Advancing health equity in cardiovascular care

Unacceptable and complex yet also often unintended and unexpected health inequities exist in cardiovascular care and outcomes.While prevalent across health care, professionals involved in cardiovascular health care should know and address the sources of these inequalities in practice and policy.This editorial provides a primer to do so. Health equityHealth equity is a principle underlying a commitment to reduce and even eliminate downstream disparities in and upstream determinants of health, including social and economic ones.Pursuing health equity means striving for the highest possible standard of health for all people, especially those at greatest risk of poor health outcomes.Accordingly, health equity is the state in which every person has a fair and just opportunity to realize their highest level of health. 1 Unlike health equality, which refers to equal health care for everyone, health equity aims to adjust healthcare resources based on need.Thus, equity refers to fairness in healthcare outcomes regardless of any social determinants of health. 1 Multiple determinants of healthKey social determinants of cardiovascular health include socioeconomic status, race and ethnicity, social support, culture and language, access to care, and residential environment. 2This also aligns with the notion that health has multiple determinants, including but beyond social determinants, such as genetic, behavioural, environmental, and physical factors. 2,3ccordingly, the health of people and communities is influenced by a myriad of physical, social, and economic conditions, including highly interrelated, clustered, and compounding social, cultural, and structural factors affecting individuals and communities.For example, educational attainment is strongly linked to individual and neighbourhood deprivation and low health literacy. 4People from low socioeconomic areas are more likely to undertake behaviour and have risk factors associated with cardiovascular disease, such as physical inactivity, smoking, diabetes, hypertension, and a high body mass index. 4,5Given upstream factors such as neighbourhood and household poverty and unequal access to education and health care are also associated with premature cardiovascular disease, patients from low socioeconomic areas, while at highest risk from multiple determinants, are ironically less likely to access and benefit from effective health care.