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Stopping to catch your breath after running a 5K, playing a wind instrument, the rapid acceleration of your heartbeat when you enter a job interview. Our hearts work hard every day to keep us alive and power our daily lives, but we usually don’t think about heart health —at least, not as much as taking care of our gut or skin. Heart disease is the number one killer in the U.S., however, and it is disproportionately higher in Black Americans.
According to the American Heart Association (AHA), the mortality rate for African Americans who have cardiovascular diseases is 32 percent higher for heart disease. The risks are higher because of systemic factors and adverse social determinants of health, or the conditions in which a person is born and lives.
Health disparities exist because of several factors, some of which are social: the National Academy of Medicine discovered that minorities receive lower-quality healthcare than white people, even when other factors like insurance, income, age and severity of conditions were comparable. It reported that minorities were less likely to be given appropriate cardiac care, for instance. AHA’s data supports this, as seen in its study of 17,755 patients hospitalized between 2000 and 2014 in four regions in Maryland, North Carolina, Mississippi and Minnesota.
It reported that Black patients had a 29 percent lower chance of getting an angiogram, an imaging technique used to see inside the heart’s blood vessels, or undergoing more aggressive therapy. They are also more likely to receive older, cheaper and more conservative treatments than white people. After surgery, minority patients are discharged earlier from the hospital than white patients, sometimes at a stage when discharge is inappropriate.
The healthcare gap started to narrow during the Civil Rights Movement in the 1960s but began widening again in the early 1980s. The National Healthcare Disparities Report shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality care and less access to care than dominant groups. Of the 1 in 10 people in the U.S. who do not have health insurance, 9.6 percent of Black people lack health insurance coverage. Health insurance helps people have regular sources of care and obtain early diagnosis and treatment, which benefits overall health and eliminates barriers to accessing care.
In 2010, the Affordable Care Act (ACA) was passed, going into full effect in 2014. It allowed more people to get affordable insurance, increasing eligibility for Medicaid and helping guarantee insurance coverage for people with pre-existing conditions. Provisions of the ACA included services like screenings for cancer and diabetes and preventative screenings for cardiovascular disease at no cost to the patient.
In March 2023, however, U.S. District Judge Reed O’Connor of Texas ruled that the U.S. Preventive Services Task Force’s preventative care recommendations do not have to be complied with. The task force issues recommendations for preventive care that insurers must cover per the ACA. If this ruling is left standing, insurers are not required to cover these preventive services.
There are organizations advocating for affordable insurance and accessible healthcare, like the Open My Heart Foundation, which seeks to eliminate heart health disparities among women of color. It hosts monthly support groups for heart attack and stroke survivors, provides free screenings and assists with co-pays. Community-based and people-centered organizations help with immediate needs and advocate for increased awareness. Still, a more long-term solution lies in making heart screening — and, by extension, healthcare — accessible to all. This lies in changing legislation and understanding years of medical mistrust among Black Americans.
It is necessary to listen to patients when they report health problems and give them the support they need; it is important to know what legislation is or isn’t being passed to make heart disease screenings covered by law. Furthermore, on an individual level, education is crucial to preventing heart disease. A diet with fresh fruits and vegetables, lowering one’s salt intake, doing physical activity and limiting alcohol intake can all benefit one’s heart health. Through education, empathy and action, accessible healthcare may be within reach.
Grace Chai can be reached at [email protected].
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