Contributor: Helping Women of Color Achieve a Healthier Future

As the chief medical officers of their families, women lead the way in choosing their children’s doctors, ensuring family members get recommended care, and serving as primary caretakers for aging parents. And yet, women often find it challenging to take care of their own health, whether due to lack of time, poor access to health care, or systemic barriers that stand in the way of living a healthy life.

This conversation is particularly important as we honor National Minority Health Month—a time to raise awareness about how underserved populations, particularly women of color, face additional barriers that create health disparities.

Studies have shown that Black, Hispanic, and Asian American/Alaska Native people experience worse outcomes compared with their White counterparts across a range of health measures, including infant mortality, pregnancy-related deaths, prevalence of chronic conditions, and overall physical and mental health status.

Implicit bias and racism in health care contributes to these disparities by influencing diagnosis and treatment decisions and quality of care for patients in historically marginalized communities. Lack of health education in these communities about the greater health risks they face for certain diseases, poor access to health care services, and social determinants compound the situation.

We can and must do better. We should expect providers to measure health outcome differences and intentionally act to close any gaps. We should ensure that women of color are educated about the heightened risks they face for cardiovascular disease, cancer, adverse maternal health outcomes, and other conditions, as well as the programs and screenings available to address those risks.

We should lower the access barriers to preventive screening and health care services. We should assure diversity in the cultural backgrounds and representation of care teams. And we should invest in research and treatments that seek to understand and promote the health of communities of color.

Help More Women Take Care of Their Hearts

Despite increases in awareness over the past decades, only about 56% of women recognize that cardiovascular disease is the leading cause of death for women in the United States. According to the American Heart Association, half of all Black women in the United States have some form of heart disease, but only 1 in 5 Black women believes she is personally at risk.

On average, Hispanic women are likely to develop heart disease 10 years earlier than non-Hispanic women, yet only 1 in 3 Hispanic women is aware that heart disease is their No. 1 killer.

Clearly, we have more work to do to increase education and awareness around risk factors and symptoms of heart disease in women of color. The American Heart Association encourages women to “know their numbers” and more actively measure and manage blood pressure, cholesterol, blood sugar, and body mass index. Recognizing symptoms is even more critical for women, as they may experience less obvious warning signs, such as indigestion, nausea and vomiting, or jaw/neck/upper back pain.

We also need to get the word out that pregnancy represents a window into the future cardiovascular health of women. Hypertensive disorders of pregnancy such as preeclampsia—a disorder 60% more common in Black women compared with White women—can have implications for the lifetime risk of developing heart disease and stroke. Prevention doesn’t end when the baby is born. In some ways, it just begins.

Joneigh Khaldun, MD, MPH, FACEP, is the vice president and chief health equity officer for CVS Health.

Building Awareness of Cancer Screening

Following heart disease, cancer is the second most common cause of death of women in the United States. While regular screenings are crucial, Black and Hispanic people are more likely to lack health insurance than their White counterparts, adding a financial barrier that stands in the way of early detection and treatment. Two cancers impact communities of color especially hard:

• Breast cancer: Black women have the highest death rate from breast cancer in the United States and are 40% more likely than White women to die of breast cancer. And although breast cancer rates among Hispanic women are lower than the general population, it is still the deadliest of cancers in that population. Routine mammography screening is the most effective screening test used today to detect breast cancer in women.
• Endometrial cancer: In the United States, Black women are nearly twice as likely to die of endometrial cancer vs White women, and both Black and Hispanic women tend to experience worse health care access and are less likely to receive guideline-concordant treatment. One JAMA Network Open study revealed that early symptoms of endometrial cancer are often overlooked by Black women and their providers. Another showed that a common screening tool often missed endometrial cancer in Black women.

To increase cancer education and begin to address inequities in cancer care, it’s clear that we need novel, equity-based solutions. A great example of such an approach is being modeled by Memorial Sloan Kettering’s Office of Diversity Programs (ODP).

ODP is improving provider diversity by recruiting racially and ethnically diverse faculty, fellows, and residents. They are working to expand participation of minority patients in cancer clinical trials, and they consistently reach out to minority and medically underserved patients to ensure they can access the hospital’s cancer prevention, screening, and treatment programs.

Ensuring diverse participants in clinical trials for cancer and other diseases is another way to address equity. Equity in trials provides an important foundation for the development of safe and effective drugs and in understanding the social determinants that influence disease diagnosis, treatment, and outcomes.

Joanne Armstrong, MD, MPH, is vice president and chief medical officer for Women’s Health and Genomics at CVS Health.

The Bottom Line

If we are to improve health care for all people, and particularly for communities of color, we must continue to bring attention to inequities and ways we can close health care gaps. The National Committee for Quality Assurance’s inclusion of race and ethnicity data in HEDIS (Healthcare Effectiveness Data and Information Set) is a good first step. By incorporating social determinants into these important quality measures, HEDIS now holds health plans accountable for addressing inequities in care and outcomes among their patient populations.

Yet, there is so much more work to do. Health equity is an American crisis. We must continue to talk openly about and understand the root causes of systemic bias and racism and resulting inequities in health care. This will enable us to take bold action as a society to improve them. National Minority Health Month offers us an opportunity to identify and address how our health care system, communities, and lifestyles affect our ability to live healthy lives, now and into the future.

To achieve equity, we must invest in programs that improve access to health care for historically marginalized communities, address social determinants, boost health education, increase representation in all levels of health care delivery, widen access to clinical trial research, and more.

This multilayered effort will require ongoing collaboration among many stakeholders, including providers, industry, government, and community-based organizations. These investments are sure to have both immediate and long-lasting health benefits not just for communities of color, but for everyone.