Health
Disparities and African Americans
Ivor Lensworth Livingston, Ph.D., M.P.H., C.H.E.S., Medical Sociologist/SocialEpidemiologist
Thos
e
of us in the health and related professions have become accustomed to the increasingly
used phrase "reducing health disparities" between minority and
majority groups in the United States. In the case of African Americans, the
disparities that set them apart when compared to their white counterparts, has
and continues to be staggering. For examples of how the federal government is
addressing these racial disparities click on the following sites (Please
note that there are no reciprocal links between these site and this web page;
therefore, in order to return to this address, web page or URL
(http://www.africanamericanstress.com) you have to hit
the back arrow on your browser): NHLBI
Strategic Plan to Address Health Disparities; NIDA
- Strategic Plan on Reducing Health Disparities.
As a Medical Sociologist/Social Epidemiologist, I have been influenced by many statistics and quotations that underscore the issue
of racial disparities in America. One such statement had to do with the position
expounded in 1984 by then Secretary of Health, Education and Welfare, Margaret
Heckler, that approximately 60,000 deaths in the African American community
could be avoided each year if African Americans had socioeconomic conditions
similar to their white counterparts.
The unfortunate tragedy of the past 20th
century and the present 21st century, is that Africa
n Americans get sicker
earlier and die from many of the known killer diseases
and afflictions of industrialized countries. Like many of my colleagues, I have
addressed some of these and the reasons for the disproportionate morbidity and
mortality rates in the 30+ scientific publications and books I have written over
the last 15 years. These articles have been published in a variety of journals,
for example: Journal of the National Medical Association, Ethnicity and Disease,
Journal of Counseling and Clinical psychology, Pediatric AIDS and HIV Infection,
to only mention a few. I have also written two books on stress, which have been
primarily directed to a more commercial audience. The first book is entitled,
"The ABCs of Stress Management - Taking Control of Your Life"
(which is being revised and should be available on or before the fall of 2001)
and 
"Understanding
Stress Using Pointed Illustrations." For more on this book
as well as various other stress-related items for sale (e.g., audio tapes, video
tapes, posters, etc.) see Products. While I have addressed the importance of stress and its
relationship to hypertension in the African American community, other notable
and related subjects have included: violence,
alcohol consumption,
end-stage
renal disease (ESRD) and HIV infection and AIDS. As reflected in the various
articles I have written over the years, stress has been presented as a
major antecedent variable in both the onset and exacerbation of the majority of
illnesses and diseases African Americans experience
.
The theoretical position I have exposed in these publications has been directed
by a Psychophysiologic Model of Stress that
I developed over ten years ago and which has been refined as the years have
accumulated.
To see the abstracts of a
select sample of some of my published scientific article click on Abstracts.
A more definitive coverage was made of the vast majority of health and related
conditions that reflect the disparities between African Americans and White
Americans in my widely acclaimed edited book entitled, "Handbook of African
American Health - The Mosaic of Conditions, Issues, Policies and
Prospects," which was published by Greenwood Press (Westport, Connecticut)
in 1994. For the wide array of subjects covered in this 27-Chapter reference
text, click on Table of Contents.
Any
serious and meaningful attempt at beginning to understand the complexities
associated with the issue of racial disparities have to most definitely include
an eclectic and multifaceted view including an appreciation of the dynamic
interplay of both macro (or societal) and micro (or individual) forces. An
example of macro or societal factors is the issue of accessibility and
availability to important health resources. Although today vast numbers of
poor and other African Americans (as well as other racial and ethnic groups) are
non-conspicuously denied access to information, screening and surgical
procedures related, for example, the preventive cardiovascular procedures (such
as catherization), this issue of denial of access to critical health resources
even worse before the 1960s. For example, it was not not until the enactment of
the Civil Rights Act of 1964 that African Americans in the deep South were
permitted to receive medical care in hospitals and other related facilities on a
non-segregated basis. It has been said by researchers associated with the
American Stress Institute in Yonkers New York, that approximately 75 percent of
the times people visit their doctors that these visits are stress-related. If
there is any hope for reducing the racial disparities in health, it lies in the
fact that many of the health problems African Americans experience are to a
degree lifestyle related, and a vast majority of these problems are
stress-related. This being the case, with the correct health education, as well
as macro-level interventions, many of the illnesses and diseases African
Americans experience can be avoided, if not controlled and reduced to lower
levels than what currently exists.
In 1984 the seriousness of the
disparity in health status of minority and white citizens was recognized with
the formation of the now famed Secretary's Task Force on Black and Minority
Health in the then Department of Health, Education and Welfare (or DHEW), which
is now called the Department of Health and Human Services (or HHS). In the
published 1985 Task Force Report, six areas were identified that account for
excess deaths for Africans compared to their white counterparts. These
areas included the number one, two and three killers of all Americans (crude
rate estimations versus specific rate estimations) - cardiovascular diseases
and stroke (1) and cancer (2). The other areas were chemical
dependency (3); diabetes (4); homicide, suicide and unintentional
injuries (5); and infant mortality. Acquired Immune
Deficiency Syndrome or AIDS was later added to the list when it was
recognized that minorities represent over 40 percent of the cases of people with
AIDS in the United States. In 1985 the Office of Minority Health (OMH) was
created to spearhead the development of programs in an effort to facilitate the
implementation of the Task Force's recommendations. See The
Office of Minority Health Resource Center.
"African American men suffer much higher rates of
almost every type of cancer than white men, and they're more likely to have
heart disease and high blood pressure," said Secretary Thompson. "Theses
leading causes of death are largely preventable through changes in our lifestyle
choices. The 9 A Day campaign will help us to start emphasizing prevention of
this epidemic by letting African American men know the vital importance of
eating fruits and vegetables to their overall health."
"We must not ignore the excessive burden of cancer in
black men," said von Eschenbach. "Black men have the highest
rates of prostate, lung, colon, oral, and stomach cancers and are over 140
percent more likely to die from cancer than white men. Since we recognize
one-third of all cancers are related to diet, this is one area that demands our
attention. By eating 9 servings of fruits and vegetables a day, the risk of
diet-related diseases affecting the African American community can be
lowered."
