Cardiovascular disease is something that impacts people from all different backgrounds, ethnicities, and socioeconomic statuses. However, some groups of people seem to suffer poorer outcomes than others. For example, one study published by the Journal of Urban Health shows that black women have a disproportionate risk of cardiovascular disease compared to other people of the same age and living in the same geographical area. One explanation for this difference in outcomes is a lack of health equity—specifically, cardiovascular health equity.
But what is health equity? Simply put, health equity means that everyone has a fair chance of reaching their highest level of health. Things like racial implicit bias, social determinants of health, and misunderstandings of symptoms create inequality in healthcare for certain groups of people.
Barriers to cardiovascular health equity: Implicit bias
Implicit bias is a negative attitude towards a specific group that a person is not consciously aware of. These attitudes are shaped by experiences and learned behaviors and can be subtle. Bias can exist against people of different race, religion, sex, belief, socioeconomic status, and more.
Recommended course: Recognizing and Mitigating Implicit Biases in Healthcare
Implicit bias in healthcare may lead healthcare providers to assume things about their patients that can negatively impact their care. In fact, there is a strong correlation between healthcare providers’ implicit bias and poorer quality of care. Unlike explicit bias, like overt racism or sexism, implicit bias can be present even in people who are doing their best to accept and relate to people with different beliefs and backgrounds.
Because they are unconscious, it can be difficult for healthcare providers to identify their implicit biases. The American Academy of Family Physicians recommends that healthcare providers practice introspection and mindfulness to identify their implicit biases, and actively look for new ways to decrease them.
Bias in cardiac symptom identification
When learning about symptoms of heart attack, most people are familiar with the “typical symptoms.” These symptoms include pain and tightness in the chest, difficulty breathing, jaw pain, and pain that radiates down the left arm. Patients who come to an emergency department with these symptoms are always seen right away.
Women often experience atypical symptoms of cardiovascular disease. These may include indigestion, sweating, back pain, or unusual fatigue. Because typical symptoms of chest pain and shortness of breath may not be present on admission to the emergency department, there may be a delay in healthcare for women experiencing a myocardial infarction. In addition, women are often unaware of their risk of developing heart disease. According to the Centers for Disease Control, only about 56% of women know that heart disease is the number one killer of both men and women in the United States.
To promote cardiovascular health equity, it is important to educate staff that cardiovascular disease looks different for different patient populations. Acknowledge that care plans may need to be modified for different genders and ethnic groups.
Healthcare providers should also recognize that health problems are determined by much more than just compliance with a certain treatment plan. There are many different factors that come together to influence the overall health of a specific individual.
Social determinants of health
Understanding social determinants of health can help nurses and other caregivers to avoid bias and stereotyping. By reducing judgment in the healthcare setting, they can create care plans that help individuals manage their disease based on the resources and capabilities that they already have.
Social determinants of health include:
- Income and social status: People with higher income generally have better health. High income and social status usually allow people to spend more time cooking healthy meals, exercising, and participating in routine healthcare checkups.
- Education: Studied have associated low education levels with increased stress, poor health, and lower self-confidence. Research has also associated higher levels of education with lowered risk of heart disease, diabetes, asthma, and obesity.
- Physical environment: Safe communities and roads, clean water and air, and hazard-free working conditions all play a role in maintaining good health. For example, people already suffering from heart disease are at an increased risk of acute exacerbations on days with high air pollution.
- Social support networks: Those with better access to social support have better health than those who are alone. Having a strong social support network decreases stress levels and the risk of cardiovascular disease.
- Culture: The foods someone eats, the way they spend their free time, and the risky behaviors they participate in may all be related to their culture.
- Access to health services: People in rural areas may have a difficult time accessing healthcare for both emergency services and regular health check-ups. People with mild cardiovascular disease may never check in with a doctor until they have an emergency. When they do have an emergency, they might be too far away from emergency services to get the help they need.
Recommended course: Introduction to Rural Nursing: The Center of Care for 60 Million Americans
Compassionate, understanding care for all
Nurses and other healthcare providers can keep these determinants of health in mind when providing care to their patients. Not all people have the same opportunities to maintain good health. Keeping this in mind will help nurses be more compassionate and understanding, allowing them to adjust care plans to the patient’s specific needs.
