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Share on Pinterest Fly View Productions/Getty ImagesAround 60 million women in the US have cardiovascular disease (CVD).Women from racial and ethnic minority groups are at greater risk of CVD death.A new American Heart Association (AHA) statement emphasizes that doctors must also consider social determinants of health when screening for CVD.These include factors such as discrimination, environment, and language barriers.

An estimated 60 million women in the US (equal to 44% of the population) live with some form of cardiovascular disease (CVD).

Additionally, 1 in 5 deaths among women stems from CVD with those from racial and ethnic minorities at greater risk.

Traditional contributing factors, such as obesity, smoking, diabetes, and high cholesterol, are frequently considered by doctors when assessing a patients CVD risk.

However, a new scientific statement from the American Heart Association (AHA), published in its journal Circulation, highlighted that medical professionals must look beyond these when monitoring and treating CVD in women, especially those from underrepresented groups.

In comparison to other women, Black women in the US (including African American and Afro Caribbean) have the highest rate of heart disease, stated Dr. Heather M. Johnson,a preventive cardiologist at Boca Raton Regional Hospital, part of Baptist Health South Florida, who was not involved with the report.

The AHA researchers stated that nontraditionalsocio-economic factors such as discrimination and environment must be considered if the gap in CVD treatment and survival between whites and racial and ethnic groups is to be reduced.

Many of these are often overlooked but can significantly affect health risks, care, and outcomes.

Understanding both traditional and nontraditional risk factors are important to prevent heart disease, but also to support the early diagnosis and treatment of heart disease in women, Johnson told Healthline. How bias, discrimination, and racism can affect your health

In the statement, the researchers said: Behavioral and environmental factors and social determinants of health disproportionately affect women of underrepresented races and ethnicities.

These factors result in a higher prevalence of CVD and significant challenges in the diagnosis and treatment of cardiovascular conditions, they added.

Five social determinants of health were emphasized in the AHAs statement. But what are they and how do they influence CVD?Discrimination

The AHA noted that discriminatory barriers faced by ethnic communities lead to high levels of stress. This, in turn, contributes to CVD issues such as inflammation and hypertension.

Research also highlights that minority groups can encounter racial bias and stereotyping from white healthcare providers which may lead to patients having their concerns dismissed or receiving poorer care.

Studies show this is often due to the activation of stereotypes that influence clinical judgment, said Heather Orom, PhD, associate professor of community health and health behavior at the University at Buffalo.

Furthermore, when actions are perceived as racially motivated or discriminatory, this can put a wedge between provider and patient and create an environment of mistrust, said Dr. Deborah L. Crabbe, a professor of medicine at the Temple Heart and Vascular Institute at Lewis Katz School of Medicine.

As a result, she told Healthline, patients may not follow through with care recommendations and may even seek other providers, perhaps delaying care for their medical condition.Language barriers

Understanding medical terms and phrasing can be tricky enough for patients at the best of times. However, things are complicated further when the doctor and patient dont share the same first language.

Language barriers can reduce patients satisfaction with their care, care quality, and safety, explained Orom.

Furthermore, she told Healthline, such barriers can hinder the doctor-patient relationship, prevent patients from advocating for themselves, and inhibit the doctor from understanding the full complexity of a patients condition and their life circumstances. Environment

The AHA statement revealed that environmental factors, such as air pollution, high long-term arsenic exposure, and cadmium and lead exposure, have been linked to CVD.

Studies show minority groups are more likely to live in areas with more air pollution and closer proximity to toxic waste and other hazards.

For decades, polluting industries, waste facilities, and other sources of exposure, such as highways systems, have been more likely to be placed in neighborhoods of color, Orom revealed. This stems from the fact these communities have had less political and economic clout. Assimilation to a different culture

The AHA statement didnt expressly state how acculturation or assimilation to a different culture can impact CVD.

However, this is an important factor for CVD that often is missed, stated Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.

For instance, he shared with Healthline that older studies of Japanese individuals showed those who traveled to Hawaii and then to the continental U.S. had higher CVD rates than their peers who stayed in Japan.Healthcare access

It was noted in the AHA statement that there is evidence that SDOH factors experienced in youth, such as inability to access healthcare or inability to afford care, may affect heart health into adulthood and contribute to CVD risk factors and outcomes in adulthood.

Research shows that Black, Hispanic, Asian-American, and Native individuals are less likely to have health insurance.

But healthcare access isnt only about insurance, said Crabbe. For example, [it also] includes geographic access to a particular health care service.

Orom concurred, stating there is a typically lack of high-quality healthcare facilities in neighborhoods where people of color have historically lived.

Other social burdens can limit access, too. For example, United States Census Bureau data shows that ethnic minority groups are generally poorer compared to white populations. Poverty can prevent individuals from purchasing necessary medications, for example.

Finally, Michele Horan, a registered nurse and COO of Healthy Alliance, shared that other daily stressors such as care responsibilities and the potential of eviction can reduce the capacity of underserved communities to access healthcare.

In most cases, these urgent situations are prioritized over ones health and well-being, Horan told Healthline. Addressing life challenges, in my experience, will almost always surpass healthcare, accessible or not. What to discuss with your doctor

If you think youre at higher risk of CVD, its crucial to ensure your doctor is aware of your concerns and potential risk profile.

Ni said discussing with your doctor means they can be more aggressive with screening.

For example, doctors might choose to test for disease states with no symptoms earlier than usual if the fear is that someone has a higher risk due to the environment they live in, he explained.

Tests and screenings generally vary depending on the patient and their history.

Its recommended that everyone understands their individual risk for heart disease and has a preventive heart health evaluation, Johnson said.

This assessment, she explained, includes a detailed discussion of their traditional and nontraditional risk factors for heart disease.

According to Johnson, further preventative screening tests are also possible and include:Electrocardiogram (EKG or ECG)Coronary artery calcium scan (also known as a calcium score)Special cholesterol tests What can healthcare professionals do to help?

According to the AHA researchers, culturally sensitive, peer-led community and healthcare professional education is a necessary step in CVD prevention.

Language barriers can be overcome by providing translators or simply using language apps, such as Google Translate. Studies show that using such app in healthcare settings can significantly improve both doctor and patient satisfaction.

Horan said healthcare providers need to screen patients from minority groups in a culturally competent and sensitive way.

Identifying barriers and the root cause behind them with a proactive lens is often the only way to effectively coordinate care in a manner that addresses their patients full spectrum of needs, she asserted.

Education is vital for both medical professionals and patients, said Crabbe.

Healthcare organizations can provide training and education to staff regarding the challenges that minorities and women face in receiving healthcare, she noted.

Meanwhile, Crabbe continued, opportunities to provide education to improve the health literacy of minorities and women could help improve patient acceptance of healthcare recommendations, and thus compliance.

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Israel announces military operation expanding in Gaza to seize ‘large areas’

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Israel announces military operation expanding in Gaza to seize 'large areas'

Israel is beginning a major expansion of its military operation in Gaza and will seize large areas of the territory, the country’s defence minister said.

Israel Katz said in a statement that there would be a large scale evacuation of the Palestinian population from fighting areas.

In a post on X, he wrote: “I call on the residents of Gaza to act now to remove Hamas and return all the hostages. This is the only way to end the war.”

He said the offensive was “expanding to crush and clean the area of terrorists and terrorist infrastructure and capture large areas that will be added to the security zones of the State of Israel”.

The expansion of Israel’s military operation in Gaza deepens its renewed offensive.

The ceasefire between Israel and Hamas that had begun in January ended in March as Israel launched various air strikes on targets across Gaza.

The deal had seen the release of dozens of hostages and hundreds of Palestinian prisoners, but collapsed before it could move to phase two, which would have involved the release of all hostages and the withdrawal of Israeli forces from Gaza.

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26 March: Anti-Hamas chants heard at protest in Gaza

The Israel Defense Forces (IDF) had already issued evacuation warnings to Gazans living around the southern city of Rafah and towards the city of Khan Yunis, telling them to move to the al Mawasi area on the shore, which was previously designated a humanitarian zone.

Israeli forces have already set up a significant buffer zone within Gaza, having expanded an area around the edge of the territory that had existed before the war, as well as a large security area in the so-called Netzarim corridor through the middle of Gaza.

This latest conflict began when Hamas launched an attack on Israel on 7 October 2023, killing around 1,200 people and taking around 250 hostages.

The ensuing Israeli offensive has killed more than 50,000 Palestinians, according to Gaza’s Hamas-run health ministry.

Read more:
Father demands protection after Gaza aid workers’ deaths
Anti-Hamas chants heard at rare protest in Gaza

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Bodies of aid workers found in Gaza

Aid group Doctors Without Borders warned on Wednesday that Israel’s month-long siege of Gaza means some critical medications are now short in supply and are running out, leaving Palestinians at risk of losing vital healthcare.

“The Israeli authorities’ have condemned the people of Gaza to unbearable suffering with their deadly siege,” said Myriam Laaroussi, the group’s emergency coordinator in Gaza.

“This deliberate infliction of harm on people is like a slow death; it must end immediately.”

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UK

Heathrow bosses ‘warned about substation’ days before major power outage, MP committee hears

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Heathrow bosses 'warned about substation' days before major power outage, MP committee hears

Heathrow Airport bosses had been warned of a potential substation failures less than a week before a major power outage closed the airport for a day, a committee of MPs has heard.

The chief executive of Heathrow Airline Operators’ Committee Nigel Wicking told MPs of the Transport Committee he raised issues about resilience on 15 March after cable and wiring took out lights on a runway.

A fire at an electricity substation in west London meant the power supply was disrupted to Europe’s largest airport for a day – causing travel chaos for around 200,000 passengers.

“I’d actually warned Heathrow of concerns that we had with regard to the substations and my concern was resilience”, Mr Wicking said.

“So the first occasion was to team Heathrow director on the 15th of the month of March. And then I also spoke to the chief operating officer and chief customer officer two days before regarding this concern.

“And it was following a number of, a couple of incidents of, unfortunately, theft, of wire and cable around some of the power supply that on one of those occasions, took out the lights on the runway for a period of time. That obviously made me concerned.”

Mr Wicking also said he believed Heathrow’s Terminal 5 could have been ready to receive repatriation flights by “late morning” on the day of the closure, and that “there was opportunity also to get flights out”.

However, Heathrow chief executive Thomas Woldbye said keeping the airport open during last month’s power outage would have been “disastrous”.

There was a risk of having “literally tens of thousands of people stranded in the airport, where we have nowhere to put them”, Mr Woldbye said.

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What are Donald Trump’s tariffs, what is ‘liberation day’ and how does it all affect the UK?

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What are Donald Trump's tariffs, what is 'liberation day' and how does it all affect the UK?

If there is a word that has dominated Donald Trump’s second term, it’s tariffs. 

Aluminium, steel, cars and champagne have all been in his firing line, while China, Canada and Mexico are the countries targeted with the heaviest costs.

Along the way, there have been threats, pauses and postponements.

So what are tariffs, what is in the pipeline – and what could all this mean for the UK?

What are tariffs and why is Trump threatening to use them?

Tariffs are taxes on goods imported into the US.

It is the importers buying the goods who pay the tariffs – therefore, American companies.

Ultimately, the intent is to protect US manufacturing and bolster jobs by making foreign-made products less attractive.

However, there is a knock-on effect: to compensate for tariffs, companies put up their prices, so customers end up paying more for goods.

Tariffs can also damage foreign countries as they make their products pricier and harder to sell.

In his second term, Mr Trump has frequently used them – or the threat of them – as a trade weapon.

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Trump’s tariffs: What can we expect?

They are a key part of Mr Trump’s efforts to reshape global trade relations, and he plans to impose a swathe of what he calls “reciprocal” taxes that would match tariffs levied by other nations.

Tariffs were also part of his playbook in his first term, when he imposed taxes on most goods coming from China and used them as a bargaining chip to force Canada and Mexico to renegotiate a North American trade pact.

On his first day back in office, the US president promised 25% tariffs on all products coming into the US from its nearest neighbours Mexico and Canada – ostensibly to force the countries to tackle illegal migration and fentanyl crossing the border.

What is liberation day?

Mr Trump has branded 2 April “liberation day”, when he could unveil the reciprocal tariffs on countries deemed to be giving the US a bad deal on trade.

The extent of potential tariffs and countries affected remains unclear, with Mr Trump at times sending mixed messages.

On 30 March, he said “all countries” could expect to be hit by tariffs.

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What is Trump’s ‘Liberation Day’?

Speaking from Air Force One, the US president rubbished a question from a reporter who asked whether it was true he was planning on targeting between 10 and 15 countries.

“Who told you 10-15 countries? You didn’t hear it from me,” he said.

When pressed on how many he was planning to hit, he said: “You’d start with all countries, let’s see what happens.”

Two days prior, he said he was open to carving out deals with countries seeking to avoid US tariffs, but that those agreements would be negotiated after 2 April.

He had previously said he “may give a lot of countries breaks, but it’s reciprocal”, adding: “We might be even nicer than that.”

How could the UK be affected?

The UK hopes an economic deal with the US will spare the country from some of the tariffs.

Sir Keir Starmer and Mr Trump have had “productive negotiations” towards a UK-US “economic prosperity deal”, Downing Street has said.

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‘Everything on table over US tariffs’

The two leaders discussed a possible deal in a phone call on Sunday and agreed negotiations will “continue at pace”, according to a statement released on Sunday 30 March.

The day before the so-called “liberation day”, Sir Keir told Sky News political editor Beth Rigby the UK was “working hard on an economic deal” with the US and said “rapid progress” has been made.

But, he admitted: “Look, the likelihood is there will be tariffs. Nobody welcomes that, nobody wants a trade war.

“But I have to act in the national interest and that means all options have to remain on the table.”

Sir Keir added: “We are discussing economic deals. We’re well advanced.

“These would normally take months or years, and in a matter of weeks, we’ve got well advanced in those discussions, so I think that a calm approach, a collected approach, not a knee-jerk approach, is what’s needed in the best interests of our country.”

Mr Trump has not explicitly said the UK is in his sights for further tariffs, though he has described VAT – a tax added on all goods and services in the UK – as unfair.

In deciding what is a reciprocal tariff for the UK, it’s possible Mr Trump could use the tax, typically 20%, to decide.

Data shows no great trade imbalances – the gap between what you import and export from a certain country – and UK figures show no trade deficit with the United States.

UK ministers have previously suggested this could be good news for avoiding new levies.

But the tariffs Mr Trump has already announced would have a big impact on the UK – particularly the car tariff.

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Business secretary hopes Trump tariffs will be ‘reversed in weeks or months’

Jonathan Reynolds, the business and trade secretary, told Sky News he is “hopeful” the tariffs can be reversed soon.

He warned: “The longer we don’t have a potential resolution, the more we will have to consider our own position in relation to [tariffs], precluding retaliatory tariffs.”

He added the government was taking a “calm-headed” approach in the hope a deal can be agreed, but said it is only “reasonable” that retaliatory tariffs are an option, echoing Sir Keir’s sentiments over the weekend.

What tariffs have already been announced?

Some tariffs have already come into effect, while Mr Trump has confirmed some that will come in on 2 April.

He has said a 25% tariff on all cars imported to the US will come into effect, with a similar tariff on car parts expected to follow in May.

This could prove even more complicated for American car makers, who source components from around the world even if the vehicle is made in the US.

Trump tariffs teaser for SEO liberation day explainer

But Mr Trump has insisted the move will “continue to spur growth”, pointing to plans from Hyundai – the South Korean car maker – to build a $5.8bn (£4.5bn) steel plant in Louisiana.

The tariff could have a huge impact on the UK’s car industry, including on manufacturers such as Jaguar Land Rover, Aston Martin and Rolls-Royce.

Official data shows the US is the UK car sector’s largest single market by country, accounting for £6.4bn worth of car exports in 2023 – 18.4% of the total.

Trump has also said he will place a 25% tariff on all imports from any country that buys oil or gas from Venezuela, which includes the US itself – in addition to imposing new tariffs on the South American country.

On 12 March, a 25% tariff on all steel and aluminium imports to the US came into effect, affecting UK products worth hundreds of millions of pounds.

The move came after he placed a 10% tax on all imports from China, which he later doubled to 20%.

He placed 25% tariffs on Mexico and Canada, but paused them for a month two days after they came into effect, meaning they are set to resume on 2 April.

The pause did not fully cover a tariff of 10% on Canadian energy products.

What has been the global response to tariffs?

There has widely been condemnation of the tariffs, especially from countries worst affected like Mexico and Canada.

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Canadian PM: ‘Tariffs are an attack’

Some have imposed, or threatened to impose, retaliatory tariffs.

China has already hit back with retaliatory tariffs covering a range of US goods, including a 15% tariff on coal and liquefied natural gas products, a 10% tariff on US crude oil and tariffs of up to 15% on key US farm exports.

Canada imposed tariffs of its own on US products, including a 25% reciprocal tariff on US steel and aluminium products and tariffs worth an estimated C$29.8bn (£16bn) on a wide range of US products including orange juice, peanut butter, alcohol, coffee and clothing.

Read more on tariffs:
It may be harder for the UK to trump metals tariffs
Stock markets tumble as Trump tariffs loom

The European Union has said it will impose retaliatory tariffs on the US, but when they will come into force is unknown.

The European Commission initially threatened to impose “countermeasures” affecting €26bn (£21.9bn) of US goods from 1 April, but later delayed this until the middle of April.

The bloc said the delay was because it wanted “additional time for discussions” with the US after Mr Trump threatened a 200% tariff on EU alcohol – including wine and champagne – if the bloc imposed duties on US whiskey.

Any tariffs imposed by the bloc would not only impact US steel and aluminium products, but also textiles, home appliances, agricultural goods and whiskey.

Why tariffs could cost you – even if Trump spares UK

Even if no tariffs are put on all UK exports to the US, consumers globally will still be impacted by the wider trade war, particularly in the US.

Economists believe that tariffs will raise costs in the US, sparking a wave of inflation that will keep interest rates higher for longer. The US central bank, the Federal Reserve, is mandated to act to bring inflation down.

More expensive borrowing and costlier goods and services could bring about an economic downturn in the US and have knock-on effects in the UK.

Forecasts from the National Institute of Economic and Social Research (NIESR) predict lower UK economic growth due to higher global interest rates.

It estimated that UK GDP (a measure of everything produced in the economy) could be between 2.5% and 3% lower over five years and 0.7% lower this year.

The Centre for Inclusive Trade Policy thinktank said a 20% across-the-board tariff, impacting the UK, could lead to a £22bn reduction in the UK’s US exports, with the hardest-hit sectors including fishing and mining.

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