A conversation on matters of the heart
Barbra Streisand is one of the most celebrated individuals in the history of the entertainment industry. The voice alone is considered by many to be a singular sensation. Streisand has sold more albums in the United States than any other female recording artist. Her awards are sweeping: from Oscars and Emmys to Grammys and a Tony, along with the Presidential Medal of Freedom.
Since the beginning of her career on the Broadway stage, Streisand has been a stalwart supporter of civil rights and humanitarian causes.
The well-known political activist and philanthropist has donated millions to a wide range of causes for social justice. Her activism dates back to the ’60s, at the start of her career. In 1965 she sang at the civil rights benefit “Broadway Answers Selma,” which featured special guest the Rev. Martin Luther King Jr.
Streisand embarked on a new mission, to bring gender equity to women in health care, when she learned that women were second-class citizens in medicine and research. To change that, in 2012 she created the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles.
But she also wanted to raise awareness among women before they found themselves in the hospital, and she wanted to help drive policy change at every level — local, state and national. That’s why in 2014, she joined forces with businessman and philanthropist Ronald O. Perelman to found the Women’s Heart Alliance. Their mission is to prevent women from needlessly facing and dying from heart disease and stroke. WHA focuses on health differences between women and men, and promotes activities that spread knowledge and create change, whether working with local communities, college students, medical professionals or policymakers.
In this special issue of Stanford Medicine on gender and biomedicine, we were looking for a voice that would add distinction and passion to the subject. What better voice is there than Streisand’s? Executive editor Paul Costello and Barbra Streisand exchanged emails in this Q&A.
Costello: Some readers may be surprised to see Barbra Streisand in a biomedical magazine, but you are a longtime advocate for gender equality in biomedical research and health care, including cardiovascular disease. What led to this focus?
Streisand: I am passionate about fighting gender discrimination in all forms and improving women’s lives, a commitment that goes back to my 40s when I made a movie based on Isaac Bashevis Singer’s story of Yentl, a young woman who has to pretend she’s a man to get an education. Initially, multiple studios turned me down. No one believed that a woman could direct or manage a budget. That fueled my determination to help women get the same chances in life as men.
Many years later, I was staggered to learn about a problem called “Yentl syndrome,” a phrase coined by cardiologist and former director of the National Institutes of Health Bernadine Healy. Dr. Healy found that women experiencing heart attacks got worse care than men. Women’s heart attack symptoms often differ from men’s, but unless a woman presented with symptoms that looked like a man’s, too often, she was misdiagnosed or undertreated.
With heart disease, women aren’t getting the same chance in life, literally.Costello: How so? How would you describe the scope of the
Streisand: Most people are stunned to learn that cardiovascular disease is the No. 1 killer of women in the United States, claiming more women’s lives than all cancers combined. One in three women die of heart disease and stroke. That’s one woman almost every 80 seconds — reflecting gaps in awareness, prevention, diagnosis, treatment and support. African-American women are especially at risk. And rates of heart disease in younger women are climbing.
So, CVD isn’t a “man’s disease.” This epidemic targets women, too. And its impact is exacerbated by the lack of knowledge and awareness among some medical professionals. For example, when women having heart attacks go to the emergency room, too often they do not receive the correct diagnostic tests or treatments. It’s common to hear stories of women experiencing a heart attack, receiving an antacid in the ER and being sent home.Costello: Why don’t more women know about their risk?
Streisand: One reason is that women aren’t encouraged to share their stories of heart disease, so we don’t realize how many people we know are affected. And, without that personal connection, it’s harder to rally a movement to fight it. But because we aren’t aware of the risk, we miss opportunities to safeguard ourselves and save the lives of women we love. It’s a devastating cycle.
That’s why one of our first WHA initiatives was a campaign to encourage every woman to get her heart checked — to talk with her doctor, know her risk factors, and learn how to fight and prevent heart disease and stroke.
But for those conversations to have their fullest impact, we need an enabling environment. That means improving access to and quality of care. It means curriculum reform in medical schools so that doctors and other health care professionals have a better understanding of women’s hearts. It means more research on sex differences in heart disease. And it means more support to help women take up and maintain the behaviors that will make a positive difference for their heart health.
WHA is working on all these fronts, and reaching out to every sector of society. We want to mobilize collective action on behalf of women’s lives.Costello: What do you mean by collective action?
Streisand: Improving heart health is everybody’s responsibility — because CVD is everybody’s problem. Beyond the human cost, there’s an economic toll as well. Nationwide, according to the American Heart Association, the annual costs of lost productivity due to CVD are $237 billion and growing.
Everyone has a part to play in turning this trend around. Employers can sponsor wellness programs at work; faith- and community-based organizations can help with outreach and engagement; local officials can promote heart-healthy development in their communities, such as walkable neighborhoods, public recreation space and farmers markets. Advancing women’s heart health is a team effort!
This February, the WHA launched an exciting new initiative called Cities/Communities with Heart that will address women’s heart health in mid-sized cities, using this collaborative model.
We’re starting in Nashville, Tennessee, where we’re working with Nashville’s wonderful mayor, Megan Barry; the health department, as well as the city’s many hospitals, health systems and clinics; academic institutions; business leaders; and faith-based and civic organizations.
Together, we identified five interventions for 2017: a program to improve the cardiovascular health of nurses at major hospitals and health systems; a clinical study on pregnancy complications and their link to CVD risk factors and CVD; a workforce health initiative to improve the heart health of female municipal workers; a screening and prevention effort in collaboration with Tennessee State University to reduce CVD and its precursors in younger women; and a community initiative centered around one or more health centers and reaching African-American, immigrant and refugee women.Costello: Is there any research that you want to see undertaken?
Streisand: For starters, we need more resources put to women’s heart research. Heart disease kills many more women than cancer does, yet in 2011, the NIH spent nearly $959 million on women’s cancer research, but only $246 million on women’s heart disease. I don’t want cancer research funding to go down, but heart disease funding should go up!
Second, we need more women participants in clinical trials. How can we optimize diagnostics and therapeutics for women if we’re not studying them in the lab?
We also need to study the differences between men and women. Take MINOCA — myocardial infarction with nonobstructive coronary arteries. People typically think of heart attacks as resulting from clogged arteries. But women’s arteries are unobstructed in up to 50 percent of acute coronary syndromes. That’s a real contrast with men. If we better understood what causes MINOCA, we could devise better tests, better prevention and better treatments. And that would be better for everyone.
Costello: You’re truly a believer.
Streisand: I am. We can do this. We can beat women’s heart disease. Because, in many ways, we have the cure already. Eighty percent of the risk of heart disease is preventable. Those are encouraging odds.
Prevention is cure.
So let’s provide more proactive screening and support. Let’s equip people with the information to make heart-healthy choices — things like quitting smoking, eating healthier, keeping cholesterol in check, getting on and staying on medication for high blood pressure, and keeping physically active. And let’s take inspiration from the breast cancer fight, which has helped bring down deaths by a third from their peak. If we focus people’s minds on the battle for women’s hearts, then, together, we can save women’s lives.