Addressing Disparities in Cardiometabolic Health with Joshua J. Joseph, MD, MPH

Health inequity is widespread across the field of medicine, and recent conversations have focused on racial- and ethnic-based disparities in cardiometabolic health, particuarly in diabetes management.

Members of various racial and ethnic minority groups and those with lower socioeconomic status are often most affected by disparities in diabetes care in the United States, making efforts to address and eliminate these health disparities in people living with diabetes, or who are at risk of type 2 diabetes, crucial for public health.

At The Metabolic Institute of America’s 7th Annual Heart in Diabetes Meeting, Joshua J. Joseph, MD, an endocrinologist at The Ohio State University Wexner Medical Center, presented a talk on advancing equity in diabetes management, from clinical practice to community-led measures.

The first part of Joseph’s presentation focused on historic discrimination and structural racism’s role in health outcomes, including redlining practices from the 20th century. Redlining was a practice in the 1930s where maps were labeled according to mortgage practices, with red as the least favorable designation. Many African American neighborhoods were labeled as red, making it difficult to obtain a mortgage for this population.

“When we look at them and look at present-day social determinants of health, and social vulnerability, what we see is many of these same communities still have high levels of social determinants of health now, and that translates into higher levels of diabetes, both diabetes prevalence, the number of individuals living with diabetes, as well as many of the cardiometabolic risk factors that impact the risk of cardiovascular disease long term, things like blood pressure and body mass index, as well as smoking,” Joseph said.

He noted that redline neighborhoods throughout the United States additionally experience the highest prevalence of stroke, coronary heart disease, coronary artery disease, and chronic kidney disease. Thus, the maps are a showcase of where the highest prevalence of cardiometabolic disease exists today.

Joseph additionally elaborated on the need to understand the context in which patients live, which cannot be done without collecting information on socioeconomic status and non-medical health-related social needs. A better understanding of these factors can be critical in designing interventions to improve health outcomes, according to Joseph.

“One of the things across the country is that many institutions are starting to ask questions around the non-medical health-related social needs, things like food insecurity, housing, instability, utilities, etc.,” Joseph said. “And with that are currently thinking about how they address these really, really important issues.”

Once clinicians and healthcare providers understand the population they are serving and the challenges they face, Joseph believes there is an opportunity to work with community-based organizations to address those needs. He noted that Ohio State is working with various organizations to improve access to such factors as healthy food and exercise opportunities.

“These are examples of not only asking the questions but also addressing the need,” Joseph said. “And where we are, right now, in this word, is that there's a lot of work being done to understand how these interventions improve health outcomes.”

Disclosures: Joshua J. Joseph, MD, MPH reports no relevant disclosures.