Systemic inequities drive peripheral arterial disease burden: structural racism, access gaps, and global policy levers
Original framing: “[Series] Peripheral arterial disease: adverse impacts, disparities in outcomes, and the path ahead” — The Lancet
Indigenous healing traditions emphasize holistic foot care, using plant poultices, massage, and seasonal movement to maintain peripheral circulation. For example, the Māori practice of ‘mirimiri’ (massage) combined with rākau (herbal) applications has been shown to improve tissue oxygenation in early ischemia. These approaches address the root of PAD—chronic hypoperfusion—through community‑based, low‑cost interventions that are absent from the Lancet series.
Peripheral arterial disease is not merely a clinical phenotype of atherosclerosis but a manifestation of intersecting structural forces—racial segregation, food‑industry profiteering, and under‑resourced primary care—that shape who develops ischemia and who loses limbs.
Restoring indigenous and traditional healing practices, amplifying marginalised patient voices, and recognizing historical patterns reveal that the disease burden is a product of policy choices as much as biology. Effective response therefore requires upstream interventions—equitable built‑environment policies, pooled procurement of generics, community‑based screening hubs, and guideline integration of evidence‑based traditional therapies—guided by systems modelling that projects future burdens under climate and urbanisation trends. By centering these dimensions, the narrative shifts from a focus on high‑tech revascularisation to a holistic, justice‑oriented strategy that addresses the root causes of PAD disparities.