Arkansas Minority Health Commission alarmed by ‘cardiology deserts’

I covered this story for Talk Business & Politics.

Many Arkansans need to make significant lifestyle changes to avoid heart disease, which is the leading cause of death in the state and nationwide. Arkansas is also being severely impacted by a growing shortage of cardiologists, making it difficult for people to get needed care, especially in the critical minutes after a heart attack or stroke.

Those were among the key points discussed at the 9th Biennial Minority Health Summit, held Friday (April 17) in North Little Rock. Participants said minorities are particularly susceptible because of a range of factors. The Arkansas Minority Health Commission hosted the event with the theme “A Bridge to Care: A Multidisciplinary Approach to Heart Health in Minority Arkansans.”

Executive Director Kenya Eddings stressed the importance of a healthy diet, not using tobacco, being physically active and having access to healthcare. She said heart health is affected by every aspect of daily life and called healthy foods “the most important medicine” people can consume. As heart disease continues to grow, she said it’s also vital that everyone is tested for different types of cholesterol.

But where people live can make that a challenge. Speakers and panelists said many rural and low-income areas have become “cardiology deserts” requiring long drives to see a heart specialist. A declining number of hospitals is also making it harder to get essential care after medical emergencies.

The keynote speaker was Dr. Anthony Fletcher, an interventional cardiologist with CHI St. Vincent Medical Group and president of the Association of Black Cardiologists. He discussed how one of the most common causes of a heart attack is the buildup of plaque causing a blocked coronary artery, which is a life-threatening situation.

“With the appropriate intervention, that artery can be reestablished through the placement of a stent and flow restored and that heart attack can be stopped. But it’s important we do this in a timely fashion. It’s called door-to-balloon time,” Fletcher said, which needs to be under 90 minutes.

Heart disease, the leading cause of heart attacks and strokes, began to decline nationally in the 1960s, he said. “Unfortunately, the most recent statistics show there’s an upswing, and we attribute that to increased diabetes, obesity and hypertension.”

Fletcher said for much of the 20th century, it was taught and widely accepted that Black people did not suffer from heart disease. But data now shows “Blacks will succumb to cardiovascular disease at a higher rate than Caucasians, Hispanics and Asian Americans.”

The reason, he said, is that conditions like diabetes, obesity and chronic kidney disease are more common in Black people. They are also more likely to have a harder time getting healthcare and testing, which leads to a major expense for the state.

“For my politicians, my economists, my policy-makers, my insurance carriers, Arkansas spends $1.47 billion each year because of cardiovascular disease. I’m seeing hospital administrators here nodding. They know all about those dollars and cents,” Fletcher said. “When we look at the risk factors, unfortunately Arkansas leads the nation in the prevalence of these factors.”

He emphasized the importance of people being tested for blood pressure, cholesterol and blood glucose, while also being aware of any family history of heart disease, which Fletcher said can be a key indicator of the risk for subsequent generations.

Joshua Harris, founder and executive director of the nonprofit Well Fed Arkansas, spoke about the role a healthy diet can have in preventing heart disease. But many areas of the state lack stores that sell foods like fruits and vegetables, leaving residents with limited options like ultra processed foods that are designed to have a longer shelf life.

“Its been so processed that there’s not food left — they’ve lost their nutrients,” Harris said. “We created a lot of problems with food that didn’t need to be created.”

His group partners with UAMS and local communities to provide nutritional education and to host pop-up mobile markets at places like libraries and churches where people can get healthy foods.

Reflecting on 35 years

The Arkansas Minority Health Commission was created in 1991 and is part of the state Department of Health. Its founding executive director was Dr. Joycelyn Elders, who at the time was director of the department. She would later be appointed by President Bill Clinton to become U.S. Surgeon General. Elders was praised during Friday’s summit for her determination and tenacity.

Several of the commission’s subsequent executive directors reflected on progress that has been made in the 35 years since its creation, but said many challenges remain in assuring minorities receive equal access to preventative care. Tommy Sproles, who succeeded Elders and led the commission for a decade, said it was created because there were “health disparities that needed to be addressed in so many ways.”

But getting adequate funding to advance its mission was difficult. While the Arkansas Legislature provided some money, he said it wasn’t until the state received its share of a national tobacco settlement from cigarette makers in 2000 — with some of that going to the commission — that solid progress could begin to be made.

Dr. Creshelle Nash, a former medical director for the commission, said the settlement provided funding for studies which provided data that was then used to establish evidence-based approaches for trying to achieve the commission’s goals. While some of the same issues identified 35 years ago remain today, she said “some progress has been made through a combination of advocacy and policy.” Nash also said the commission has provided a training ground for future leaders.

Former commission Executive Director Dr. Idonia L. Trotter Gardner praised former governors Mike Beebe and Asa Hutchinson for supporting initiatives that used federal funds to buy private insurance for low-income adults through the Affordable Care Act marketplace rather than expanding traditional Medicaid. That expanded coverage to 250,000 additional Arkansans, including many minorities who had experienced challenges in obtaining coverage.

Even after that, Melissa Laelan, chief executive officer of the Arkansas Coalition of Marshallese Inc., said the natives of the Marshall Islands was identified as a group that still faced significant challenges in getting the same care available to others.

“Children were sick and parents couldn’t get access to healthcare,” said Laelan. “We were having a lot of issues with students not going to school.”

In 2018, the Arkansas Department of Health, UAMS and Arkansas Advocates for Children and Families made a concerted effort to work with the Marshallese community to help people sign up for the coverage. But when the COVID-19 pandemic hit in 2020, Laelan said the Marshallese suffered a higher death rate compared to the general population.

“Long years of not being able to access Medicaid was why they had a high rate of death,” she said. “We need to think about marginalized communities that are still struggling. Now people are being kicked off of Medicaid and SNAP programs. So as we celebrate this 35th anniversary we need to keep in mind what we can do to help these marginalized people.”