In addition to the ongoing COVID-19 pandemic, significant public health concerns include opioid overdoses, maternal mortality disparities, and climate change.
In the opening session of the 2022 American Heart Association Scientific Sessions, a panel of experts discussed how clinicians across multiple disciplines can engage with public health issues such as hypertension, maternal mortality and climate change.
The COVID-19 pandemic continues to be front and center, and former Surgeon General Jerome Adams, MD, discussed his experience in that role from 2017 to 2021. COVID-19 is likely to be one of the biggest cardiovascular risk factors -vascular negative results, Adams said, and all clinicians should urge patients to keep up with their booster shots. Importantly, Adams noted that the same patients at risk for cardiovascular, kidney disease and other problems were those who were not boosted.
Adams also tackled the opioid epidemic, maternal mortality and hypertension during his tenure as surgeon general. To address the rising number of opioid overdose deaths, Adams said he urges all clinicians to carry naloxone and encourages patients to do the same. He pointed to teaching CPR as an example, saying CPR saves lives the same way naloxone does.
“The majority of overdose deaths seen were not receiving naloxone,” Adams said, adding that there are significant disparities around education and availability of naloxone in communities of color.
Adams also highlighted maternal mortality in the United States, calling it “the biggest and clearest example of structural racism.” Most other disparities tend to improve when education and income levels are controlled for, but Adams said that’s not true for maternal mortality. For example, a black woman in the United States with a doctorate is still significantly more likely to die during childbirth than a white woman without a high school diploma, Adams said.
“We have to be willing to face the fact that our systems are not set up to help those most in need and those most likely to suffer negative outcomes,” Adams said.
Regina Benjamin, MD, MBA, the 18th surgeon general of the United States, agreed with Adams, adding that many of the disparities in communities of color also occur in rural areas. Benjamin also highlighted the impact of climate change on public health, citing his experience in Alabama after Hurricane Katrina. Climate change has myriad impacts, including health, economic issues, lifestyle and social impacts, mental health, cancer and allergens.
From a cardiovascular perspective, Benjamin noted that core body temperature is known to affect heart rate and respiration.
“We need to describe the health of the climate in a way that people really understand,” Benjamin said. “It’s been so politicized for so many reasons, and some of them are really aimed at discouraging us and denying climate change.”
Benjamin runs a clinic in Alabama that was significantly affected by Hurricane Katrina. While that experience was challenging, Benjamin said he believes climate change issues are getting worse. She pointed to the Texas ice storms and the Mississippi River drought as examples, and noted that all of these compounding issues cause significant stress.
To address these health care issues, Benjamin said it is essential to build resilient communities and individuals by continuing to advocate for their health. One potential way to advocate on these issues is by engaging in robust air and water quality standards.
“It’s not just about disasters,” Benjamin said. “It’s about how we live between these disasters.”
Finally, Dr. Fausto Pinto, Past President of the World Health Federation and Past President of the European Society of Cardiology, provided a global perspective to the discussion. Pinto said there is a global need to prepare future clinicians and prepare them to address unmet needs and disparities in cardiovascular care. He noted that there is a very important role for scientific societies and other organizations to provide guidance on training.
“I feel that we all have that responsibility and it’s by working together and providing solutions and identifying needs [that we can do that]Pinto said. “It’s our duty to find the best solutions, or at least try to find the best solutions and implement them.”
Adams J, Albert M, Benjamin R, Kalif R, Patel M. Moving science into public health: Lessons learned. Presented at the 2022 American Heart Association Scientific Sessions November 5, 2022.