Equity Lens: Antiracism is integral to reducing health inequalities      

Considering the words we use, the decisions we make, and the attitudes we hold, along with recognising discriminatory practices in everyday healthcare settings, are crucial steps public health professionals can take to address health disparities among ethnic minorities. As part of JACARDI’s Equity Lens series, this article examines differences in treatment and care for ethnic minorities, the importance of building trust, and concrete actions professionals can take to achieve more equitable health outcomes.

Since racism directly affects health outcomes, adopting an antiracist approach is integral to quality care, emphasizes Dr. Najma Yusuf, a medical doctor and an antiracism educator for the JACARDI Masterclass titled “Antiracism is care: Advancing Equity in Healthcare”. It is vital to recognize harmful structures, deconstruct them, and avoid past mistakes, especially in the current political climate.

Understanding structural racism and historical context

Racism in healthcare has been well documented and is rooted in structural issues. Studies show that patients from ethnic minorities may receive different treatment than the majority population. This discrepancy is visible even in common medical tests; for instance, in the case of pulse oximetry, which can lead to significant delays in initiating therapy. Diagnosis and treatment decisions made by healthcare professionals can also be influenced by cultural biases.

Dr. Yusuf shed light on the controversial history of medicine, noting that unethical medical experiments conducted on ethnic minorities were a regular occurrence not too long ago. The enduring effects of this history mean that certain minority groups remain wary of healthcare professionals today. Consequently, building trust must begin from the very start, which requires time.

From race-based to race-conscious medicine

A key concern is that race is still used as a risk factor for disease in health research. This persists despite the fact that it has been well-established that race is a social construct, rather than a biological risk factor.

Dr. Yusuf argued that, instead of relying on biology, race should be defined as a social and power construct. This approach allows practitioners to understand and see the effect that race has on an individual’s health and wellbeing. Moving away from race-based medicine toward race-conscious medicine will eventually lead to the reduction of racial health inequalities.

Five concrete ways to promote active antiracism

Antiracism requires active action, and there are concrete ways to promote it within healthcare and healthcare research. Dr. Yusuf presented five actions that professionals can take:

1. Admitting the existence of structural racism
2. Having active plans to reduce structural racism
3. Meeting patients without prejudice
4. Disaggregating data in health research for equity monitoring (by country of birth, language, ethnicity)
5. Using participatory approaches involving affected communities

Resources:

• Online course on anti-racism for professionals (videos are in Finnish with English subtitles)
• The Moni Suomi Study
• Pulling at the heart: COVID-19, race/ethnicity and ongoing disparities by Chin-Hong, P et al.
• From race-based to race-conscious medicine: how anti-racist uprisings call us to act
• Tackling structural racism and ethnicity-based discrimination in health

About Dr. Najma Yusuf

As a physician specializing in emergency medicine, and an anti-racism expert at the University of Helsinki, Dr. Yusuf has a demonstrated history of working in healthcare, biomedical sciences, and public health. Beyond her medical practice, she is actively engaged in advancing equity and inclusion, serving as a Board Member of the Finnish-Somalia Association (FSA) and as a trainer for doctors in Finland, contributing to a JACARDI pilot program developing antiracist training for healthcare professionals.

About the JACARDI Equity Lens Series:

Throughout this series, we share why equity and diversity are not optional add-ons but core components of truly equitable healthcare as well as a shared responsibility for everyone working in the field. To share the knowledge generated within JACARDI, the Equity Lens article series draws on the JACARDI Equity Masterclass series that provides an in-depth look into matters related to equity and diversity for JACARDI pilot teams conducting 143 healthcare interventions across Europe. The article series offers insights shared by a diverse pool of public health professionals within the consortium. By looking through an equity lens, we can build a more inclusive system for everyone. Join us in learning how an equity lens can shape daily practice and drive meaningful change.

Read the first article in the series: JACARDI’s 4Cs framework for advancing equity and diversity

From pilots to policy: highlights from the Irish JACARDI Heart Health Symposium

The Irish JACARDI Heart Health Symposium took place on 13 February at University College Dublin, bringing together clinicians, researchers, policymakers and programme leads from across Europe. The day showcased the strength of collaboration under JACARDI and the practical progress being made in cardiovascular and diabetes prevention.

The symposium opened with a welcome from Ireland’s Minister for Health, Jennifer Carroll MacNeill, setting the tone of innovation and equity in cardiovascular and diabetes prevention. Dr Benedetta Armocida, Coordinator of JACARDI, provided an overview of JACARDI’s objectives, highlighting the Joint Action’s commitment to shared learning and scalable implementation across Member States.

The spotlight then turned to the pilots – the core of JACARDI. Six pilots from Ireland, Finland, Belgium, Hungary and Ukraine presented their work, with a particular focus on cardiovascular screening and patient self-management.

Pilot presentations: progress across Europe

• Ireland:
  • STOP‑CVD (HSE): Katie Ellwood and Pooja Salgar outlined progress using natriuretic peptide screening to support risk stratification in primary care.
  • Healthy Heart Clubs (Croí Heart & Stroke Charity): Lisa Hynes highlighted the importance of structured rehabilitation and long‑term self‑management after cardiac events.
• Finland: Mia Färm (Finnish Diabetes Association) presented the Finnish Risk Calculator, supporting early identification and timely lifestyle intervention.
• Belgium: William Leysen (Diabetes Liga) shared preliminary results from the Halt2Diabetes studies, demonstrating the value of coordinated community‑level screening.
• Hungary: Gréta Máto (OKFŐ) discussed the role of advanced nurse practitioners in strengthening cardiovascular and diabetes screening in primary care.
• Ukraine: Nataliia Hryb (Public Health Centre Ukraine) discussed how they are delivering type 2 diabetes screening in challenging circumstances, underscoring resilience and commitment to patient care.

Across all pilots, a clear message emerged: prevention must be systematic, data-informed and patient-centred.

Women and cardiovascular health: advancing equity

The mid-morning session turned the focus on women with cardiovascular disease (CVD), a key pillar of JACARDI’s commitment to equity and diversity in cardiovascular and diabetes care. The session featured a keynote from JACARDI’s own Dr Héctor Bueno, Co-Leader on the Work Package on Data, who delivered a powerful message: “women are not small men”. His presentation emphasised the need to recognise sex-specific differences in disease presentation, diagnosis, and management.

This was further explored by Dr Mary Ryder, Associate Professor of General Nursing, and Prof. Amy O’Higgins, Consultant Obstetrician at The Coombe Hospital, offering complementary perspectives. Dr Ryder discussed the importance of addressing social determinants of health in cardiovascular prevention, while Prof O’Higgins focused on optimising cardiovascular health during pregnancy, a critical window for long‑term outcomes.

The session was rounded out by a patient story, providing a personal perspective on living with CVD. Her experiences reinforced the human impact behind the statistics and research, leaving a lasting impression on all attendees.

Diabetes and cardiovascular health

The afternoon session turned to diabetes, reflecting its deep interconnection with cardiovascular disease. Dr James (Jim) Januzzi from Harvard Medical School delivered a keynote on heart failure risk across the spectrum of dysglycaemia, stressing the need for integrated approaches. Dr Lisa Devine outlined the successes of Ireland’s Chronic Disease Management Programme, demonstrating how structured, national-level programmes can support early detection, patient engagement, and improved outcomes.

Finally, Prof. Sean Dinneen discussed progress toward a National Diabetes Registry in Ireland, reinforcing the importance of robust data to ensure interventions reach those who need them most, and highlighted the synergies brought about by projects such as JACARDI.

People at the heart of prevention

One of the strongest impressions from the day was how much can be achieved when expertise, curiosity, and compassion are translated into structured action. The symposium wasn’t just about data, tools, or programmes. It was about people: the teams working on the ground across Europe translating strategy into practice, the patients whose stories remind us why these efforts matter, and the exchange of knowledge among colleagues united in a common purpose.

The symposium left attendees not only informed but inspired. It reaffirmed the importance of integrated, patient-centred approaches for a healthier and stronger Europe.

From evidence to impact: a united call for equity-driven and sustainable action on NCDs

• JACARDI, JA PreventNCD, WHO Europe, OECD and the European Commission’s DG SANTE have published a joint Comment in The Lancet Regional Health, based on the findings of the newly published report ‘Avoidable mortality, risk factors and policies for tackling NCDs: leveraging data for impact’, by WHO Europe.
• The Comment underscores the critical role of cross-national collaboration in translating WHO findings into actionable policies, with a focus on equity, data-driven solutions, and integrated care pathways.
• These organizations call for an accelerated, harmonised and equity-driven European agenda on non-communicable diseases.

Non-communicable diseases (NCDs) remain the leading cause of death and disability in Europe, and recent trends reveal both progress and setbacks. While tobacco use, hypertension prevalence, and alcohol consumption have declined since 2010, obesity and diabetes rates continue to rise alarmingly, and physical inactivity shows no signs of improvement. This mixed picture is compounded by a slowdown in the implementation of vital public health policies since the COVID-19 pandemic.

These findings are discussed in a Comment published in The Lancet Regional Health and developed through a collaborative effort bringing together JACARDI, JA PreventNCD, WHO Europe, OECD (Organisation for Economic Co-operation and Development), and the European Commission’s DG SANTE. The publication summarises the findings of the report Avoidable mortality, risk factors and policies for tackling noncommunicable diseases – leveraging data for impact: monitoring commitments in the WHO European Region ahead of the Fourth United Nations High-Level Meeting, by WHO Europe, reinforcing the urgency of renewed action. It emphasises the need for comprehensive solutions that prioritise strengthening health systems, accelerating the implementation of proven interventions, effective policies, and integrating equity-driven approaches.

The Comment presents key insights taken from the WHO Europe Report on the current state of NCD prevention and management in Europe. It highlights key challenges, such as the decline in the number of countries that have fully implemented NCD surveys, which fell from 28% in 2021 to 19% in 2023, and the reduction in the number of countries with operational multisectoral NCD strategies, which decreased from 60% to 55% during this period.

Despite these challenges, the authors note that 85% of European countries have adopted management guidelines for the four major NCDs: cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases; demonstrating significant foundational progress.

“These figures paint a complex picture. Despite decades of progress in reducing premature mortality from the four major NCDs prioritised by global agenda, currently the region is off track to meet its 2025 targets. Moreover, the rise in obesity and diabetes and the slowdown in policy implementation highlight the urgent need to reinvigorate our efforts”, comments first author Dr Benedetta Armocida, from the Department of Cardiovascular, Endocrine-metabolic Diseases and Aging at Istituto Superiore di Sanità-ISS, Rome (Italy) and Coordinator of JACARDI.

The Scientific Coordinator of JA PreventNCD, Prof Knut-Inge Klepp, concurs and is particularly concerned regarding the slowdown in the implementation of population level policy interventions:

“We know how critical such policies are if we are to succeed in having a significant and lasting impact across population groups in Europe. Inequalities in NCD-related health remain a key challenge across and within European countries”.

Driving change

The European Union’s flagship initiatives under the EU4Health Programme are pivotal in addressing these challenges. JACARDI and JA PreventNCD are at the forefront of strengthening cross-national collaboration and implementing integrated strategies for NCD prevention and management.

JA PreventNCD targets primary prevention by tackling root causes such as unhealthy diets, tobacco and alcohol use, and lack of physical activity. JACARDI, meanwhile, focuses on secondary and tertiary prevention, aiming to enhance outcomes for cardiovascular diseases and diabetes through evidence-based interventions and integrated care pathways. Together, these initiatives exemplify the EU’s commitment to tackling NCDs across the care continuum, supported by a combined budget of €160 million and participation from 27 European countries.

The WHO NCD Global Monitoring Framework, which includes nine global voluntary targets, notably the headline goal of a 25% reduction in premature mortality from NCDs by 2025, is about to expire. That is why the authors provide a clear roadmap for advancing the fight against NCDs, ensuring systematic policy implementation and strengthening data infrastructures to translate commitments into measurable health outcomes.

“There are no more excuses. We have the knowledge and the tools. What remains is the will to implement them swiftly and hold ourselves accountable for delivering real results. This is not just a matter of public health; this is a matter of justice, security, and competitiveness, and a shared future”, says Dr Hans Henri P. Kluge, World Health Organization Regional Director for Europe.

Armocida and Klepp underscore the power of collaboration in achieving meaningful change: “We truly believe this joint effort reflects the strength and unity across Europe, bringing together a diverse group of organisations, initiatives, and stakeholders committed to reducing the burden of NCDs. The collaborative authorship of this Comment itself serves as an example of the collective commitment and shared vision needed to address one of the region’s most pressing public health challenges.”

The Comment calls for an accelerated, harmonised, and equity-driven European agenda on NCDs, particularly in the lead-up to the 2025 UN High-Level Meeting on NCDs.

The JA PreventNCD and JACARDI Joint Actions encourage policymakers, researchers, and public health advocates to explore this vital publication and join in building a healthier, more equitable future for Europe.

JACARDI (Grant Agreement 101126953) and JA PreventNCD (Grant Agreement 101128023) projects have received funding from the EU4Health Programme 2021-2027.

JACARDI takes the floor at OECD policy dialogue on Europe’s Cardiovascular Health

On 5 May 2025, the OECD convened a high-level policy dialogue in Brussels to address one of Europe’s most pressing public health challenges: the growing burden of cardiovascular diseases (CVDs). With the participation of the European Commission and key representatives from national governments, civil society, and international organisations, the event marked an important moment in shaping the OECD’s analytical work on CVD trends, prevention, and care across the EU. Represented by its Coordination Team, JACARDI brought forward lessons from its cross-country collaboration, referencing tools, frameworks, and reflections that align with the OECD’s strategic priorities, particularly around equity, data, and cross-sectoral integration.

Cardiovascular diseases (CVDs) remain the leading cause of mortality and morbidity across Europe, placing immense pressure on health systems, economies, and societies. Addressing this burden demands more than incremental change—it requires a shared, data-driven, and equity-focused vision for action.

The OECD’s policy dialogue, “Burden of Cardiovascular Disease in the EU,” held on 5 May 2025 with the participation of the European Commission, convened key stakeholders to discuss forthcoming OECD work that aims to analyse trends in CVD burden, prevention, and management across the EU.
The event gathered representatives from national governments, civil society, and intergovernmental organisations to ensure that the forthcoming report reflects stakeholder priorities and is rooted in collective insight.

JACARDI—the Joint Action on Cardiovascular Diseases and Diabetes—was represented by its Coordination Team: Benedetta Armocida, Graziano Onder and Beatrice Formenti. During both plenary and roundtable sessions, JACARDI shared reflections on the future of CVD response in Europe, highlighting insights from its ongoing collaboration with countries and stakeholders. The Joint Action welcomed this opportunity to align with OECD’s strategic direction and contribute to a common agenda for strengthening CVD prevention and control.

Six key areas of alignment were highlighted:

1. A shared framework: the Patient Journey
   Echoing the OECD’s analytical framework, JACARDI supports a patient-centred approach that addresses the full continuum of care—from health promotion and early prevention to integrated treatment and long-term management. This patient journey model underpins JACARDI’s operational structure and is currently being implemented through real-world pilots in 18 European countries.
   Notably, JACARDI integrates cardiovascular diseases and diabetes within a unified framework, recognising their clinical, biological, and systemic interlinkages. This convergence reflects a growing consensus: that sustainable improvement in population health requires integrated, system-strengthening, and equity-oriented solutions.
2. Equity as a structural imperative
   JACARDI endorses the OECD’s emphasis on reducing health inequities, particularly among migrants, ethnic minorities, and other underserved groups. Equity is not an add-on but a core pillar of JACARDI’s approach—operationalised through the 4C Equity Framework: Critical reflection, Contextualised data, Co-design, and Clear, inclusive communication.
   This commitment is made tangible through specific tools like capacity-building masterclasses, a dedicated maturity matrix, and pilot initiatives targeting institutional barriers, including racism and discrimination in healthcare. JACARDI advocates for the standardisation and institutionalisation of such equity-driven models across EU health policies and programmes.
3. Putting women’s hearts on the Agenda: gender-sensitive CVD responses
   Despite notable advances in CVD care, gender disparities persist. Women remain underdiagnosed, undertreated, and underrepresented in research—leading to suboptimal outcomes. JACARDI addresses these challenges through a gender-sensitive approach, following The Lancet Commission on Women and Cardiovascular Disease which underscores the need to embed sex- and gender-specific data into every level of policy and practice.
   For example, in Spain, an interactive tool is being developed to map gender-based health disparities regionally. In France, a comprehensive data linkage is underway to examine how gender and social deprivation intersect in influencing disease risk and care pathways. These initiatives represent a shift toward gender-responsive and inclusive health systems.
4. Data for change: building the evidence base
   Fragmented, delayed, and non-comparable data continue to hinder effective CVD policy implementation. There is a pressing need for harmonised, disaggregated, and interoperable health data—especially data disaggregated by sex, ethnicity, and socioeconomic status.
   JACARDI is addressing this gap by developing a conceptual data framework for mapping and improving national and regional datasets. The framework spans risk factors, disease conditions, and modifiers of disease or care across population, outpatient, and hospital settings. The information is also structured by domains (care, results, quality indicators), offering a comprehensive and standardised approach to data mapping.
   This framework will inform a practical consultation tool to support standardised, comparable, and interoperable data collection across Europe. The aim is to enhance research, promote accountability, and strengthen European health information systems in alignment with OECD, WHO, and EC priorities.
5. Screening and early detection
   A key recommendation from JACARDI reported within the dialogue was the creation of a centralised platform to oversee CVD screening—ensuring quality, transparency, and accountability throughout all stages, from design to evaluation. Such a platform would also house validated risk prediction tools tailored to diverse populations.
   JACARDI supports this vision with a suite of tools developed across the Joint Action, including guidance for implementing, monitoring, and evaluating screening programmes; roadmaps for sustainability; and strategies for disease burden surveillance (via WP7). These resources reflect JACARDI’s holistic approach, linking prevention, early detection, and continuous care.
6. Workplace interventions
   CVDs and diabetes significantly impact Europe’s labour market. JACARDI addresses this challenge by promoting workplace interventions that support people living with NCDs in maintaining or returning to employment.
   Strategic recommendations include strengthening occupational health services, fostering inclusive workplace cultures, combating stigma, promoting intersectoral collaboration, and increasing awareness and research investment. By aligning employment policy with health priorities, JACARDI aims to reduce economic strain and improve quality of life.
   
   

From prevention to rehabilitation: closing the gaps

Effective care for CVD and diabetes requires integrated, person-centred pathways that span the full spectrum of need—from early detection to long-term management and reintegration into society. Reducing fragmentation, ensuring timely access to services, and addressing the needs of chronically ill individuals are essential. JACARDI is actively supporting Member States in designing and implementing more cohesive, sustainable care models—bridging current gaps and promoting resilience in national health systems.

Looking ahead: building Europe’s CVD response together

As the OECD-led analytical report continues to evolve, JACARDI remains committed to contributing to this inclusive, co-creative process. Through piloted innovations, practical tools, and sustained cross-border collaboration, the Joint Action seeks to strengthen Europe’s collective response to CVD and diabetes.

JACARDI’s contribution rests on four foundational principles:

1. Equity as structure and substance—addressing the needs of women, migrants, and other underserved groups throughout the policy cycle;
2. High-quality, harmonised, and disaggregated data—to enable effective monitoring, accountability, and action;
3. Cross-sectoral integration—connecting health with education, employment, social protection, and digital transformation;
4. Inclusive, multi-stakeholder engagement—ensuring that patients, professionals, policymakers, and civil society shape the future together.

In closing, JACARDI exemplifies what is possible when countries align around a shared vision. Through collaboration, knowledge exchange, and an unwavering commitment to inclusion, we are not only shaping better health outcomes—we are building a lasting legacy of equity, resilience, and solidarity across Europe.

“JACARDI, together with all key stakeholders, is showing what’s possible when Europe comes together with a shared purpose and vision—turning knowledge into action, and collaboration into a legacy of healthier, fairer societies for all, starting with the urgent challenge of cardiovascular diseases.”

— JACARDI Coordination Team, Benedetta Armocida and Beatrice Formenti

Janne Sørensen: Being aware of one’s own biases is part of a patient-centered approach

The diversity of JACARDI’s experts is a tremendous asset to the project, as it brings many different perspectives to the table, according to Janne Sørensen, diversity expert at the University of Copenhagen in the Department of Public Health. As a member of JACARDI’s Scientific Advisory Board, she shines a light on how vulnerable groups are impacted by diabetes and cardiovascular disease, and how healthcare professionals can better answer their needs. Her message to people working in healthcare is to see the whole person in front of them and to consider implementing equity as a lifelong learning process.

What significance does JACARDI hold for you and your organisation in terms of its mission and values?

As a public health expert, one of the core elements of my work is addressing health inequalities and striving for greater health equity for all. JACARDI’s focus on combating these inequalities, particularly in the context of cardiovascular diseases and diabetes, resonates deeply with both my personal mission and the goals of my organization.

How do you see JACARDI’s role in tackling the increasing prevalence of cardiovascular diseases and diabetes in Europe?

Well, this is a big question and a significant challenge, as diabetes is on the rise. We need to stop its progression and bring the situation under control. JACARDI is a large initiative and, I believe, a serious attempt to address this challenge. You are confronting the problem head-on with innovative approaches. JACARDI positions itself at the heart of the EU’s efforts to tackle this issue. It is an impressive project, and I am very happy to be part of it.

How do you see our role in promoting equity in healthcare?

JACARDI plays a significant role here because it aims to address inequalities. In other words, we see disparities affecting many vulnerable groups who are significantly impacted by these health issues. For example, people with lower socio-economic status, migrants, ethnic minorities, and LGBT groups all have a higher prevalence of diabetes and cardiovascular diseases.

I must say this is an ambitious objective for such a large project, and it might be quite challenging to mainstream diversity, reach everyone, and ensure that everyone adopts principles of equity and diversity.

How do you see the significance of cultural diversity in the development of diabetes and CVD treatment? And what is the most important or critical aspect of this?

This is significant because you are addressing these particularly vulnerable groups. It is therefore crucial to ensure that you consider meeting people with their diverse identities, vulnerabilities, and characteristics in order to effectively tackle the issues of diabetes and cardiovascular disease.

Implementing diversity can be challenging, but you’ve brought it to the forefront. Ideally, the insights gained from this project will inspire experts to incorporate them into their own work and organizations long after it concludes. JACARDI brings together a diverse group of experts, representing a wide range of educational backgrounds, nationalities, ethnicities, and experiences. This diversity is a tremendous asset to the project, as it brings many different perspectives to the table.

You are providing training for healthcare professionals on cultural diversity. Are there questions that professionals often ask?

Some people ask why it is necessary to discuss diversity, especially if they are already working with a patient-centered approach. My answer is always that while you might have a patient-centered approach, it doesn’t necessarily require that you, as a health professional, reflect on your own background, biases, and stereotypes. Understanding these is crucial when interacting with patients.

Additionally, we discuss health inequalities: that many people are worse off in terms of health because they have fewer opportunities from the beginning of their lives, simply because they belong to specific groups and face discrimination within the healthcare system. These differences also exist among various groups, such as people with disabilities or those from the LGBT community, and so on.

What is your message to healthcare professionals then?

My message is that you need to see the whole person in front of you, in addition to knowing the prevalence of diseases and risk factors and being able to diagnose. This is not easy, because as a healthcare professional, you have to consider many things during a short appointment.

I believe we are trying to improve communication and interaction between healthcare professionals and patients by raising awareness of the disadvantages the patient may face, as well as the risk factors. At the same time, it’s important to recognize what professionals bring into the meetings.

This is a lifelong learning process, not something that can be mastered through a short course. Applying these lessons in practice after completing a course is an entirely different challenge.

Janne Sørensen is a specialist in diversity and diversity competence, based at the Department of Public Health at the University of Copenhagen. Her work focuses on integrating diversity competence into medical education through training programs for students and healthcare professionals. Alongside her teaching, Janne conducts research on various aspects of diversity and addresses issues of discrimination within medical student communities.

Learn more about Janne Sørensen and her work and connect on LinkedIn.