Getting to the heart of diversity with Kevin Harris
As the senior associate dean for diversity, equity and inclusion, he works to educate others about diversity in health care
Residents of Richmond’s Gilpin Court neighborhood have, at birth, an average life expectancy of 63 years. Residents of Westover Hills, little more than 5 miles southwest of Gilpin Court, are born with an average life expectancy of 83 years.
Harris recently hosted an enlightening VCU Internal Medicine Cardiology Grand Rounds presentation on diversity within the field of cardiology. More than a discussion on the demographics of cardiology, the presentation explored how diversity within cardiology might play a role in health outcomes and heart-related health disparities.
“If you were to walk into a particular department,” said Harris in his presentation, “and not see anyone, just at the surface level, that looks like you, that may have had the same experiences as you, you may have to make some decisions about what your experience will look like.”
In 2016, just 3% of practicing adult cardiologists were Black, while more than 50% were white. As Harris asks: “Is there an appropriate sense of belonging, a sense of mattering, for all the individuals and stakeholders that might be in a given situation?”
Over the course of 20 years, one study followed 5,115 participants to analyze the onset and prognosis of heart failure. In 27 of those participants, researchers observed the development of heart failure before the age of 50. Of those 27 who developed heart failure, all but one were Black.
Heart disease is the wedge between life expectancies of Black Americans and their white neighbors, and scientists and physicians have long sought to uncover the biological mechanisms that may be driving this disparity.
But research results are now leading investigators to question whether the causes of these disparities are actually biological.
The answer to that question is clear: Black patients are subjected to lower rates of intervention, advanced therapies and even heart transplants.
These studies tell us that heart-related health disparities arise from a social origin, rather than a biological one. Greg Hundley, M.D., Pauley Heart Center director and chair of the Division of Cardiology, spoke to this during the discussion portion of Harris’ presentation.
“Many of us do research and we use race as a covariate,” said Hundley, “but maybe what’s going on are the environmental factors that are impacting a certain group of people because of their social situation, dictated by centuries of racism and suppression.”
Providing Black Americans with more equitable health care requires more than mandatory diversity training and hiring the right demographic.
Greater access to health care and better health outcomes for Black Americans will only come from a movement which not only considers social determinants of health, but also actively understands them and incorporates them into treatment.
“That movement,” said Harris, “has actually been codified in terms of shifting from what Dr. Dorothy Roberts calls race-based medicine — this idea that race has important relevance, has central relevance as a biological variable — towards a concept of race-conscious [medicine].” A practice of race-conscious medicine “emphasizes racism, as opposed to race, as a key determinant of health outcomes.”
But the move from race-based to race-conscious medicine, from race to racism, demands an alternative understanding of race itself.
“99.9% of who we are is who we are,” said Harris, in reference to the fact that all humans are 99.9% genetically similar.
The differences observed in humans are not enough to divide them into unique races within our species. The term race is not even used formally in the taxonomic hierarchy. Much like the factors motivating health disparities, the concept of race is of a social origin.
“There is very little debate about it,” said Harris. “Race is a social construct and has its primary relevance in social and political contexts.”
Despite this being well known, researchers have continued to look for physical characteristics that both determine a person’s skin color and increase their risk of heart failure. Shifting the research and medicine perspective is necessary to repair the damage of health disparities, and that shift necessitates a thorough understanding of those cultures in need of better care.
If we are to eliminate health disparities and provide better health outcomes and greater quality of life to all people equally, we must understand how and why race was invented, how concepts of race perpetuate racism, and how the ideas of race and racism have historically been leveraged for the purposes of maintaining a specific power structure.
Troublesome as they are, the low number of Black cardiologists and the excessive rates of heart failure among Blacks are but symptomatic of their social causes. Improving cardiovascular care for all requires, in Harris’ words, “looking at the underlying culture in cardiology and understanding how we build in the structures to sustain an inclusive culture, and a presence and a perspective of cardiology that actually does not repel, but draws in.”
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