedded part of legal, business and social constructs and a feature of the social, economic and political systems in which we all exist. Although structural racism has existed for centuries, the COVID-19 pandemic exposed and exacerbated the existing disparities in health disparities, as evidenced by the way the virus is disproportionately more prevalent in people from Black, Asian, American Indian/Alaska Native or Hispanic/Latino communities.”

The Association also announced new strategic business goals, with an increased focus on health equity. By 2024, the American Heart Association will champion health equity by advancing cardiovascular health for all, including identifying and removing barriers to healthcare access and quality. Specifically, the Association has committed to:

* Drive advances in research and discovery,

* Raise awareness, empower people and engage communities to improve their cardiovascular and brain health,

* Advocate relentlessly to improve healthcare quality and ensure access to healthcare for all, and

* Innovate new solutions to achieve equitable health for all.

“For the American Heart Association to continue to be a relentless force for longer, healthier lives for all people in all communities, in the U.S. and globally, it must boldly respond to structural racism,” said Bertram L. Scott, chairman of the Association’s Board of Directors.

“Structural racism in housing, education, healthcare and more is a significant impediment to the American Heart Association’s goal to equitably achieve cardiovascular health of all people.”

In addition to working with allies to advocate for system change, the American Heart Association is examining its own organizational practices and processes to ensure they embrace antiracism within the Association and externally to better account for its interactions with volunteers, members, supporters and other organizations to end all forms of racism.

“The Association cannot by itself dismantle structural racism, but we can serve as a catalyst, convener and collaborator toward this end point, in particular, within the realm of cardiovascular science, medicine and health care,” Elkind said. “We recognize not everybody thinks the same way about these issues. But we are convinced that we’re doing the right thing. We hope using our foundation in science as our guiding principle and method we can also convince others to join us on what we think is the right side of this issue.”

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