American Heart Association: We need evidence-based approaches to eliminate inequities

Improvements in the nation's health care system—particularly changes that address inequities in care and the impact of social determinants of health—are necessary to achieve the goal to equitably increase healthy life expectancy in this country, according to a new advisory published by the American Heart Association, the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke.

The document was published in the journal Circulation as an American Heart Association Presidential Advisory, a formal organizational review of the science and policy landscape surrounding urgent health issues that outlines key principles to guide practice, policy and research. The advisory includes core principles to ensure health care is adequate, accessible and affordable for everyone living in the United States. The principles build on health care advisories the American Heart Association issued in 1993 and 2008, which guided the Association in evaluating federal and state health care proposals.

"Despite major gains in the number of people with health care coverage over the past decade, millions of people lack health insurance and millions more have coverage that is inadequate to meet their needs," said John Warner, M.D., FAHA, the advisory's lead author, past volunteer president of the American Heart Association and Executive Vice President of Health System Affairs at the University of Texas Southwestern Health System in Dallas, Texas. "Health care must be adequate, accessible and affordable for everyone in this country."

An estimated 30 million people in the U.S. are uninsured and another 44 million are underinsured, making it difficult, if not impossible, to access potentially life-extending care. In addition, progress over the past 50 years in reducing cardiovascular death and disability has stalled.

The advisory comes as the American Heart Association's new strategic impact goals for the next decade call for equitably increasing overall healthy life expectancy from 66 to at least 68 years domestically and from 64 to at least 67 years globally by 2030.

"One's chances of surviving cardiovascular disease and many other serious chronic conditions vary dramatically by geography, sex, gender identity, race and ethnicity," said Keith Churchwell, M.D., FAHA, an advisory author, a volunteer member of the American Heart Association Board of Directors and Executive Vice President/Chief Operations Officer, Yale New Haven Hospital in New Haven, Conn. "To achieve the American Heart Association's 2030 impact goals, we must address inequities in health and health care that result from where people live, how much money they make, their level of education and other social determinants of health."

The Association's new principles focus on many of the tenets of previous advisories, such as improving access to affordable health care and coverage, increasing the availability of evidence-based preventive services and accelerating investments in biomedical research. The new principles place greater emphasis on eliminating health disparities and inequities in the health care system, promoting diversity within the public health and health care workforce, improving the health system's ability to address social determinants of health, increasing the focus on value in health care and ensuring health care is affordable—not just for individuals, but for employers, governments and society at large.

"We are publishing these principles as the 2020 election season gets underway so we can effectively utilize them to respond appropriately to health care proposals from federal and state candidates and elected officials," said Nancy Brown, CEO of the American Heart Association. "We will review proposals on the merits, without regard for ideology or political party, and our analysis will always be driven by what is equitable, evidence-based and in the best interests of patients and consumers."