American Heart Association issues call for action on structural racism in cardiovascular care

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Structural racism is a major cause of poor health and premature death from heart disease and stroke, according to a presidential advisory issued today by the American Heart Association (AHA). “Call to Action: Structural Racism as a Fundamental Driver of Health Disparities,” was published today in the Association’s journal Circulation.

The advisory reviews the historical context, current state and potential solutions to address structural racism in the USA, and outlines steps it 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 SV Elkind, president of the American Heart Association, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians and Surgeons and attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center, New York, USA. “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 marginalised communities deserve nothing less—and society must demand it.”

The Association said it 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 USA.

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, AHA said in a press statement. The Association noted that:

  • 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 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.
Mitchell SV Elkind, AHA president

“Structural racism, by definition, is not a personal action or behaviour or belief, it is not something that a few people or institutions choose to practice,” said Keith Churchwell, chair of the Advisory writing committee and president of Yale New Haven Hospital in New Haven, USA. “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 goals, with an increased focus on health equity. By 2024, the American Heart Association has said it will champion health equity by advancing cardiovascular health for all, including identifying and removing barriers to healthcare access and quality.


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