Cardiovascular disease (CVD) remains the leading cause of death across various communities, yet certain populations experience a disproportionate burden. According to Dr. Lee Kirksey, a Cleveland vascular surgeon and health equity advocate, low-income individuals, women, racial minorities, and rural Americans face higher rates of heart attacks, strokes, and limb loss. This alarming trend is exacerbated by systemic barriers such as low health insurance rates, and the term “Cardiovascular Desert” has emerged to describe areas lacking adequate access to cardiologists, primary care physicians, and hospitals.
Dr. Kirksey emphasizes that physical proximity to healthcare services significantly influences health outcomes. Growing up in the rural community of Alliance, Ohio, he witnessed firsthand how geographic isolation impacts access to care. For residents in these areas, a trip to a medical facility can involve lengthy travel and loss of wages, adding to the challenges they already face. This has contributed to widening gaps in life expectancy between rural and urban populations since the 1990s.
The “rural death gap” in Ohio is linked to the decline of manufacturing industries, particularly steel and automobiles, which has led to economic downturns in these regions. Dr. Kirksey recalls the words of political consultant James Carville: “It’s the economy, stupid!” This sentiment underscores the interconnectedness of economic conditions and health disparities.
While rural areas are often highlighted, “deserts” also exist within metropolitan regions. These areas suffer from a lack of healthcare services due to political decisions, policies, and socioeconomic factors. Recent federal legislation has raised concerns about the future of vulnerable populations. The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, is projected to cut federal spending on Medicaid by more than $900 billion over the next decade.
The American Medical Association warns that new administrative burdens and work requirements could lead to over 11 million people losing their health coverage. Furthermore, the elimination of the Grad Plus Loan program may deter medical students from low-income backgrounds from applying, thereby worsening the existing physician shortage in underrepresented areas. Research indicates that medical students from these communities are more likely to return and serve their home regions, which will be increasingly difficult under current policies.
In terms of treatment, innovations such as the medications Wegovy and Ozempic have revolutionized diabetes and obesity management, potentially reducing cardiovascular risks. However, access to these medications is inconsistent, with out-of-pocket costs soaring to around $1,000 per month, making them unaffordable for many in cardiovascular deserts.
Telehealth presents a promising avenue for improving access to care, yet significant obstacles remain. Collaboration with broadband providers is essential to create community networks and expand affordable internet access. The “Digital Divide” represents a major barrier, as many vulnerable communities lack the digital literacy necessary to utilize remote health technology effectively. Long-term commitment from payers to reimburse telehealth services will incentivize healthcare providers to invest in infrastructure and develop best practices for consistent utilization.
Dr. Kirksey remains committed to advocating for communities like his own in Ohio, which exemplify the challenges faced by many Americans. Addressing cardiovascular deserts is not merely a health issue; it requires political will, collaboration, and tailored strategies to effectively bridge the gaps in healthcare access. The fight against health disparities is ongoing, and it is essential that stakeholders prioritize these urgent needs to improve health outcomes across all communities.
