The interface of science, medicine, and society were on full display at the American Heart Association Scientific Sessions 2022. High-level basic, applied, and population health research; initiatives for the coming decade that emphasize health and education in rural communities, health disparities, and “food is medicine”; and the pivotal role of the scientific community to combat misinformation that negatively impacts healthcare and erodes the public trust were major highlights.
An overarching theme for the 95th Scientific Sessions was captured in the tag phrase visible throughout the Convention Center, “One World. Together for Science”. The Presidential address given by Michelle Albert, MD, MPH added pragmatic, tangible, and a call-to-action challenge for all in attendance and those joining remotely, “be leaders for inclusive excellence, be instruments for change, and be the generation that said no to the status quo and yes to taking on health disparities and adversity at their roots”.
How will change take place? Where does one begin the journey? What are the priorities and best next steps? Who will be involved in the transformation? Identifying the barriers to equity in healthcare and preparing researchers to specifically address obstacles are inherent to the mission of the American Heart Association.
A major barrier to advancing health care and equity for all is a lack of diversity in researchers who conduct clinical trials. Clinical trial training curricula often do not include specific course work and opportunities to understand and to work with professionals, people and communities who represent the under-served. The resulting skill sets after training frequently lack portability, contemporary tools such as artificial intelligence, machine-based learning, and digital-first research and translatability to careers in the public, academic, federal, and private sectors.
Other important considerations that obstruct healthcare equity were brought to light at the AHA Scientific Sessions 2022.
Asking the Wrong Questions: Data-driven hypotheses are a pillar of research undertakings; however, one must acknowledge that person- and community-inspired perspectives and needs must be factored into the equation.
Lack of a Diverse Workforce: Increasing diversity of the collective workforce to understand health care at its deepest roots, formulate actionable ideas, engage people in the community through trust, knowledge, and mutual respect, conduct high-quality research that clearly addresses unmet needs and implement the findings consistently and fully to those at greatest need is a prerequisite for success.
Poor Representation of Diverse Populations in Clinical Trials: One strategy that has not been scaled up in a sustainable way is engaging community clinicians in research. There is considerable evidence that clinician recommendations play an important role in helping patients to consider participating in clinical trials.
Lack of Clinical Trial Access: A major challenge that impacts the conduct of clinical research and implementation of evidence-based therapy is the inverse relationship between health care providers and populations in need. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector.
Non-Diverse Representation in Site Selection for Clinical Research Trials: Typical site-selection practices create another substantial barrier to answering questions that impact under-represented patient populations. To meet recruitment goals and timelines, industry sponsors repeatedly use the same large sites and investigators to conduct clinical research. These sites and investigators may not provide care to underserved populations and are often not easily accessible to diverse communities.
Fear of Harm Stemming from Participating in Research: Some potential participants may fear being exploited or harmed by the medical establishment. Ensuring cultural safety of evidence-based interventions to improve health is an absolute necessity for person-level implementation.
Lack of Understanding the Under-served Communities in Urban and Rural areas: The conduct of life-impacting research requires a deep understanding of the environment, the people, and the most relevant questions. Policy, legislation, and advocacy are important components of shaping honest conversations with a goal of action and sustainable impact for those in greatest need.
Lack of Research Designed to Move Policy: Research that considers the ways in which social determinants of health affect engagement of people and communities could help reduce disparities in health delivery. Disparities in health outcomes can’t be eliminated unless investigators measure the effects of policies and interventions on equity.
The Global Innovators to Transform the Medical Workforce panel articulated the soul and spirit of what is needed to address inequities in medicine and healthcare, “an inclusive pedagogy that fosters belonging, support, mentorship, and learning, throughout one’s life”.
As the American Heart Association nears its centennial celebration in 2024, it can reflect on its many accomplishments that honorably embraced science, culture, society, and their integration for the common good. The global organization, working closely with its volunteers and partners will undoubtedly be prepared for a journey that firmly establishes the foundation, precedent, and roadmap for reaching “the people” in support of its mission “to be a relentless force for a world of longer, healthier lives”.
Dr. Becker has no conflicts of interest to report.
Illustration by April Brust