A conversation with Dr. Bruce Ovbiagele, MD, MSc, MAS, MBA, Professor of Neurology, University of California, San Francisco.

Interviewed by Dr. Saurav Das, MD, Fellow in Vascular Neurology, Washington University School of Medicine, St. Louis.

They will be discussing the article “HEADS-UP: Understanding and Problem-Solving: Seeking Hands-Down Solutions to Major Inequities in Stroke,” published in November 2020 issue of Stroke. The article is part of a Focused Updates series of articles on topics related to health equity.

Dr. Das: Dr. Ovbiagele, at the outset, I want to thank you on behalf of the Blogging Stroke team for organizing this timely and reflective series of articles. I read with enthusiasm your introduction to the series. Thanks for finding time for this interview.

Dr. Ovbiagele, COVID-19 and the killings of unarmed Black individuals by police recently have brought to the forefront discussions about pre-existing racial disparities in stroke care. However, the idea of HEADS-UP was envisaged even before these extenuating circumstances. Please throw some light on the origins of the idea.

Dr. Ovbiagele: My co-chair, Dr. Amy Towfighi, and I have been involved in stroke disparities research for a while (Amy doing work with the Latinx population in Los Angeles, and I doing work with people of African ancestry in South Carolina and Sub-Saharan Africa), and had lamented about both the lack of successful interventions and a clear pipeline of next generation stroke disparities researchers. We observed that with changing U.S. demographics and anticipated worsening of stroke inequities, stroke disparities research and publications seemed to mostly focus on repeatedly pointing out the existence and magnitude of racial/ethnic disparities, that the stroke disparities community was not routinely connected or integrated in a sustainable way, and that early career individuals interested in stroke disparities did not appear to have an established avenue through which to nurture that interest into a successful independent academic career. We thought that if we could bring key stakeholders together in a forum that routinely informs and inspires established and budding stroke disparities researchers to better solutions and greater heights, we might be able to accelerate the pace of discoverers and discoveries. We approached the American Stroke Association, National Institute of Neurological Disorders and Stroke, and several of our esteemed research colleagues about the idea, and then collectively planned and implemented the inaugural Symposium.

Pictured, from left to right, at the International Stroke Conference 2020, are Dr. Amy Towfighi, Dr. Bruce Ovbiagele, Dr. Ralph Sacco, and Ms. Adrienne Kenton, daughter of Dr. Edgar Kenton III, after whom the Kenton Award is named.
Pictured, from left to right, at the International Stroke Conference 2020, are Dr. Amy Towfighi, Dr. Bruce Ovbiagele, Dr. Ralph Sacco, and Ms. Adrienne Kenton, daughter of Dr. Edgar Kenton III, after whom the Kenton Award is named. Photo provided, with permission, by Dr. Ovbiagele.

Dr. Das: Dr. Ovbiagele, you have summarized in your introduction a series of key papers from the 2020 HEADS-UP symposium in Los Angeles, California. These papers explore biological and social determinants of disparities and explore multi-level interventions. However, neither of these categories have explored “racism,” individual or systemic, as a study variable in stroke research. What are your thoughts, and will this be addressed in the HEADS-UP symposium in 2021?

Dr. Ovbiagele: The HEADS-UP Symposium was planned and took place before the racial justice protests earlier this year. While the issue of racism is lightly referred to in a couple of the articles, it was not discussed in any direct or definitive way. It is obviously a sensitive and controversial topic, but in the wake of COVID-19, racial disparities, and the killings of unarmed Black individuals earlier this year, there seems to be increasing awareness of, and interest in, the overt and covert effects of racism on health and survival. This awakening, if sustained, could allow more open conversations and even investigations of the potential impact of racism on stroke inequities. We currently do not have racism as a discrete agenda topic for HEADS-UP 2021, which has a theme of Community Engagement, but I would not be surprised if it features in some of the invited presentations or submitted abstracts.

Dr. Das: In this series, you have brought together a team of prolific authors and stroke academicians to address six different topics. Could you reflect on your choice of authors and their respective topics?

Dr. Ovbiagele: The authors and topics were selected by the HEADS-UP Symposium Planning Committee to reflect the seasoned experts in the key aspects of the disparities research continuum, from promising bench work all the way to multi-level community-based interventions. We wanted them not just to give us their views on the current state of the science, but to also provide their visionary perspectives on the potential roadmaps for achieving sustainable equity in stroke care and outcomes for underserved and vulnerable populations, which could be of actionable interest to other researchers, as well as to community partners and policy makers.

Poster session at the HEADS-UP 2020 conference.
Poster session at the HEADS-UP 2020 conference. Photo provided, with permission, by the American Heart Association.

Dr. Das: Dr. Ovbiagele, how can resident and fellow trainees interested in stroke disparities benefit from the HEADS-UP program?

Dr. Ovbiagele: First, read these Focused Update articles written by the leading experts in the field. Second, consider participating in ongoing stroke disparities research studies being conducted at your institution under the guidance of a local mentor. If you are unaware of studies in your own department, look across campus to see if other departments are engaged in stroke and/or cardiovascular diseases research and get involved. If you can’t find anyone on campus, feel free to reach out to me or any of the HEADS-UP faculty to see if you can get involved in one of their projects or lead a spin-off project of your own. Third, consider submitting an abstract based on such work to the HEADS-UP Symposium to be considered to receive a travel award scholarship. The symposium is an opportunity to present your work and get feedback, hear directly from leaders in the field, engage in career development activities, and liaise with other house-staff interested in stroke disparities.