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Transcript of Health Disparities
The U.S. Religious Landscape Survey, conducted in 2007 by the Pew Research Center’s Forum on Religion & Public Life noted that 83% of African Americans are affiliated with a religion (DeShay).
Imange courtesy of DeShay.
African Americans are...
Social class and Status
According to the U.S. Census Bureau, 11.5% of African Americans live in government funded housing, 13.6% receive welfare assistance, and over 25% receive Food Stamps. 2.9 million African Americans are currently unemployed. In 2012, 28.1% of African Americans lived at or below poverty status. Medicaid is the most common health insurance for African Americans and coverage mostly consists of children as one in 5 African Americans are uninsured (Cumberbatch 2013). It is estimated that once fully implemented, the Affordable Care Act will provide coverage for 6.8 million African Americans (Cumberbatch 2013).
Image courtesy of DeShay.
African American observance of life events tends to align with that of the mainstream American culture. However, African funerals and death customs differ from those of American culture. Death is viewed as a homegoing rather than a finale to life. Homegoings are often followed by gatherings with food, music and dancing for a celebration of life. When a death occurs in an African American community, the entire community bands together to create support system and assistance in the decision making process for the family of the deceased. The cosmology of the African American culture affects perceptions of health. African Americans view illnesses such as diabetes and hypertension as the natural parts of aging instead of as preventable conditions (DeShay).
An overwhelming majority of the African Americans that are affiliated with a religion are Christian affiliated. In Christianity, many health issues are treated with prayer as Christians believe that God is in control of any obstacles that they encounter during their lives. Christianity also recognizes that there are medical issues that cannot be treated with prayer and need the assistance of medical professionals. Christians are often weary of medications out of fear of becoming over medicated and addicted to a substance but realize that medication can be used in addition to traditional prayer and it does not have to be one or the other. This is beneficial to the medical community when creating treatment plans for patients (DeShay).
What does this mean?
An astounding number of African Americans do not have a regular source of healthcare or the ability to maintain positive health behaviors due to lower socioeconomic status. African Americans have not been spared from the economic recession and their health has been greatly impacted.
When approaching the issue of health disparities in any culture, it is necessary to remember that the culture may not have the resources necessary to improve the problem. In African American culture, health promotion planners must begin with the devastating lack of positive health behaviors while living in poverty.
Morbidity, Mortality, and Disability Rates
African Americans experience the highest rates of hypertension in the world. Hypertension is known as the silent killer due to its presence without noticeable symptoms of illness. About 15% of African American adults are living with diabetes. In 2009 diabetes was the cause of death for 5,488 African American males and 6,472 African American females. In 2013 23.3% of African American males and 15.1% of African American women age 18 and older considered themselves to be smokers (GO AS).
African American women are at a greater risk than men are of developing cardiovascular disease. As of 2013, among African Americans age 20 and older, 68.7% of men and 79.7% percent of women are considered overweight and of these, 37.9% of men and 53.9% of women are considered obese. Among African Americans age 20 and older, 42.6% of men and 47.0% of women have High Blood Pressure. 33.9% of African American women report living an inactive lifestyle (GO AS).
African American culture exists on a present time orientation. This means that living in the present is very important to African Americans. Because of this, African Americans may not be able to see the future benefits of healthy behaviors today. One negative effect of living in the present is that there is little adherence to clock time. This makes it difficult to complete tasks on time and keep schedules, and attend appointments (Galanti).
Perceptions of Community
African Americans have a very strong sense of community and are often weary of outsiders coming into the community. Gaining the respect of the community can achieved by first approaching the head of the community. The head of the community is often a church leader or elder of a well respected family. Problems are often handled internally and the members of the community see the problems of one member as the problems of the entire community (Culture 2002).
What does this mean for health promotion program planners?
African Americans will not ask for help with community problems very often. They see it as a sign of failure for not being able to handle the problems of the community within the community. Researchers must explain that the program will benefit the community as a whole and that some problems cannot be handled within the community and require the help of professionals.
In an interview with the Huffington Post Khadijah Tribble stated of her experience living in Washington's Ward 8 near the Anacostia River, "Where I live, there is not a gym within two miles; there is one grocery store that serves 73,000 folks; there is high crime, which is a big deterrent for me being outside; and five rec centers, which are subpar at best. In terms of restaurants … there is an IHOP, a McDonald's, a Popeye’s, about six or seven Subways, a 7-Eleven, and maybe 10 to 15 carryouts" (Cumberbatch 2013).
Read more of the interview here:
The proximity of a fast food restaurant to an African American household has been linked to body-mass index. A study published in the American Journal of Public Health led by Lorraine Reitzel, Ph.D. reported that the closer an African American lives to a fast food restaurant, the higher the body-mass index. The study discovered that "on average there were 2.5 fast food restaurants within a half mile, 4.5 within a mile, 11.4 within 2 miles and 71.3 within 5 miles of participants’ homes." The study found that for every mile away from a fast food establish that African Americans reside, African Americans have a body-mass index 2.4% lower (MD 2013).
The accessibility factor is the main cause for this. African Americans live at low socioeconomic status and often do not have the transportation or financial means to seek healthier dining options. Grocery stores may be too expensive and too far away to travel to so therefore fast food is the only alternative.
Response to Illness
Western Healthcare and Health Promotion Use
The first response to illness in African American communities is to visit a traditional healer such as a herbalist, spiritual or supernatural healer. African Americans believe that there is a direct connection between the body and forces of nature. Therefore, African Americans will often take zodiac signs and numbers into consideration when making decisions about healthcare. Good health can be achieved by maintaining a balance among the mind, body, and nature. Illness occurs when the balance is disturbed. Many African Americans who reside in the Southern United States rely on the The Farmers Almanac for information about natural phenomena and illness. (Culture 2000).
African Americans believe in four main causes of illness "dirt", "cold", "improper diet", and "improper conduct." The "cold" is associated with the production of mucus and enters the body when it is must vulnerable such as after childbirth for women. There is also the belief that the "cold" can enter the body when an individual is young but not manifest until the individual is older. "Dirt" is associated with germs that circulate in the blood. "Dirt" can be acquired through unhealthy habits such as failure to bather, irregular menses and sexual intercourse. "Improper diet" is known as high blood and low blood and are treated with home remedies and changes in diet. High blood is associated with a diet of rich and reddish foods. Low blood is associated with anemia. "Improper conduct" is expressed as behavior and physical abnormalities in children as punishment for the parents wrongdoings (Culture 2000).
The Tuskegee experiments on African Americans has left a significant imprint on the African American views of Western healthcare. African Americans have a difficult time disclosing personal information about health to medical professionals. It is important for medical professionals to build a trusting relationship with any patient but especially important with African Americans in order to ease any fears of Western medical practices. African Americans appreciate the inclusion of a spiritual leader when making decisions about medical care as religion is very important (Carteret).
Health Behavior Practices
As many African Americans live in low socioeconomic status, it is difficult to maintain positive health behaviors, seek preventive care and access regular healthcare. African Americans consume large amounts of fast foods but live sedentary lifestyles with serious medical conditions.
African American health behaviors towards mental health are not positive. Due the absence of health insurance, African Americans often visit the emergency rooms of hospitals for psychiatric care. The quality of care received is not top notch because emergency room physicians are not trained psychiatrists or psychologists. There is also a social stigma against seeking treatment for mental health. African Americans view themselves as a resilient people and receiving help for mental illness is viewed as sign of weakness (Williams 2012).
African Americans are faced with life in low socioeconomic status. African Americans have high rates of diabetes, hypertension, and obesity. Preventive healthcare is not easily accessible for African Americans and fast food is all too accessible. Poor lifestyle habits such as inactivity, smoking and high quantities of fast food consumption have led to negative health outcomes in the African American community. These are all factors that contribute to cardiovascular disease.
Predisposed to a variety of cultural, environmental, and physical health challenges that contribute to the development of cardiovascular disease.
A study conducted by the Diabetes Prevention Program Research Group investigated methods than can be used to lower the incidence of diabetes in African Americans. The study discovered that a healthy life style is the most effective method in preventing and controlling diabetes in African Americans. This is important for health promotion program planners because Diabetes is a risk factor for cardiovascular disease. The planners will be able create programs that encourage healthy lifestyles (Diabetes 2002).
Heart Failure Study
African Americans develop heart failure at younger ages than any other racial groups. The Atherosclerosis Risk in Communities (ARIC) study investigated the differences in cardiac structure and function, clinical characteristics, and prognosis in a sample of African-Americans with preserved ejection fraction and African-Americans with heart failure and reduced ejection fraction. This study is significant to health promotion program planners because the study discovered that preserved ejection fraction and reduced ejection fraction are distinct cardiovascular conditions. Health promotion planners will need to learn which condition is the most common in the community that the program will be implemented in (Gupta et al. 2013).
Working with an African American population requires patience, respect, and trust. When developing programs for lowering the incidence of cardiovascular disease in African Americans, it is important to examine the differences in the rates in men and women. Studies have shown that active lifestyles can lower risk factors for cardiovascular disease but many African American communities do not have the resources for this lifestyle.
Communities need healthy food options and safe recreation spaces to encourage positive health behaviors such as exercise and socialization. Access to preventive care is also important. A far too large number of African Americans do not have access to preventive care and a lack of preventive care can damage health at young ages which will lead to poor health in adult life.
(2002). Culture-Sensitive Health Care: African American. In What Language Does Your Patient Hurt In?: A Practical Guide to Culturally Competent Care. Retrieved from http://www.diversityresources.com/health/african.html
Carteret, M. M. Ed. Heath Care for African American Patients/Families [Web log post]. Retrieved from http://www.dimensionsofculture.com/2011/05/health-care-for-african-american-patientsfamilies/
Cumberbatch Anderson, J. (2013, July 23). Black Health Rx: Finding A Cure For America's Health Disparities. The Huffington Post. Retrieved from http://www.huffingtonpost.com/2013/07/23/black-health_n_3633248.html
DeShay, Akiim. Interesting Facts About the African American Population. Retrieved from http://blackdemographics.com/
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine, 346(6), 393.
Galanti, GA. (n.d.). Concepts [Supplemental Material]. Retrieved from http://www.gagalanti.com/concepts.html
GO AS, Mozaffarian D, Roger VL, Benjamin EJ et al.; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2013 Update: a report from the American Heart Association. Circulation. 2013; 127:e6-e245.
Gupta, D. K., Shah, A. M., Castagno, D., Takeuchi, M., Loehr, L. R., Fox, E. R., ... & Solomon, S. D. (2013). Heart failure with preserved ejection fraction in African Americans: the ARIC (Atherosclerosis Risk in Communities) study. JACC: Heart Failure, 1(2), 156-163.
Martin, R. MD. (2011, December 20). Why does heart disease disproportionately affect African-Americans? [Video file]. Retrieved from
MD Anderson News Release. (2013, May 16). Lower-income African-Americans living close to a fast food restaurant may have higher BMI. Retrieved from the University of Texas MD Anderson Cancer Center website: http://www.mdanderson.org/newsroom/news-releases/2013/higher-bmi.html
Theodros, Abby. (2013, May 22). Fast food distance linked to high BMI among African Americans. Medill Reports Chicago. Retrieved from http://news.medill.northwestern.edu/chicago/
Williams, M. (2011, November 2). Why African Americans Avoid Psychotherapy. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/colorblind/201111/why-african-americans-avoid-psychotherapy
Video courtesy of the