Cardiovascular disease remains the leading cause of death globally, with particularly severe impacts on low-income individuals, women, racial minorities, and residents of rural areas. Dr. Lee Kirksey, a Cleveland vascular surgeon and advocate for health equity, emphasizes the urgent need to address what he terms “cardiovascular deserts.” These regions suffer from a scarcity of cardiologists, primary care physicians, and hospitals, leading to poorer health outcomes and lower life expectancy for affected populations.
The prevalence of cardiovascular disease is exacerbated by factors such as obesity, diabetes, high cholesterol, and smoking. These health issues often intersect with systemic barriers, including inadequate health insurance coverage. The term “cardiovascular desert” has emerged to describe geographic areas where access to essential healthcare services is severely limited, contributing to higher rates of heart attacks, strokes, and other serious conditions.
Growing up in the rural area of Alliance, Ohio, Kirksey has witnessed firsthand the effects of geographical isolation on healthcare access. Despite being close to urban medical centers, many individuals from rural communities face significant challenges in reaching necessary care. For those living far from specialized services, the journey can involve long travel times, missed workdays, and lost income, further amplifying health disparities.
Kirksey points to the widening gap in life expectancy between rural and urban communities, a trend that has persisted since the 1990s. He notes that this “rural death gap” correlates with the decline of manufacturing jobs in Ohio, particularly in the steel and automobile sectors. As James Carville famously stated, “It’s the economy, stupid!” Economic decline and lack of healthcare access have created a vicious cycle that affects the health of these communities.
Recent legislation, specifically the One Big Beautiful Bill Act (OBBBA), has raised concerns about its potential negative impact on vulnerable populations. Signed into law on July 4, 2025, OBBBA reduces federal Medicaid spending by more than $900 billion over the next decade. The American Medical Association estimates that over 11 million individuals could lose their healthcare coverage due to new administrative requirements and cuts to programs like the Affordable Care Act and the Children’s Health Insurance Program.
Furthermore, OBBBA has eliminated the Grad Plus Loan program, which allowed medical students to borrow funds for tuition and living expenses. This change could deter students from lower-income backgrounds from pursuing medical careers, worsening existing physician shortages in underserved areas. Research indicates that medical students from these communities are more likely to return and practice in their hometowns, making access to education crucial for improving healthcare outcomes.
On the therapeutic front, medications like Wegovy and Ozempic have transformed the management of diabetes and obesity, significantly reducing cardiovascular events. Yet, access to these medications is inconsistent across different insurance plans, and the out-of-pocket costs can reach up to $1,000 per month, making them unaffordable for many in cardiovascular deserts.
While telehealth offers a promising avenue for expanding access to cardiovascular care, significant hurdles remain. Establishing partnerships with broadband providers is essential to develop community networks that ensure affordable internet access. The “Digital Divide” is a critical factor among the social determinants of health, with many vulnerable communities lacking the necessary digital literacy to utilize remote health technologies.
Long-term commitments to telehealth reimbursement from payers are vital for incentivizing healthcare infrastructure improvements and fostering best practices that enhance provider utilization.
Dr. Kirksey’s advocacy highlights the urgent need for a multifaceted approach to tackle cardiovascular deserts. It requires political commitment, collaboration across sectors, and tailored strategies to address the specific needs of these communities. By focusing on these disparities, there is hope for creating a more equitable healthcare landscape that ensures better outcomes for all individuals, regardless of their geographic location or socioeconomic status.
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