Closing the Cardiovascular Health Gap for Women Through Policy

By
Jessie Holtzman, MD
-

Sex-based disparities in health care delivery and clinical outcomes in cardiovascular disease have been widely documented, yet gender parity has yet to be achieved [1]. Speakers at the Lancet Commission Educational Symposium hosted on February 17th, 2023, in New York City by Women as One and the Lancet Women and Cardiovascular Disease Commission proposed ambitious strategies to improve outcomes and care for women with cardiovascular disease, focusing upon education, prevention, research, policy, as well as diversity, equity, and inclusion.

Dr. Athena Poppas, Chief of Cardiology at Brown University and Past President of the American College of Cardiology framed the goal to reduce disparities in the provision and outcomes of cardiovascular care for women through the lens of policy. She highlighted that health policy aimed at gender equity should target both the social determinants of health and health care quality.

The social determinants of health have a tremendous impact upon health outcomes, with only an estimated 20% of an individual’s health attributable to quality of and access to clinical care. Another 80% of a person’s health has been shown to be attributable to behavioral factors and the physical environment in which a patient lives [2]. As such, health policies aimed at both increasing access to equitable, evidence-based clinical care and improving social factors that influence clinical outcomes including education, employment, income, and physical environment may be most durable and impactful.

Proposed strategies to mitigate the social determinants of health include increasing insurance enrollment, prescription medication availability, and access to care in rural regions, as well as addressing literacy, pay equity, and obtainability of healthy food and stable housing options. Regarding clinical care, society guidelines may consolidate data to support sex-specific recommendations and shift the priority of sex-based research from observational to implementation-focused work. Fundamentally, the implementation of impactful policy will require collaboration between government organizations, private funders, non-profit organizations, and medical societies.

Dr. Poppas additionally noted a dearth of formalized policy surrounding clinician education in sex-based care, ranging from medical school, to residency, fellowship, and beyond [3]. She called for attention to medical curricula surrounding sex-specific pathophysiology and care for women, stating that “looking at policies around education is a place where we can really make a change.”

Regarding health policy, Dr. Poppas states “this is an area we can really do something because I think there this is a gap.” We have the data and the tools; now is the time to shift toward implementation. Now is the time to act.

Dr. Jessie Holtzman is chief medicine resident at the University of California, San Francisco, and was CardioNerds Conference Scholar for the RISE 2023 conference hosted by Women as One.

References

[1] Wenger NK, Lloyd-Jones DM, Elkind MSV, Fonarow GC, Warner JJ, Alger HM, et al. Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association. Circulation. 2022;145(23):e1059-e71. doi: 10.1161/CIR.0000000000001071.

[2] Institute for Clinical Systems Improvement. Going Beyond Clinical Walls: Solving Complex Problems. 2014. Graphic designed by ProMedica.

[3] Shaw LJ, Pepine CJ, Xie J, Mehta PK, Morris AA, Dickert NW, et al. Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine. J Am Coll Cardiol. 2017;70(3):373-88. doi: 10.1016/j.jacc.2017.05.051.