Adrienne Gonzalez, Senior Director, Bristol Myers Squibb Foundation
Interviewer: Miranda Wesley, Communications Specialist, Grantmakers In Health
Cardiovascular disease (CVD) is the leading cause of death globally and in the United States, with a disproportionate impact on underserved communities (WHO; CDC 2023). To discuss the Bristol Myers Squibb Foundation’s focused strategy on addressing these disparities and driving equitable access to cardiology care, Grantmaker In Health’s Miranda Wesley spoke with the Bristol Myers Squibb Foundation’s Senior Program Director, Adrienne Gonzalez. This interview has been edited for length and clarity.
Tell me about the Bristol Myers Squibb Foundation and its health funding priorities.
Adrienne Gonzalez: The BMS Foundation is a separate 501(c)(3) entity from our primary donor company, Bristol Myers Squibb. Our north star is advancing health equity. We focus on facilitating access to quality health care for patients who live in underserved communities—recognizing that if you are in an underserved community, then your choices are going to be limited based on what you are able to access in terms of geography, but also in terms of finances and other practical considerations.
The strategic approach has two pillars. First is health systems strengthening—how do we help organizations address the barriers that are inside the walls of their clinic? Then second is community engagement and involvement—how do we help them address barriers that are within the community that impact a patient’s ability to access quality health care? We take a more holistic approach to advancing health equity because if you are only focusing on what’s happening inside the clinic, but ignoring things like social determinants of health, e.g., reliable transportation, then you are ignoring significant barriers to a patient’s ability to access quality health care, even if you are positioned as the health care institution to give them the best care possible.
Then we have our areas of grantmaking, both in terms of geography and therapeutic areas, which is informed by our donor company’s therapeutic areas. Right now, we conduct grantmaking in cancer, immunology, cardiology, and a large-scale diversity in clinical trials initiative. In terms of geography, we are focused here in the US, Brazil, China, and in 10 countries in sub-Saharan Africa.
Describe the burden of cardiovascular diseases (CVDs) in the United States.
Adrienne Gonzalez: Cardiovascular disease is the leading cause of death for men and women in the US. Once you go deeper, you realize that there are disparities within that fact that get exacerbated based on gender, race, and socioeconomic status. For example, African Americans are two to three times more likely to die of heart disease than their white counterparts. African Americans are 50 percent more likely to have a stroke compared to their white counterparts, and African American men are 70 percent more likely to die from a stroke than their white counterparts.
For example, the stroke belt, which is a region within the American southeast, has a 34 percent higher rate of cardiovascular disease than the national average. Imagine if you are an African American man living in an underserved community within the stroke belt. The data says that your risk of dying from a cardiovascular event is quite significant. When you are coming from a particular group and/or community coupled with living in a certain part of the country—all of those things further impact a risk already present for the general US population.
What are the challenges faced by underserved communities in accessing quality cardiovascular care?
Adrienne Gonzalez: I would take a step back because if you’re living in an underserved community, access to primary care is challenging enough. Then, accessing specialty care—be it for a cardiac condition or another condition that requires seeing a specialist—can be even more difficult for those patients. Be it geography, financial awareness, things of that nature that just make it harder. So you have patients being diagnosed with uncontrolled hypertension or atrial fibrillation, an irregular heart rhythm—both which are manageable chronic conditions—only after they’ve suffered a stroke, which as we know can be catastrophic. Some of the projects we fund look to reach those patients and increase their access to a specialist and/or a primary care health professional who can help them manage the condition.
How can philanthropy most effectively address and break down these barriers?
Adrienne Gonzalez: This is an ongoing conversation about the role of philanthropy and how that continues to evolve as the world changes and evolves. What remains true is recognizing that we are only one of the stakeholders that can participate—we can’t do it all on our own. Being newer to philanthropy, I appreciate the conversation about philanthropy challenging itself to reflect on the power dynamic, unconscious biases, and the unintended impact of some of our processes. We need to listen better and more thoughtfully to the communities that we are seeking to serve and be more mindful of the power dynamic between funders and our nonprofit partners. Our team recognizes that it’s a privilege to be able to make our living trying to make a difference and are guided by the notion of how we continue to “do good, better” so that we empower our partners to achieve the intended impact in the right way.
How does the BMS Foundation’s cardiovascular grant program drive equitable access to specialty care?
Adrienne Gonzalez: We have several projects that we’re funding in cardiovascular disease. Rather than giving you a laundry list, I’ll focus on two or three examples of projects we’ve funded and organizations that have thought about a particular area within cardiovascular health and the community that they’d like to serve. They have said, “What are some of the barriers inside the clinic and what are some of the barriers outside of the clinic that we think we can address with this intervention?”
For example, we are funding a project with the American Pharmacists Association Foundation (APhAF), on a project that spans 20 states. It is focused on atrial fibrillation, which is an irregular heart rhythm that increases the risk for having a stroke that often unfortunately goes undetected until a stroke or other cardiac event occurs. The symptoms can be mistaken for other things, so it becomes understandable why patients don’t realize that they have this condition. APhAF’s project leverages the relationship between community pharmacists and the community by expanding a pilot that couples atrial fibrillation screening with screening for social determinants of health (SDoH). The idea is that pharmacists are seeing these patients on a more regular basis. There’s a rapport there; there is an awareness of the other medications these patients are taking. It creates the opportunity to have the conversation, “Have you had XYZ symptoms? Would you be interested in or are you open to being screened for atrial fibrillation? Let me tell you what that is.” Also, communicating with the doctor’s office to say, “We screened this patient for AFib and this is what we found.”
The project involves thinking about those barriers inside of the clinic with the medical screening and outside of the clinic e.g., “Do you have reliable transportation getting here to the pharmacy and/or to your doctor’s appointments? Are you experiencing food insecurity? Are you experiencing housing insecurity?”
We are also funding a project with the American Heart Association (AHA) in a disease called hypertrophic cardiomyopathy (HCM), which has a genetic component. When we talk about patient awareness and education, think about family history. If you have no idea that this is a condition that runs in your family, how can you possibly have an intelligent conversation with your health care provider to say, “I’m aware that this runs in my family. What are the things that we can do? Who else in my family should get screened for it?”
Often, cardiomyopathies and cardiac events come on the general population’s radar when, for example, a young athlete collapses during practice or during a game, and there was no indication prior to that point that there might have been a cardiac issue. Now people are like, “My goodness, what is going on that a 17-year-old or a 21-year-old is collapsing during a routine football practice or during a basketball game?” To be clear, it’s not always hypertrophic cardiomyopathy. But it flags that this young person had a cardiac condition that was previously undiagnosed.
The AHA project has two pieces that we are supporting: there is a consumer awareness piece specifically focusing on African American and Hispanic college students where AHA has partnered with several Historically Black Colleges and Universities and Hispanic-serving institutions to increase awareness. The second piece is the creation of the first Outcomes Registry for Cardiac Events in Collegiate Athletes (ORCCA), which is being done in partnership with the University of Washington to get a handle on the incidence rate of cardiac events in collegiate athletes. The ORCCA team is also working to create an effective educational and awareness framework for athletic departments and the student-athletes themselves and their families. This seeks to increase awareness on the part of the target population, educate the broader community, and understand the extent of this condition. Right now, the data is quite sparse because historically, it has not been tracked in this way.
Tell me about the strategic collaborations and partnerships that have moved this work forward.
Adrienne Gonzalez: It goes back to respecting that our grantee partners are the ones who understand the community and understand the science behind the therapeutic disease area in which they’re focused. Whether atrial fibrillation, stroke, or hypertrophic cardiomyopathy, it is partnering with organizations that have substantive medical expertise and scientific expertise. When you are talking about underserved communities, you want to engage with those communities in ways that resonate with them. If you are talking to them at a level that doesn’t meet them where they are, you’re not going to connect with them. The organizations that we have funded, particularly in the cardiovascular space, have been very adept at understanding the importance of making medical knowledge approachable and relatable for the patients they are looking to serve.
Regardless of project type, it is that approach and that thinking that runs through all of our cardiovascular projects in terms of respecting and being thoughtful about the community they’re looking to serve, and then coupling that with medical and scientific knowledge.
What are the BMS Foundation’s next steps in addressing cardiovascular disease?
Adrienne Gonzalez: We will continue to be guided by where the need is and where we think we can make a meaningful difference. Unfortunately, just under 18 million people a year worldwide lose their lives to cardiovascular disease. That’s a lot of people that either don’t get served or didn’t get served in time.
While we are guided in part by where our donor company goes in terms of therapeutic areas, for us, it really is about how we can advance health equity in that space. If it is expanding access in rural communities and helping organizations that are getting more creative about how you facilitate that access in communities where the access has now been severely limited by closures, then that’s where we may go. But it may be in other directions, being guided by how we have the most meaningful impact where we can make the difference.
References
World Health Organization. “Cardiovascular Diseases.” Accessed March 28, 2024.
Centers for Disease Control and Prevention. “Heart Disease Facts.” May 15, 2023.