The pursuit and understanding of health equity is an integral guiding principle for quality and comprehensive healthcare. Health equity refers to the equal access and universal allowance of the highest level of healthcare to all individuals, regardless of their socioeconomic status, race, ethnicity, gender, or geographical location. Achieving health equity is essential. However, as many know, numerous disparities persist within and beyond the healthcare system perpetuating inequalities in healthcare and health outcomes.

Within the rapidly growing field of Neurocritical Care, there is a lack of longstanding, high-quality research guiding the care of individuals with acute neurological diseases. These diseases, which encompass a wide range of conditions including stroke, traumatic brain injury, epilepsy, brain tumors, and infections, require not only advanced medical treatments and interventions that are still under study, but also a vital understanding of a patient’s social determinants of health (SDOH) to provide comprehensive care and improve health care outcomes. Patients who experience an acute neurological disease may also lose decision-making capacity for their health, which makes this population particularly vulnerable to additional stressors.

Understanding this need, the National Institute of Neurological Disorders and Stroke (NINDS), aligned with the U.S. Department of Health and Human Services, established the Healthy People 2030 initiative. This initiative aims to promote research efforts to improve healthcare by facilitating a variety of health opportunities, and further fortifies the enduring importance of health equity in healthcare research. The additional traction from this initiative has resulted in a shift in focus regarding how to best conduct this type of research and translate it into actionable change to optimize equity for all.

Dr. Nirupama Yechoor, a Neurocritical Care physician at Massachusetts General Hospital with a research focus on health equity and SDOH in stroke patients, commented on refocusing how to best approach the problem: “The traditional approach [to studying health equity] is looking to see what makes our patients different that they have worse outcomes. For example, we study race and income as determinants of clinical outcomes. However, I think a new way forward could be [asking] how do we, as the health system, make decisions differently based on factors that lead to worse health outcomes. This shifts the paradigm to modifying our care, which is possible, and not simply focusing on factors we can’t modify, such as someone’s race.”

Given her passion for health equity research, Dr. Yechoor recently spoke at both the Neurocritical Care Society’s World Coma Day and the American Heart Association’s International Stroke Conference. In her presentations, she shared that “social and structural determinants of health can seem overwhelming and intimidating. But there are several feasible and actionable steps towards starting this work, especially in our neurological patients. [And] understanding [SDOH] is just one way to build a bridge between clinical medicine and public health.”

Additional studies have shown that the knowledge gaps arising from a lack of exposure to racial and ethnic diversity and sexual and gender minorities may lead to barriers in access to clinical care for disadvantaged populations. Simpkins et. al. also highlighted the need for transdisciplinary team science and diversity enhancement to address unconscious decisions that limit accessibility for diverse populations, whether influenced by implicit biases of individual providers or larger-scale systemic biases. Diversity in the neuroscience workforce and a push towards team-based science can help improve research innovation and creativity while offering a broad scientific perspective. The field of neurocritical care, as a fast growing and multidisciplinary community, is at the forefront of leading such initiatives. We stand at the brink of new and exciting research that will lead the path forward to improve healthcare and outcomes through optimizing health equity, particularly in our vulnerable population of patients with acute brain injury.