Dr Clyde Yancy on the Persistence of Health Disparities in the US

Clyde Yancy, MD, MSc, FHFSA, professor of medicine, chief of cardiology, and vice dean of diversity and inclusion at Northwestern University Feinberg School of Medicine in Chicago, Illinois, speaks to the systemic changes that have had the greatest impact on the reduction of cardiovascular disparities in recent decades.

At the 2024 Family Heart Global Summit, Yancy delivered a talk titled, "The 40th Anniversary of the Heckler Report: Are We Making Progress in Reducing Health Care Disparities?" The Heckler Report, released by the US government in 1985, brought minority health to a national stage and illuminated health disparities and provided recommendations to reduce inequities.

Transcript

Can you discuss the basis for your presentation, "The 40th Anniversary of the Heckler Report: Are We Making Progress in Reducing Health Care Disparities?"

I was so pleased to receive the invitation to join in a discussion about the impediments to best care, the barriers to care. Within the space of this session in which I engaged, we talked about this explicit bias phenomenon, if you will—misinformation. We talked about the very poor implementation from the database generated by the Family Heart Foundation—striking numbers of people with obvious indications for therapy, not receiving therapy or receiving ineffective therapy. The short version is less than half of the patients—less than half—who have an indication for medical therapy are receiving it. So we have to understand what are those barriers?

The part of the barrier that I wanted to present to the audience, which is challenging, is to really think about, once again, what's happening as a function of race, ethnicity, or in a more contemporary conversation, what's happening for minoritized, marginalized populations—the populations that are not considered mainstream? It was a very provocative session and a really great conversation.

Based on the Heckler Report, what key systemic changes do you believe have had the most impact on reducing cardiovascular disparities, and what barriers still remain?

So the specific part of the barrier construct that I addressed had to do with health inequity, but its source from a footnote in American medical history is the Heckler Report. The Heckler Report was authorized by Margaret Heckler in the early 80s when she served as the Secretary of Health and Human Services within the Reagan and Bush administrations. It's very important to recognize that Margaret Heckler was a pioneer—one of the first women in Congress, one of the first cabinet members, and as a Republican, she voted for the Civil Rights Act. As a Republican, she recognized this striking observation of health disparities. In fact, she wrote health disparities as an evident concern over 40 years ago.

So our conversation about health disparities, it's not a new conversation. But what's sobering is that in the report she commissioned, because she thought it was so egregious that in this country, with our technology, in the early 80s, we were so poorly equipped to provide equitable care. She called it an "affront." The report surmised that there would be 60,000 excess deaths in patients self-identified as Black or African American if the circumstances present at the Heckler Report persisted—60,000. Fortuitously or inconveniently, depending on how you look at this, I am part of research group that updated the morbidity and mortality totals for persons described as Black or African American. Specifically, using the CDC WONDER data set, we identified mortality as a function of race over the last 21 years and published our data 1 year ago, in 2023. We identified that over 21 years, 1.6 million excess lives were lost.

Now, if you put this into perspective, if the Heckler Report estimated 60,000 excess deaths per year, over that same 20- to 21-year period, we should have seen 1.2 million, unacceptable as it is; instead, we saw 1.6 million. Listen to this: We're even worse off now than we were when the Heckler Report was penned. That is incredibly sobering, but it tells us the barrier that we face if our intention to make certain that every patient has an opportunity for their best possible health, and that we're intervening accordingly. And both the Heckler Report and our report, our report being a group between Northwestern and Yale, demonstrates the cause of death is exactly the same as it was 40 years ago. This is not murders and homicides and HIV/AIDS, this is heart disease and cancer. That's the truth 40 years ago, and that's the truth today.