By Bryan T. Fisher
April 27, 2017 at 5:00 am ET
Progress is not a myth. Over the past few decades — and even just the past few years — our nation’s health care system has evolved. More people than ever have access to health care and better treatments. However, one major problem continues to boil under the surface and hinder health outcomes: racial inequity.
There are many things to be said on this topic. But, instead, I will focus only on my area of medical expertise: limb loss due to pre-existing medical conditions. This is because large-scale change must start small. And when it comes to staving off life-altering amputation, there are some very practical ways that advocates and policymakers alike can make a difference.
The prevalence of limb loss is a significant burden on our nation’s health system with an estimated 500 Americans undergoing amputation each day. It’s also an inconceivable struggle, pushing patients to the brink both physically and psychologically.
However, not all Americans are affected equally; amputations are significantly more prominent among minority groups. African-Americans, for instance, are up to 400 percent more likely to have an amputation than their white counterparts. Similarly, Hispanic Americans are up to 75 percent more susceptible to limb loss than Caucasians. The scale of limb loss is particularly tragic because the condition is largely preventable. In fact, it’s now estimated that nearly 60 percent of amputations triggered by diabetes — one of the most prominent drivers of limb loss in minority populations — could have been evaded given proper attention.
Taken together, these numbers suggest something quite powerful. That is, despite innovative procedures and technologies designed specifically to prevent limb loss, minority populations are simply not reaping the benefits. And, as a result, they are needlessly losing limbs at an alarming rate.
It’s precisely for this reason that a new national awareness campaign to combat limb loss disparities has emerged here in the United States. Its name is Standing Tall Against Limb Loss (Standing TALL), and its mission is expanded access to clinically appropriate care, especially for minority groups. I’m proud support the Standing TALL initiative, as an advocate who is acutely aware that limb preservation fundamentally improves lives. But I’m also very conscious of the challenges ahead.
If I’ve learned anything during my five years of practicing medicine, it’s that limb loss is incredibly complex. Amputations not only derive from injury; they are commonly triggered by a range of pre-existing conditions. To reduce limb loss, we must strengthen understanding among the most at-risk populations while simultaneously improving access to interventional treatments across the care continuum.
One primary focus is peripheral artery disease — a life-threatening circulatory condition where arteries are narrowed, reducing blood flow to limbs. Crucially, PAD is exacerbated by diabetes, chronic hypertension, and renal disease, all of which are most prevalent in minority populations.
Despite being at greater risk of PAD, however, non-white Americans typically have inadequate access to interventional treatments, which can sure up blood flow and stave off limb loss from the start. The implication of this is clear: both patients and caretakers need to know more about vascular disease. And politicians must ensure that limb preservation procedures are available to all Americans, no matter where they live or how much money they make.
This will require the collaboration of many stakeholders. Thus, Standing TALL aims to coalesce patient advocacy, disease, minority, faith-based, veteran and professional organizations. I am confident that such unity — which expands outside the medical profession — can leverage broad-based knowledge into better health outcomes and slowly but surely alleviate racial disparities.
I am incredibly proud to be taking part in the National Minority Quality Forum’s Health Braintrust event this week with the Congressional Black Caucus, which aims to address African American and minority health disparities on Capitol Hill and create legislative and policy solutions to reduce health disparities and promote good health outcomes in multicultural communities. Coordinated efforts by health care professionals and lawmakers are necessary to ignite change for minority communities unfairly facing fewer health care options.
In the end, our Standing TALL campaign rests on a few basic principles. First, no one should experience limb loss unnecessarily. And second, Americans of all backgrounds should be treated equally for limb-threatening conditions and have access to limb preservation procedures. These are things we can all agree on. So now let’s turn understanding into action and ensure limb preservation is prioritized among clinicians and policy makers alike.
Bryan T. Fisher is a recipient of the National Minority Quality Forum’s 40 Under 40 Leaders in Health and the co-director of Limb Preservation at Centennial Medical Center and is an endovascular surgeon at the Surgical Clinic in Nashville, Tenn.
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