CardioExchange Archive

In a recent publication in Circulation: Cardiovascular Quality and Outcomes, I wrote a piece called “The Gap in Current Disparities Research” recounting an afternoon 14 of us spent immediately after the close of the AHA’s Quality and Cardiovascular Outcomes Research (QCOR) in June.  For 4 hours, we met with the founders of 2 pivotal organizations which provide food, shelter, and social and economic support to some of the poorest residents of Baltimore (the conference host city).  All of us there were struck by the vast chasms that separated our world from the largely African-American and destitute communities we visited. It became very clear, as we heard story after story about poverty, drugs, gang violence, joblessness, and despair that afternoon, that:

1)      Health is only one of many pressing priorities for poor people.  While this is an obvious statement, as clinicians we often practice medicine either oblivious or in denial of this reality, leaving our patients to juggle on their own competing priorities of extreme poverty, hunger, health illiteracy, gang violence, and single parenthood.

2)      The status quo of disparities research is untenable. The 14 of us were academicians and had ourselves published about racial and economic disparities in medical care (some in high-impact journals).  But after decades of disparities papers, it was less clear that we as a scientific community had made much of a difference in improving the lives of those about whom we have described.  It was clear that a new agenda for future disparities research was required—one that focuses on developing effective interventions—in order for us to move from describing to reducing such disparities

3)      As a research community, we need to lead and find ways to make it easier for people to be healthy. If we want to close the chasms that separate black from white, poor from rich, uninsured from insured, physicians will need to become more proactive in fighting for programs to ensure that the poor can have the resources and time to focus on their health.  I almost always cringe when my residents describe a patient as “non-compliant” or “a frequent flier”, because I know deep down, more often than not, they are not able to be compliant or stay out of the emergency room because they could not afford the medications with which they were sent home—or worse, they don’t even have a place to call home.

I would love to hear what you think, about your ideas and prior efforts, especially if you have found an approach or a program that has worked in your clinical practice.  This will help me and others learn about what has been tried, whether and why it worked or failed, and whether it has been sustainable.