“How can we advance health equity in cardiovascular care?” asked David Thompson, PhD, professor of nursing, School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, on 2 2024 Congress of the European Society of Cardiology.
To even know where to begin, it’s important to first understand that health equity and health equity are not the same thing, he explained in the section “Diversity in Cardiovascular Care: Advancing Health Equity.”1
“We use terms health equality, health equality, differencesand results interchangeably and can sometimes lead to confusion,” he explained. Health equity requires equal care for everyone, health equity requires equity in needs-based care even in the presence of social determinants of health (SDOH), health disparities are how health outcome measures differ between groups, and health outcomes health is exactly like that. – results after care.2-4
Based on data he published last year5—and more than 40 years of research on psychosocial interventions, health-related quality of life in heart disease, and meta-analyses of cardiovascular disease (CVD) prevention and rehabilitation—presented his case for the field of CV care, noting that SDOH are not the only determinants of health in CVD. There are other determinants – such as education, language and lack of health literacy (or health misinformation); culture; no access to health care; social support networks (“We know that people who live alone or have no social support do much worse,” Thompson said); home environment and living conditions; and job and income insecurity to name a few.
But social determinants may be more important than health care or lifestyle choices in influencing health, he said.
So how do these barriers intertwine in fair CV care? Health care can be unaffordable, resulting in patients often having insufficient insurance coverage; unavailable, which may translate into delays in care that includes diagnoses and rehabilitation; culturally biased due to treatment preference in care delivery; geographically inaccessible (ie poorer countries); hampered by inadequate transportation infrastructure (“One of the big obstacles to cardiac rehabilitation is getting people into cardiac rehabilitation programs.”); and unknown to many. Patients may also have other disabilities, face communication and language barriers, or be unaware of the services offered or not offered at all.
David Thompson, PhD | Image credit: Queen’s University Belfast
“All of this can lead to unmet health care needs,” Thompson said.
The Lancet Regional Health-Europe The Commission on Inequalities and Disparities in Cardiovascular Health was recently created to address “ongoing and widening disparities in cardiovascular health, [that] despite overall declines in cardiovascular mortality, they highlight inequalities in the distribution of advances in cardiovascular care.6
The panel’s research to date demonstrates differences leading to adverse CV health outcomes among 4 patient populations6:
- Women usually have limited access to health care, low income and insufficient social support.
- Racially and ethnically disadvantaged individuals also have limited access to health care and low income, but are more likely to experience family instability and systemic racism.
- People with mental illness are more likely to face discrimination and engage in unhealthy behaviors (e.g. poor diet, physical inactivity, alcohol or substance abuse).
- Older individuals have higher rates of loneliness, are underrepresented in clinical trials, and lack family and caregivers.
Ageism and sexism are also to blame.
Promoting health equity requires equitable social interventions, access to care, high-quality clinical care, care experiences and care structures, “all of which need to be addressed if we want to improve health and well-being,” Thompson said. But they must be preceded by a concerted effort to change how we think, feel and achieve.
Suggestions for achieving this include addressing all determinants of health (not just SDOH) and ensuring effectiveness and equitable access to care, employing a diverse workforce that reflects the patients they serve, adhering to professional and ethical codes of conduct, always championing health equity in CV care, aware that health inequalities exist and committed to addressing them in a targeted manner training and empowering patients, their families and care providers to speak up.
Research from 2 recent studies supports these claims.5.7
Another potential solution is digital CV health innovation and ensuring patients are digitally literate by empowering them through training and technical support on the devices and apps they would need to advance their CV care and better navigate the healthcare system , with Thompson emphasizing that “we should be using technology more.” This can also contribute to greater social cohesion within a community, he added, and a greater awareness of social justice.
“As cardiovascular health care professionals, we must recognize and celebrate diversity in cardiovascular care, strive to promote health equity to ensure fair and equitable health care for all, and recognize that health inequities are common in cardiovascular care—both in prevention , so in management. ” he summed up.
This effort to understand and reduce disparities should be supported by the triple threat of professional, moral, and ethical obligations and collaboration with patients, families, local communities, and care team members to create trusted partnerships.
“I think we’re pretty good at it, but we can always improve,” Thompson emphasized.
Reference
1. Thompson DR. Diversity in cardiovascular care: advancing health equity. Presented at: ESC Congress; August 30 – September 2, 2024; London, England.
2. On equality in health. CDC. Accessed 31 August 2024. https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/about/index.html#:~:text=Health%20equity%20is%20the%20state,their%20highest%20level%20of 20% health
3. Rosa WE, Hannaway CJ, McArdle C, McManus MF, Alharahsheh ST, Marmot M. Nurses for health equity: guidelines for addressing the social determinants of health. Qatar Foundation/World Health Innovation Summit. 2021. Accessed 31 August 2024. https://wish.org.qa/wp-content/uploads/2024/01/Nurses-for-Health-Equity.pdf
4. Equality in health. World Health Organization. 2024. Accessed 31 August 2024. https://www.who.int/health-topics/health-equity#tab=tab_1
5. Thompson DR, Ski CF, Clark AM. Promoting health equity in cardiovascular care. Eur J Cardiovasc Nurs. 2024;23(3):e23-e25. doi:10.1093/eurjcn/zvad131
6. Bugiardini R, Gale CP, Gulati M, et al. Notification The Lancet Regional Health-Europe Commission on Cardiovascular Health Inequalities and Disparities. Lancet Reg Health Eur. 2024:41:100926. doi:10.1016/j.lanepe.2024.10092
7. Bodine J. The future of nursing 2020-2030: mapping the path to health equity: implications for preceptor development. J Sisters Prof. Dev. 2023;39(2):115-116. doi:10.1097/NND.0000000000000975