Heart Month, February 2013. I had just concluded my community talk on heart disease prevention strategies. A middle-aged lady approached me after my presentation. She wanted to eat healthy, but felt she could not afford to incorporate daily servings of vegetables into her meal plan. “Frozen vegetables” was my response. “Cheaper than fresh vegetables, healthier than canned vegetables, and might fit within your budget.” She smiled; frozen vegetables had not occurred to her. It suddenly dawned on her that she could afford to eat healthy.

Society is made up of people with different backgrounds. Social, economic, racial, educational and cultural differences exist in nearly every community. For a variety of reasons, not everyone is able to achieve the highest level of [cardiovascular] health. This is known as health inequity. The reasons may be socioeconomic, political or environmental.¹ These social determinants of health play an important role in health inequity. Children born in certain countries may have shorter lifespans. Residence in certain zip codes may determine access to healthcare, the quality of school choices and eventual economic status for adults in the community.²

Economic or social status, in turn, play a role in determining people’s life choices, career opportunities and quality of life. The political and health care policies of a country can also lead to health inequity within a country or geographic region. Health inequity ultimately leads to health disparities, i.e., differences in health care outcomes among groups of people, due to obstacles or other characteristics which lead to exclusion or discrimination.^3,4

"On a personal level, we can examine ourselves for implicit bias in our patient-provider healthcare encounters, and ensure that we practice evidence-based medicine with all our patients."

As early career physicians, we are uniquely positioned to engage in activities that can make a difference over the course of our career. The big picture problem regarding health inequity may initially seem daunting. We may not have the power to alter the inequitable distribution of resources, money or power in our communities,¹ and our work-family life schedule may render us too busy for large projects such as volunteer mission trips abroad. However, if we pause and look around us, opportunities exist whereby, with a little effort on our part, we can make a difference and promote health equity in our local communities.

On a personal level, we can examine ourselves for implicit bias in our patient-provider healthcare encounters,⁵ and ensure that we practice evidence-based medicine with all our patients. In addition, there are several ways that we can assist with the identification and resolution of the factors which contribute to health inequity in our local community. Many health care institutions have a number of community-healthcare center partnerships, such as an annual free community health day or a “walk-with-the-doc” program. We can sign up as a physician volunteer or take up a leadership role and organize similar events in our community. We can raise public awareness, give talks on preventive cardiology at local community social events or spend a couple of hours as a career role model at the local high school.

One changed life can have a positive impact on an entire family. Early career physicians can also engage in health disparity research. Several national grants and fellowships exist for physicians interested in health disparity research.⁶

Collectively, we can partner with our ACC State Chapter, and/or other cardiovascular societies to work to eliminate health inequity and disparity in health care. The ACC Political Action Committee (ACCPAC), a non-partisan branch of the College, is devoted to promoting and advocating for relevant cardiovascular health policies on Capitol Hill. As early career physicians, our support of ACCPAC helps the College in its global mission to reduce health inequity and eliminate health care disparities.

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References

1. World Health Organization, Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action On The Social Determinants Of Health. Available at http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf. Accessed May 19, 2017.
2. Gebreab SY, Davis SK, Symanzik J, Mensah GA, et al. J Am Heart Assoc 2015;4:e001673.
3. Health Disparities. Available at https://medlineplus.gov/healthdisparities.html. Accessed May 19, 2017.
4. Paving the Road to Health Equity. Available at https://www.cdc.gov/healthequity/index.html. Accessed May 19, 2017.
5. Cooper LA, Roter DL, Carson KA, et al. Am J Public Health 2012;102:979-87.
6. Grants, Funding and Fellowships. https://www.nlm.nih.gov/hsrinfo/disparities.html#498. Accessed May 19, 2017.

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Keywords: ACC Publications, Cardiology Magazine, Evidence-Based Medicine, Fellowships and Scholarships, Health Policy, Healthcare Disparities, Heart Diseases, Leadership, Quality of Life, Social Determinants of Health

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