It’s been 20 years since I led a study evaluating gender disparities at leading medical institutions in the U.S. and Canada. Our research was among the first to show that women were vastly undertreated than their male counterparts despite having a similar degree of coronary disease. Over the past decade, I’ve also had the privilege of serving as a Trustee for The AstraZeneca Foundation’s Connections in Cardiovascular Care, where we’ve funded more than $20 million in innovative, non-pharmaceutical based community projects to marginalized communities. However, systemic discrimination continues to pervade our country’s healthcare system and should be classified as a health risk. Upon medical school graduation, reciting the Hippocratic Oath is a rite of passage. One of its core tenets reads that a physician is “to treat the ill to the best of one’s ability”. This statement is meant to encompass ALL people: of all races, religions, genders and sexual orientations. Unfortunately, research has shown that this important oath has not been upheld properly. It’s time for the medical community to recognize this and make systemic changes.
It takes activists and community leaders working together alongside dedicated professionals to help reduce health care disparities. Progress can be achieved through greater awareness in the medical community, and educational initiatives in the patient population. Such an initiative might include a series of educational messages featuring BIPOC (actors or medical professionals or patients) on media-based platforms that are promoted by prestigious organizations such as the American Heart Association. The goal of these messages would be to increase knowledge and relevance of heart disease risk factors, such as hypertension in underserved communities. Another goal would be to ensure that heart healthy foods are readily available in all communities, focusing on those with food insecurity. One such successful program is the Sankofa Community Development Corporation in New Orleans, LA which educate
s high-school age youth and their families about heart healthy lifestyles, nutrition and techniques for growing fruits and vegetables.
A third goal would be to integrate healthy nutrition with measures to increasing physical activity to help reduce the high rates of obesity in underserved communities. An example of one such successful program is the “Partnering for Youth Cardio-Fit Project,” which provides free-after school programs to enhance physical fitness and overall well-being. The fourth goal would be to offer programs that help to reduce chronic stress that in itself, remains a significant health issue in these communities. This might include yoga, meditation, tai chi, dance instruction and spirituality exercises. For example, in my Baltimore community, there are a number of local wellness advocates who provide free access to yoga and meditation.
Right now, there is considerable unconscious (and conscious) bias that arises when medical professionals see a patient that is part of the BIPOC community. For example, when a Black patient discusses their health concerns, medical professionals (on average) are less likely to take their concerns as seriously as they might a White patient. This shows that these problems must be solved NOT ONLY with community outreach, but also with a revised curriculum for medical professionals. Physicians, nurses, PAs, etc. must all be trained in unconscious bias and learn how to recognize how these biases affect patients in real time. In addition, medical schools need to revise their curriculum to include case studies that showcase conditions in multiple races (since diseases may manifest themselves differently depending on the racial makeup of a patient). For example, @brownskinmatters is an awesome instagram account that does this for dermatological conditions.
The bottom line is that as health care professionals, we need to do better and treat all of our patients as if they were our family members, regardless of race, religion, gender or sexual orientation.
Michael Miller, MD is a cardiologist and Professor of Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland. His latest book, “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” is published by Penguin Random House, USA.