Race, Healthcare Inequities and Stroke Systems of Care

Over the past two weeks, the death of George Floyd and countless others by white police officers has caused people across the United States and across the globe to examine their own role in perpetuating white supremacy in its many forms. Deep examination of our individual and collective racism is necessary to begin to dismantle the many social and political systems that are founded on the concept that some lives are more valuable than others.  As we asked ourselves several difficult questions about racism in our personal and professional lives, we couldn’t help but think about our many years spent coordinating stroke systems of care.

The community of stroke caregivers has long known of deep racial disparities in stroke care.  The 2011 Statement by the American Heart Association on Racial-Ethnic Disparities in Stroke Care: The American Experience summarizes that “minorities use emergency medical services systems less, are often delayed in arriving at the emergency department, have longer waiting times in the emergency department, and are less likely to receive thrombolysis for acute ischemic stroke. Although unmeasured factors may play a role in these delays, the presence of bias in the delivery of care cannot be excluded. Minorities have equal access to rehabilitation services, although they experience longer stays and have poorer functional status than whites. Minorities are inadequately treated with both primary and secondary stroke prevention strategies compared with whites” (Cruz-Flores, et al).  To be a Black man or woman experiencing a stroke means receiving different treatment throughout the continuum of stroke care, and with a far worse outcome.  Similar disparities are seen in other ethnic minorities, including Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander.  While the drivers of these disparities are multifactorial and complex, we simply cannot ignore the fact that systemic racism and injustice is a stark reality in our daily work as stroke leaders.

Acknowledging the problem is the first step. But, fixing the problem is complex and, at times, overwhelming. It is difficult to address socioeconomic and political drivers of healthcare at the level of an individual program or system. However, if we are going to be a part of the solution, we must evaluate what can be done at the program level to address the inequity. It literally means the difference between life and death for Black Americans and other racial-ethnic minorities.

We propose a few ideas that we hope serve as the beginning of the conversation. We are committed to continuing to examine our own privilege as we build content for Stroke Challenges, and will continue to closely examine the role of race in stroke care and share ideas to make a measurable change.

• Measure and report racial differences in your stroke programs each time you report data. All stroke programs have quality improvement initiatives, and many have addressed the timeliness of thrombolysis treatment over the past several years.  Have you evaluated the role of race and ethnicity in timely care?  Is there an opportunity to carve out racial differences in your other quality improvement initiatives?
• Evaluate key aspects of your program, including caregiver education, patient education and secondary stroke prevention. Are these aspects of your program planned for Black and other Minority patients?  How can you better build your program for these patient groups?
• As you plan your 2020-2021 outreach activities, how can you support those at the highest risk of stroke and death from stroke?
• As stroke leaders, get involved in healthcare reform and policy that work to end racial and ethnic disparities in health

What other ideas do you have to be an ally to all people of color?  Please email your ideas to us at sarah.livesay@strokechallenges.com and debbie.hill@strokechallenges.com. We want to hear from you!

Respectfully,

Sarah Livesay, DNP, RN, ACNP-BC, CNS-BC, FAHA

Debbie Hill, BS, FAHA