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Better Care for All

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Heart disease treatment is an evolving science. Prior to the early 1990s, the medical consensus was that cardiovascular disease didn’t often affect women, because their symptoms, outcomes and even the age at which events like heart attacks occurred differed from men. And men, usually of European background, were often the only ones included in such studies, with the exception of a few efforts such as the landmark Women’s Health Study.  

We now have a much better understanding of how heart disease affects women. We have also started paying greater attention to how heart disease (and all disease) affects people of various ethnic groups in unique ways.  

The medical field has begun focusing on how individuals of different ethnic groups get different levels of care. Health care leaders, such as Johns Hopkins endocrinologist Sherita Hill Golden, M.D., M.H.S., are at the forefront of seeking to understand the factors that contribute to health disparities and what more can be done to bring people of all backgrounds closer to optimal health. 

What do you need to know about health equity in order to get the best care for yourself? Find out what Golden has to say.

Q: What stands in the way of some groups obtaining the highest level of health?

Golden: There are multiple reasons people experience different levels of health. Ethnic background is one factor.

For example, African-Americans and Latinos have very high rates of diabetes, which is a major risk factor for heart disease. Similarly, African-Americans have very high rates of high blood pressure, another heart disease risk factor. 

Q: So if you come from one of those backgrounds, what should you do to protect yourself?

Individuals from high-risk backgrounds should undergo screening early and regularly for heart disease risk factors such as diabetes, high cholesterol and high blood pressure.

Q: Are there other factors, regardless of race, that some groups face?

Golden: Yes. For example, where an individual lives affects his or her health. Less–advantaged neighborhoods are likely to have fewer gyms, health clubs and safe walking trails. They also tend to have less access to grocery stores that offer healthier foods such as fresh fruits and vegetables. 

The health care environment is important, too. Minority individuals and those with lower socioeconomic status may have less access to adequate health care, either because of a lack of insurance or other factors. Those who live in very rural areas might not have access to quality health care near them. 

Q: What can be done to close these health care gaps?

Golden: Part of it is just raising awareness that health disparities exist. I think now there is heightened awareness, which is really important for closing that gap. 

Here at Johns Hopkins, we have been trying to address the gaps from a research perspective. We have several health disparity centers focused on issues such as obesity in adolescents and cancer. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, of which I’m a member, is working on developing interventions (such as taking steps to reduce high blood pressure) at the level of the patient, the health system and the community. 

There are a lot of efforts to address these issues from a research standpoint. Once we understand that, then we can work with other health systems and institutions to share our findings and eliminate these disparities. We’re also training the next generation of research scientists, so that they know how to conduct the research in this area and continue moving the field forward. 

Q: What can patients do to help themselves get better care, even when faced with individual risk factors or income-related challenges?

Golden: If you know you are at increased risk because of family history of heart disease or a personal history of risk factors, it’s important to have a good primary care doctor. Talk to your doctor to make sure that he or she is aggressively treating you to prevent heart disease. Identifying a doctor covered by your insurance plan and establishing a good relationship with that person is very important.

Q: Why is heart disease a good place to start when you’re working to reduce health disparities?

Golden: Obesity, diabetes and high blood pressure are more common in lower-income populations, and they are all risk factors for heart disease. Addressing any one of those disparities could have a significant impact on heart disease.

We can also address all of these risk factors through behavior and lifestyle changes. That means patients are an important partner with the health care team in prevention and treatment. 

Our goal is to empower patients to better participate in their health care. Our studies have explored training to improve patient-physician communication as well as patient education to teach patients health problem-solving skills. 

Ultimately, we need interventions not only at the patient level but also at the health system and community levels to eliminate health disparities and to promote health equity.

 

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