systemic racism

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Highlights of “Not to Miss Sessions” at the #AHA20 Virtual Meeting!!

Lina Ya'qoub, MD

AHA20 virtual meeting has been packed by so many amazing sessions, covering all aspects of cardiovascular disease from basic science to clinical outcomes. I wanted to share some of the sessions “not to miss sessions” at AHA20 virtual meeting!!

Opening Session

Dr. Braunwald and Dr. Wenger, two of the legends in cardiology, took us back to history, structural racism, and correlated what we are living now during the pandemic and the social justice crisis to how it was when living in war!!!! Dr Harrington and Dr Yancy led a great discussion. Definitely, a very interesting talk that everyone should listen to!!

Structural Racism Session

This is a novel yet a wonderful session at AHA20!!! It is part of AHA leadership commitment to equity, diversity, social justice in healthcare across the nation and the globe. There were several amazing discussions with experts and leaders in the field, sharing data on how structural racism can in fact affect the health of both healthcare employees and patients, calling for action to increase diversity and inclusion in leadership positions for minorities and women. If you missed this session, you should check out the on-demand portal and listen to it. Kudos to everyone involved in this and who made this happen!!

Presidential Session

This was an inspiring session by Dr. Elkind, MD, AHA President about his journey in neurology and science. This was followed by an amazing talk by Nancy Brown, AHA CEO, emphasizing the AHA vision on social equity, diversity, and inclusion in research, science, and access to health care. Then, we watched many inspiring women receiving distinguished AHA awards for their excellence in leadership and academic achievement. They all share the AHA’s vision and commitment to lead science in order to have comprehensive policies and unite team efforts for better healthcare for all as well as bridge the AHA’s visions into actual practice not only across the nation and also across the globe.

Late-Breaking Science and Meet the Trialist Sessions

There are late-breaking science sessions on multiple days on various sub-specialties of cardiovascular diseases, including preventive cardiology, resuscitation, heart failure, interventional cardiology, structural heart disease, electrophysiology, among other specialties. Later each day, there are sessions where you can meet the trialist, ask questions through Q&A side chat and you’ll hear their input on the trials they presented earlier in the day.

Move More and Dance Break Session

This is a fun session to motivate us to move more!! It was the first session of each day on AHA20 but you can watch it on-demand anytime whenever you want!!

#AHA20 is packed with so many great sessions for all sub-specialties in cardiology!! I look forward to AHA21, and hopefully, it will be an in-person meeting next year!!

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Structural Racism: A Call to Action

Anika Hines, PhD, MPH

If there is any silver lining to the horror that the COVID-19 pandemic has invoked, it is that this time has positioned us to take a critical look at systemic failures (or successes). Undoubtedly, the COVID-19 pandemic has magnified the institutionalized inequities that scholars have pointed to for decades as the root causes of health disparities. It is easy to point out the ways that we perceive the system has failed. It is much more sobering to consider that the system, in fact, has done exactly what it was designed to do. Rooted in structures as old as slavery and maintained by subsequent post-slavery policies aimed at maintaining white privilege well into the 20th century, structural racism represents a stronghold in American society hundreds of years in the making. As aptly drawn out by the AHA’s recent Presidential Advisory, these historical structures are tied to modern-day health outcomes. In a volley between ideals and policies, at face value, the effects of structural racism are easily disguised as individual behaviors, but we must be keen.

Structural racism (as defined by Lawrence and Keleher and employed by the advisory) is “the normalization and legitimization of an array of dynamics—historical, cultural, institutional, and interpersonal—that routinely advantage White people while producing cumulative and chronic adverse outcomes for people of color”.  For example, Dr. David Williams pointed out during Saturday morning’s Structural Racism keynote that African American people earn $0.59 to every $1 earned by White people—a disparity that has existed since 1978. Moreover, regarding wealth—an even stronger predictor of health—African Americans have $0.10 to every $1 of wealth for White people. At every education level, race matters. Inequities reverberate through every social sector, including housing, the physical built environment, education systems, access to capital, and manifest in health outcomes. Indeed, “racism has produced a truly rigged system” by which the marginalized life and, ultimately, die.

The AHA highlights its strategies to address structural racism, including advocacy, quality improvement, leadership, human resources/business operations, and, of course, science (see Figure 3, below).  CEO Nancy Brown summarized the AHA’s role as one of “catalyst, convener, and collaborator”.

Assuming that “the long arc of the moral universe leans towards justice”, speakers during Tuesday’s press release and Saturday’s panel discussion emphasized that undoing structural racism should not fall solely on the shoulders of the communities that already bear the burden. Instead, the issue of achieving equity should be of interest to all. Further, Dr. Regina Benjamin emphasized that “allyship is more important than collaboration and that the privileged should work hand-in-hand” with the affected to dismantle these social ills. Solutions entail reforming the science and healthcare workforce, according to Dr. Lisa A. Cooper, to include more diversity, which leads to improved academic and workplace environments, organization academic excellence, improved access to care, and reductions in healthcare disparities. Others emphasized that we should evaluate our “investments as a moral template” and that real change may require “remapping entire curriculum and rethinking mentoring”.

In summary, as an early career scientist, I’m encouraged by the direction of this discussion. Though the length of my career in health disparities research pales in comparison to the giants on whose shoulders I stand, the attention to structural racism as a fundamental driver of health disparities feels like a long-awaited arrival. The path ahead will be even longer, but admission is the first step towards recovery. Moreover, I believe that all involved in the AHA’s thrust to acknowledge structural racism would agree with the African proverb,

“If you want to go fast, go alone. If you want to go far, go together.”

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Quotes from AHA 2020: Structural Racism in Healthcare

Dapo Iluyomade, MD

In a year wrought with challenges spanning social, political, and healthcare spheres, one issue has risen to the forefront of our collective consciousness. Structural racism.

What is structural racism? A recently published presidential advisory from the American Heart Association states that “structural racism refers to the normalization and legitimization of an array of dynamics–historical, cultural, institutional and interpersonal–that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color.”

The planning committee for this year’s AHA Scientific Sessions took it upon themselves to address the presence of structural racism in Cardiology with a comprehensive series of lectures and discussions on the topic. The sessions kicked off on Friday, November 13th with an awe-inspiring fireside chat featuring legends in the education and treatment of cardiovascular disease, Drs. Eugene Braunwald and Nanette Wenger. The discussion was moderated by legends in their own right, Drs. Clyde Yancy and Robert Harrington.

“When I arrived in Atlanta in the early 1960s, racism was prevalent…and sadly, it continues more than half a century later” – Dr. Nanette Wenger

The morning continued with the main event session, “How to Use Behavioral Interventions to Advance Equity in Cardiovascular Health.” Drs. Keith Norris, Eberechukwu Onukwugha, and LaPrincess Brewer eloquently proposed solutions for tackling disparities in hypertension management and post-discharge care, as well as shared a bold new vision for cardiovascular health interventions to address disparities across the board.

“I am issuing a call for us, as an American Heart Association, community to integrate community-based interventions to promote cardiovascular health […] First, we must recognize the historical improprieties and wrongs in research, from events such as the Tuskegee syphilis study and the Henrietta Lacks cell line, which have led to a lingering mistrust of scientists and clinicians among racial and ethnic minority groups.” – Dr. LaPrincess Brewer

Arguably the main highlight of the morning was the AHA Fellows-in-Training session, titled “Racism in Medicine: What Medical Centers & Training Programs Can Do to be Antiracist.” This program sought to implore early career cardiologists to engage in the fight against structural racism, as well as provide trainees with a forum to learn more about racism in Medicine. The esteemed panelists, Drs. Clyde Yancy, Ileana Pina, and Michelle Albert led an incredible discussion with plenty of teaching points and actionable items to strengthen and support diversity, equity, and inclusion in medical training.

“It’s not about the number of people in the room or what they look like […] it’s about the diversity of thoughts in the room” – Dr. Clyde Yancy

This year’s AHA Scientific Sessions is off to a great start! Judging by the quality of programming on Day 1, there will be plenty more to write home about after this weekend.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Black Lives Matter- Doctors, We Need to Talk

Nasrien E. Ibrahim, MD

I immigrated to America with my siblings and mom in the summer of 1998. Three years later on April 7, 2001, when I was a freshman in college at the University of Cincinnati, the Cincinnati Police killed an unarmed Black teenager named Timothy Thomas, igniting several days of protests. That was the first time I came face-to-face with the cruel reality of racism, police brutality, and violence against the Black community in America. After Timothy Thomas came many others. Sean Bell. Oscar Grant. Trayvon Martin. Rekia Boyd. Eric Garner. Michael Brown. Tanisha Anderson. Tamir Rice. Walter Scott. Freddie Gray. Sandra Bland. Samuel DuBose. Alton Sterling. Philando Castile. Stephon Clark. Atatiana Jefferson. Breonna Taylor.  Ahmaud Arbery. [and many, many more…]. And most recently, George Floyd- who like his 6-year-old daughter Gianna said while sitting on the shoulders of one of her father’s best friends, retired NBA player Stephen Jackson, her “daddy changed the world”. The world watched in horror as a police officer kneeled on Mr. Floyd’s neck for 8 minutes and 46 seconds as he pleaded for his breath, killing him on May 25, 2020. Protests erupted all over the world.

I wish I knew the answers. I wish I knew how to change the world. I wish I knew how to change the reality of being Black in America. What I do know is that this time it feels different. This time I am hopeful. This time I have witnessed people speaking up who never speak up. I have seen hearts shattered all over the world and emotions exploding across every continent. Systemic racism is a disease in America and the system needs dismantling. Change can no longer wait.

Why did I say we needed to talk, doctors? Because we desperately need to. Violence, police brutality, and injustices against the Black community are a public health crisis. How do we expect to talk to Black patients about blood pressure and glucose control without addressing the trauma Black women and men experience on a regular basis living while Black in America? We took an oath, to serve mankind, now is our time to step up like we have never stepped up before. This is not a bipartisan issue; this is a human issue.

Academic and non-academic medical institutions all over America kneeled on June 5, 2020 in remembrance of Mr. George Floyd after they issued statements (ranging in directness of messaging) denouncing his soul-crushing murder. While this display was profound, we cannot stop there. We must move past the vigils, remembrances, thoughts, and prayers, emails, diversity and inclusion workgroups, and committees, and meeting after meeting after meeting, to the implementation of initiatives that dismantle the systemic racism ripe in medicine. Black women and men are grossly underrepresented beginning in medical school all the way to professorships, tenured positions, chiefs of divisions, and medical school deans.

I do not know all the answers, but I do have some suggestions:

  • When you get invited to speak at a school about being a doctor, rather than feel good for the day and add it to your curriculum vitae, connect with a Black student or 2 that may be interested in medicine and mentor them. Find out if your institution has a summer program for minority students interested in medicine and get them connected. Maintain a relationship with them and guide them through their journey in medicine. You may be the only person that has made them feel like they belong in medicine and that their dream is within reach.
  • Recruit Black women and men into your residency and fellowship programs and mentor and sponsor them throughout their training. If they are interested in research, provide them with opportunities to work with your team. Amplify their voices and work on the national and international stages you have the privilege of presenting on. Recommend them for local, national, and international committees. Recommend them for speaking opportunities. Connect them with your colleagues and friends at other institutions during their job searches.
  • Recruit Black women and men into your institutions and work hard to retain and promote them. Recommend them for leadership positions. Guide junior faculty in their research efforts and put them on your grants. Cite their work. Get them to the podium on national and international stages. Invite them to meetings where big decisions are being made. Recommend them for local, national, and international committee positions (other than the cliché “Diversity and Inclusion Committee” positions). Recommend them for promotions and tenure.
  • Let go of the idea that Black patients are the responsibility of safety net hospitals alone. In any given city, there are more Black residents than what a single hospital can handle. Go into Black communities and build relationships and welcome Black patients into your hospitals. If Black patients say they are not comfortable being cared for at your hospital, then you desperately need to change the face of your hospital.
  • Which brings me to my next point, diversifying your hospitals means diversifying the faces from environmental services, valet, and food services all the way to division chairs and hospital presidents.
  • Speak up right then and there, every single time, in defense of your Black students, trainees, and colleagues when discrimination occurs in your presence. And defend them when they are discriminated against when they are not present.

Nothing seems to have changed since I immigrated here in 1998 but I do feel that this time is different. My fellow doctors, this is not the time to watch from the sidelines. It is not the burden of Black doctors to dismantle the systemic racism that plagues medicine. Use your privilege to act, I promise you will not lose it. When this wave of protests, kneeling, and anti-racism training settles, I want us to remember those horrific 8 minutes and 46 seconds and remember the role we each must play in dismantling systemic racism.

Rest in paradise Black Queens and Kings. We will not let up.

Black Lives Matter- today, tomorrow, and forever.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”