A framework for addressing disparities in cardiovascular health.

Health disparities are pervasive in the United States. Life expectancy remains higher in women than in men and higher in whites than in blacks by approximately 5 years. In general, the health of racial and ethnic minorities, poor and uneducated people, and those without health insurance is worse than the health of the overall population. The care of these vulnerable groups tends to be of worse overall quality because they have trouble accessing the system, because standards of care are applied to them unevenly, and because health professionals are not consistently trained in culturally sensitive approaches. These disparities have been demonstrated in all aspects of health and healthcare for cardiovascular diseases, including the use of diagnostic and therapeutic interventions, prevalence of cardiovascular risk factors, and access to health information. Examination of national surveys revealed disparities in all cardiovascular disease risk factors, hospitalizations for major cardiovascular disease, overall mortality, and quality of life. Eliminating these disparities is a major public health challenge in the United States. Their causes and underlying mechanisms, however, remain incompletely understood. The healthcare delivery system itself, access to care, quality of care received, communication barriers, individual behaviors, culture and lifestyles, and discrimination and bias all play a part. The pursuit of systems and policy changes to address these determinants remains crucial. We present a strategic framework for eliminating health disparities that takes these determinants into account and provides an opportunity for cardiovascular nurses to make an impact on this important issue.