The American Heart Association, the leading global voluntary health organization dedicated to fighting heart disease and stroke, is making an unprecedented series of investments focused on enhancing its commitment to addressing the social determinants of health and the barriers to achieving health equity for all communities — urban, suburban and rural.
The Association will raise and invest more than $230 million of its own funds over the next four years to support targeted initiatives and programs, while leading additional efforts to drive systemic public health change focused on removing barriers to equitable health for everyone, everywhere.
“In order to ensure every person has the same opportunity for a full, healthy life, the barriers that worsen the economic, social and health inequities of vulnerable communities must be dismantled,” said American Heart Association Chief Executive Officer Nancy Brown. “It is the right thing to do, the just thing to do and the only way to improve overall health in this country. We look forward to working with like-minded organizations and supporters to be a relentless force for change that will result in longer, healthier lives for all.”
Specifically, the American Heart Association has comprehensively committed to:
Investing $100 million in new scientific research programs and grants focused on evidence-based solutions to health inequities and structural racism. The Association also will expand diversity-research opportunities for underrepresented racial and ethnic groups in science and medicine through grant funding, STEM programs and its established historical black colleges and universities (HBCU) and EmPOWERED to Serve Scholars programs.
Investing in hyper local, community-led solutions to address health inequity and structural racism. Specifically, the organization will dedicate at least $100 million more to address targeted, community-level health equity barriers through its Social Impact Fund, the Bernard J. Tyson Social Impact Fund, as well as its community-based issues campaigns, including those of its Voices for Healthy Kids initiative. Earlier this month, the Association announced its latest gift – a $1 million gift to the Bernard J. Tyson Social Impact Fund from the Andréa W. and Kenneth C. Frazier Family Foundation. That contribution will be directed to local non-profits and social entrepreneurs working to improve access to health care, food and housing, and economic empowerment in North Philadelphia. And, last month, Voices for Healthy Kids awarded $2.6 million in campaign grants to improve health equity.
Launching, in partnership with the U.S. Department of Health and Human Services (HHS), a $121 million nationwide hypertension initiative to address a main source of poor cardiovascular health in Black, Hispanic and Indigenous communities, funded by the federal government. Under the partnership, the American Heart Association will team with HHS to support select Health Resources and Services Administration (HRSA) funded health centers and associated communities.
The collective aim is to elevate the quality of care delivered in these centers, provide evidence-based education to providers and clinicians and engage patients with training to effectively control hypertension. The Association will also leverage and expand its existing hypertension programs in Federally Qualified Health Centers (FQHCs).
Additionally, as part of this sweeping series of actions, the Association will elevate scientific discourse around health equity by publishing more science focused on disparities, anti-racism, health equity and community-based participation in its suite of peer-reviewed scientific journals, including Circulation and Stroke.
The American Heart Association also will leverage its extensive hospital-based clinical registry programs and networks to capture data to advance scientific discovery and understanding of the negative effects of the social determinants of health and health care quality variances among racial and ethnic groups. The organization will further focus its continuing efforts in public policy-making to ensure access to health care in under-resourced communities of color and rural areas while fighting to reduce access to tobacco products and sugary beverages – products historically heavily marketed to communities of color.
Structural racism is a major cause of poor health and premature death from heart disease and stroke, according to a new American Heart Association Presidential Advisory, “Call to Action: Structural Racism as a Fundamental Driver of Health Disparities,” published in November 2020 in the Association’s flagship journal Circulation. The advisory reviews the historical context, current state and potential solutions to address structural racism in the U.S., and outlines steps the Association is taking to address the root causes of health care disparities.
“Our financial commitments build on the presidential advisory and add to our pledge to take immediate and on-going action to accelerate social equity and improve health for everyone,” said Dr. Mitchell S. V. Elkind, president of the American Heart Association, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians and Surgeons and attending neurologist at New York-Presbyterian/Columbia University Irving Medical Center in New York City. “The American Heart Association looks forward to working with allies across the country on the national, state and local level to break down barriers impeding the health of rural communities and communities of color who have been historically and systematically marginalized.”
“The American Heart Association is responding boldly to addressing health inequity as it is imperative to the overall health and well-being of the nation that this issue be addressed head on,” said Bertram L. Scott, chairman of the Association’s Board of Directors. “We are putting actions behind our words because barriers to equity in housing, education, health care and elsewhere are not only wrong – they impede the American Heart Association from achieving its goal of equitable cardiovascular health for all people.”
As part of a new 2024 health equity impact goal, the Association is focusing its own operations more aggressively on addressing societal barriers because they contribute significantly to the disproportionate burden of cardiovascular risk factors (including high blood pressure, obesity and Type 2 diabetes) in Black, Asian, American Indian/Alaska Native and Hispanic/Latino people compared with white people in the U.S.
Additionally, rural populations have significantly higher rates of uncontrolled traditional cardiovascular risk factors compared with urban areas in part due to older average age, inadequate and unaffordable health care and other systemic barriers that contribute to worse health outcomes.
Several targeted initiatives are underway in advance of American Heart Month and Black History Month, including:
A discussion with leading corporate CEOs on major barriers to health equity including structural racism and racial inequity, and how to positively impact employee and community health was held earlier this month.
A complete replay of the virtual round table, presented jointly on Jan. 15 by the American Heart Association and Business Round table, can still be viewed. Visit the AHA CEO Round table for more information.
While overall death rates from heart disease and stroke declined over the past two decades until a recent plateau, these gains were not equitably shared among all people.
Black Americans continue to experience the highest death rates due to heart disease and stroke. Black Americans experience a nearly 30 percent higher death rate from cardiovascular disease (CVD) and a 45 percent higher death rate from stroke compared with non-Hispanic white Americans. Black and Hispanic/Latino patients experience significantly lower survival to hospital discharge than white patients even when controlling for socioeconomic status.
In regard to rural health, there is a three-year life expectancy gap between rural and urban populations. Rural areas see higher rates of tobacco use, physical inactivity and obesity, which have given rise to higher rates of diabetes and hypertension. In turn, rural communities have higher death rates from cardiovascular disease and stroke and higher maternal mortality rates due in part to cardiovascular deaths.
Rural areas have higher death rates for CVD and stroke than urban areas, and the gaps are widening. One study found that heart disease–attributable mortality declined 42 percent in urban areas between 1999 and 2009 but only 35 percent in rural areas. In rural areas, people may face geographic and other transportation barriers to reaching emergency care expediently.