Cardiovascular disease (CVD) remains the leading cause of death globally, disproportionately affecting low-income individuals, women, racial minorities, and rural populations. Dr. Lee Kirksey, a vascular surgeon and health equity advocate from Cleveland, highlights the urgent need to address the so-called “cardiovascular deserts” in healthcare, where access to essential medical services is severely limited.
These deserts are defined as geographic areas with insufficient availability of cardiologists, primary care physicians, and hospitals. Individuals in these regions face heightened risks of heart attacks, strokes, and limb loss due to factors such as obesity, diabetes, high cholesterol, and smoking. The situation is exacerbated by systemic barriers, including low rates of health insurance coverage, which significantly impact health outcomes.
Growing up in Alliance, Ohio, Kirksey experienced firsthand the challenges that rural communities face in accessing healthcare. He points out that even communities located near major medical centers can struggle with long travel times, lost wages, and missed workdays, all of which contribute to widening gaps in life expectancy between rural and urban areas.
Economic Impact on Health Disparities
The roots of these health disparities can often be traced back to broader economic shifts. In Ohio, the decline of the manufacturing sector during the 1990s, particularly in the steel and automobile industries, has contributed to a significant “rural death gap.” Kirksey emphasizes the importance of economic stability in addressing health outcomes, echoing political consultant James Carville’s famous assertion: “It’s the economy, stupid!”
Recent federal policies have raised concerns about the future of healthcare access in these vulnerable communities. The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, is projected to cut federal Medicaid spending by over $900 billion over the next decade. According to the American Medical Association, these changes could result in more than 11 million people losing coverage, further compounding the challenges faced by low-income populations.
Additionally, the elimination of the Grad Plus Loan program is expected to deter medical students from lower-income backgrounds from applying, worsening the existing physician shortages in underserved areas. Research indicates that students from these communities are more likely to return and practice in their hometowns, emphasizing the need for targeted support.
Innovations and Barriers to Access
While advancements in medical technology have produced groundbreaking treatments for conditions like diabetes and obesity—such as Wegovy and Ozempic—access to these medications is often inconsistent. High out-of-pocket costs can reach up to $1,000 per month, making them unaffordable for many individuals in cardiovascular deserts. This discrepancy highlights a troubling reality: medical innovations can inadvertently widen the gap between those who can access care and those who cannot.
Telehealth offers a promising solution to enhance access to cardiovascular care, yet significant barriers remain. There is a pressing need for partnerships with broadband providers to create community networks and improve internet access. The “Digital Divide” poses a significant challenge, as many individuals in vulnerable communities lack the necessary digital literacy to effectively use remote health technologies.
To make telehealth a viable option, long-term reimbursement commitments from payers are essential. This would encourage healthcare systems to invest in infrastructure, develop best practices, and ensure consistent provider utilization.
Dr. Kirksey emphasizes the importance of not forgetting the communities that reflect the best of Ohio. Addressing cardiovascular deserts is crucial in the broader fight against health disparities, requiring political will, collaborative partnerships, and targeted strategies. The time to act is now, as the health of many depends on the collective efforts to bridge these gaps in care.
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