Introduction From Edited Book                    

Handbook of Black American Health (2^nd Edition): Policies and Issues Behind Disparities in Health (2nd. Edition), Volumes I and II.  

Praeger, Westport, Connecticut, London, 2004 (www.praeger.com)

IBSN: 0-313-32477-- (set)

0-313-33220-7 (vol. I)

0-313-33221-5 (vol. II)

Foreword: Dr. David Satcher

On the international front, the 21^st century has ushered in many of the same occurrences of the previous century, economic strife, famines, military conflicts, sociopolitical turmoil, ill-health and various diseases. In terms of health conditions, the world is more interconnected today than it was before, hence from a public health perspective, the potential for rapid spread of infectious diseases like Severe Acute Respiratory Syndrome (SARS). What is spreading equally fast throughout the world, as well as in countries like the United States, which is the focus of this book, is the further dichotomizing of people into the "haves" and the "have nots." Although the focus of the book disallows any full elaboration on the reasons (e.g., slavery, racism, war, poverty) for this accelerated dichotomy, given the topic of interest covered in the book, this division has enormous implications for the growing racial and ethnic divide in terms of health disparities seen in the United States today.

"This higher burden of disease and mortality among minorities has profound implications for all Americans, as it results in a less healthy nation and higher costs for health and rehabilitative care. All members of a community are affected by the poor status of its least healthy members" (Smedley, Stith & Nelson, 2003, p. 31).

A relationship that has stood the test of time, is the inverse relationship between socioeconomic status (SES) and ill-health and disease. Low SES individuals (i.e., those who are relatively poor) have other attending social, psychological and physiological problems that serve to further confound and exacerbate the realities of the SES-health outcome relationship.

Whether the SES-health relationship is examined in the United States or elsewhere, the outcomes are the same, people who are poor and occupy the lower strata of the SES continuum, are more at risk to get prematurely sick or infirmed, require more medical care and, ultimately, have a disproportionately higher premature mortality rate than their counterparts who occupy middle and upper levels on the SES continuum. Sustained improvements in the SES-Health relationship can only be attained through a multilevel approach involving the government, private sector communities, the neighborhood/community agencies, and impacted individuals as well.

A Public Health War on Poverty                                                                                                                                                              One possible solution to the problem of inequities in health along racial and ethnic lines, is to literally wage a credible and lasting "war" on poverty. Basically, because of the extreme, long-lasting and destructive health-related effects of poverty, it should be defined in terms of a public health problem. This being the case, the war-like effort that is suggested will include the application of all necessary resources to its eradication. Such a war would have great implications for the health of minority populations, especially African Americans, given their disproportionate representation at lower levels on the SES continuum. However, for such a war to be successful, there has to be unprecedented agreements and cooperation on various fronts, including issues dealing with politics, economics, health, race, culture, mutual respect for each other, and the belief that adequate health care is a fundamental right, and not a privilege, for all Americans. Without such far-reaching agreements and commitments from leaders at the federal, state and local levels, as well as from the private sector, any successes achieved regarding the war on poverty will not be sustained and the racial and ethnic disparities in health will get progressively worse.

For the United States to successfully win its war on poverty, which involves a complex series of conditions, it has to address a fundamental issue that is undeniably linked, in part, to poverty. The problem I am referring to is institutional racism, where minorities, especially people of color, like African Americans, have been systematically and insidiously denied basic rights and opportunities. Therefore, it is the denial of these rights and opportunities, which in turn have contributed to their overall relatively dismal economic standings (i.e., compared to their White counterparts), that have played a large role in the conditions that are, then, responsible for the need for this book to be written with the ensuing theme "Eliminating Racial and Ethnic Health Disparities."

Although a "war" of sorts is being waged in the United States, for example at the level of the federal government with the Healthy People 2010 initiative, there still exists vast disparities in SES, ill-health and disease outcomes, especially for minority populations in general and African Americans in particular. This being the case, the question that needs asking is as follows: Is there a deep and genuine commitment by those in power to rectify the ills of the past, thereby allowing racial equality, among other things, to be achieved? Only with time can an accurate answer to this question be given.

Essentially, Healthy People 2010 presents a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a "roadmap" for improving the health of all people in the U.S. during the first and second decade of the 21^st century. Healthy People 2010 is committed to a single, overarching purpose – promoting health and preventing illness, disability and premature death.

Known Disparities in Health                                                                                                                                                                         The existence of significant racial and ethnic disparities in healthcare have been widely reported and documented in various government reports, including Healthy People 2010 (USDHHS, 2000) and " A Public Health Action Plan to Prevent Heart Disease and Stroke" (USDHHS, 2003). Most striking are the differences between the incidence and prevalence of many diseases affecting African Americans when compared to the U.S. population as a whole. Although life expectancy and overall health for most Americans have improved tremendously over the past two decades, there continues to be major disparities in the burden of disease/illness and death experienced by African Americans in this country.

The three leading causes of death in the U.S. in 2000 are heart disease, cancer, and stroke. In each of these categories, the African American death rate is significantly greater than the White rate (NCHS, 2002). In fact, when one looks at the ten leading causes of mortality in this country, the African American rate exceeds the White rate in every category except chronic obstructive lung disease, suicide and Alzheimer’s disease. The ten leading causes of death in the U.S. in 2000 for African Americans were: heart disease, cancer, stroke, unintentional injuries, diabetes, homicide, HIV/AIDS, chronic lower respiratory disease, kidney disease, and influenza and pneumonia. (National Center for Health Statistics [NCHS], 2002).

The plight of African Americans is particularly devastating and urgent because, as a group, they experience a disproportionate burden of poverty, sickness, and death. By way of summary statistics, one-third of Blacks live in poverty, a rate three times that of the White population (U.S. Bureau of the Census, 20000). Over half live in central cities, areas characterized by poverty, urban congestion, poor schools, a pervasive drug culture, unemployment, and stress. Additionally, diabetes is three times that of Whites; heart disease is more than 40 percent higher than Whites; prostate cancer is more than double that of Whites; HIV/AIDS is more than seven times that of Whites; breast cancer is higher than it is for Whites, even though African American women are more likely to receive mammography screening than are White women; and infant mortality is twice that of Whites (National Center for Health Statistics [NCHS], 2002). However, the best cumulative statistic that underscores the racial disparities in health is life expectancy, especially for Black males (68.3) who trail White males (74.8), Black females (75.0) and White females (80.0). (Minino & Smith, 2001). Again, the question begs asking, "Why do African Americans continue to manifest these vast disparities in morbidity and mortality rates?

Purpose of the Book

This volume is not intended to examine exhaustively all critical areas affecting the health of African Americans. However, as a call for action, its 47 chapters represent a variety of conditions and issues, all of which need serious examination in any attempt to achieve racial parity in health. For some skeptics who look beyond the posturing of program bureaucrats and technocrats and other like-minded persons, the belief is that the needed "seeds" have not been adequately sown to reap the intended harvest, especially as it relates to improvements in the health conditions of African Americans (and other Blacks) living in the United States. The Handbook of Black American Health: Policies and Issues Behind Disparities in Health, provides authoritative, factual, and insightful information and guidelines about a variety of "seeds" and how these seeds can, and should, be sown to reap the intended harvest of eventual racial parity in health for African Americans.

This 47-chapter volume is intended to show the complexity and scope of conditions and issues that contribute to racial and ethnic disparities in health. In the book’s comprehensive view, these conditions and issues include, but are not limited to, the leading causes of morbidity and mortality (e.g., cardiovascular disease, stroke, cancer). In keeping with the comprehensive view that needs to be taken in addressing the very complex problems associated with eliminating racial and ethnic health disparities, some infrequently addressed areas are included, such as: ophthalmology (especially the problem of glaucoma), the politics of health and health care, unintentional injuries, homelessness, environmental racism, rural America, organ transplantation and the human genome.

Organization of the Book

As a marked departure from the first edition written a decade ago, this edition includes a variety of new (e.g., human genome, complementary/alternative health, rural health) topical areas (20 in all), although not directly contributing to morbidity and mortality rates for African Americans do, in the long run, contribute vital information that could lower these rates over time. The book is divided under five Parts. For an example of the five major parts of the book, and a selection of topics that fall under each of these parts, see Figure 1. Chapters are grouped under each of the parts according to one or more commonalities. What follows is a brief overview of the chapters that fall under each of the five Parts of the book.

Figure 1 goes about here

In Part I, "Cardiovascular and Related Chronic Conditions," there are six chapters. This section holds priority status, because cardiovascular diseases are the number-one killer of all Americans. Chapter1, Richard Gillum, introduces the area with an overview of cardiovascular diseases. Chapter 2, Ivor Livingston and colleagues, looks at coronary heart disease from a social epidemiologic perspective, emphasizing salient risk factors and the need for lifestyle change in modifying these risk factors. Chapter 3, Gary Friday and Edgar Kenton, examines cerebrovascular disease in Blacks, which is the number three killer of all Americans. Certain types of strokes are discussed, along with treatment modalities and risk factors. In Chapter 4, Keith Norris and David Martins discuss hypertension in Blacks. They looked risk factors and discussed primary, secondary and tertiary ways of intervening to reduce its incidence. Community education was emphasized as an important mode of prevention. In Chapter 5, Lawrence Agodoa examines the issue of end-stage renal disease, discussing its causes, distribution, and treatment in the general and Black population. In Chapter 6, Eugene Tull Earl Chambers look at diabetes mellitus in the African American community, considering the different types of diabetes, the etiology of diabetes, and its risk factors and treatment modalities.

In Part II, "General Chronic Conditions," there are seven chapters. These chapters, with the possible exception of one (cancer), while not contributing as directly to overall mortality as the chapters in Part I, they, too, have an enormous impact on the long term racial and ethnic disparities in health. In Chapter 7, Ki Moo Bang, looks at cancer among Blacks examining its epidemiology and risk factors. In Chapter 8, Ki Moon Bang looks at chronic obstructive (COPD) disease and asthma in Blacks, examining their etiologies, risk factors and treatment modalities. In Chapter 9, Joseph Telfair looks at sickle cell anemia and uses a biopsychosocial model to suggest better ways to understand the disease and to intervene when it becomes necessary. In Chapter 10, Shaffdeen Amuwo and colleagues look at ophthalmology in Blacks, with an emphasis on selected entities. Some of these entities, which present differently and are sometimes disproportionately seen in Blacks, include cateract, glaucoma and diabetic retinopathy. The distribution of these entities are discussed, as are their risk factors and treatment. In Chapter 11, Marguerite Neita and Lateef Olopoenia discuss the epidemiology of immunologic disorders in Blacks (e.g., sarcoidosis), immune sensitivity reactions and risk factors contributing to the outcomes. In Chapter 12, Yolanda Slaughter and Joan Gluch discuss racial disparities in oral health and disease, at-risk behaviors for these diseases and public health strategies to reduce these disparities. In Chapter 13, Joan Payne and Carolyn Stroman present a discussion on communications disorders in Blacks, and issues in speech, language and hearing for African Americans.

In Part III, "Lifestyle, Social and Mental Outcomes," there are thirteen chapters. In Chapter 14, Donald Ware and Ivor Livingston present information as to why the Black male is oftentimes referred to as the "endangered species." Racial disparities in the morbidity and mortality of selected diseases are discussed and prevention strategies are presented. In Chapter 15, John McNeil and Kim Williams present an array of information on the social epidemiology and clinical aspects of HIV/AIDS and sexually transmitted diseases (STDs) afflicting African Americans. Prevention strategies are presented, as well as future trends in the area. In Chapter 16, Marian McDonald and colleagues present an expanded discussion and epidemiology on racial differences in selected infectious health outcomes (e.g., viral hepatitis, influenza), as well as various prevention strategies to adopt. In Chapter 17, Le’Roy Reese and colleagues, present the epidemiology of racial differences in various forms of intentional violence (e.g., homicide, suicide), where they normally occur, possible reasons for their occurrence and suggested prevention strategies. In Chapter 18, Christine Branche and colleagues discuss evidence as to racial disparities in various forms of unintentional injuries (e.g., drowning, falls, motor vehicle injuries). Risk factors were discussed along with prevention strategies.

In Chapter 19, Howard Chilcoat and James Anthony present epidemiologic evidence of racial disparities in the use of illicit drug and drug-related activities, co-morbidities and outcomes (e.g., arrests, HIV/AIDS). In Chapter 20, Frederick Harper and colleagues look at the racial differences in alcohol use and abuse, what groups are more at-risk, patterns of use/abuse and diagnoses and therapeutic intervention modalities. In Chapter 21, Jane Otado and colleagues look at risk factors for infant mortality and strategies for improvement. In Chapter 22, Colwick Wilson and David Williams presents a brief history of mental health in America and provides information on the multiple indicators of mental health for African Americans. In Chapter 23, Ivor Livingston and colleagues looks at the relationship between social status and stress and examines the implications for African Americans using a conceptual model. In Chapter 24, Deborah Blocker and Ivis Forrester-Anderson looks at nutrition concerns of African Americans, how these dietary habits predispose them to unnecessary sickness and disease, and ways to intervene. In Chapter 25, Carlos Crespo and Ross Andersen use national data sets to show how African Americans are disproportionately inactive and how this relates to higher racial and ethnic morbidity and mortality rates concerning their health. In Chapter 26, Diane Rowley and Yvonne Fry, look on the epidemiology of selected reproductive health problems for African American women, what are the risk factors involved, and ways of reducing these risk factors.

In Part IV, "Socio-Political, Environmental and Structural Challenges," there are twelve chapters. The topics covered by these chapters deal with events and conditions in the social and physical environment, as well as macrolevel challenges that urgently need addressing. In Chapter 27, Hector Myers and colleagues address the very important and support role the Black family plays in the health of the African American community. In Chapter 28, Akima Howard and colleagues addressed the complexities associated with disparities in medication use, action and prescribing for African Americans and the implications for disparities in health. In Chapter 29, Reynold Trowers looks at the dynamics associated with the use of the Emergency Department (ED), the procedures that need following and the implications for African Americans’ health. In Chapter 30, Richard English and colleagues, compared empirical data in assessing the plight of the African American homeless and the implications for their health. In Chapter31, Martha Crowther and colleagues, examine the role spirituality and religion play in the lives of African Americans and the implications for their health. In Chapter 32, Ron Manuel and Jacqueline Smith, using empirical data addressed health disparity issues between Blacks and Whites and within Blacks themselves. In Chapter 33, Mark Eberhardt examine the sometimes forgotten subject of rural health and African Americans and the ensuing implications.

In Chapter 34, Wade Boykin and Robert Jagers, use a program they are affiliated with to show the important relationship between the African Americans’

readiness to attend school, their academic achievements and the relationship to their overall health, moreso when they become adults. In Chapter 35, Eric Bailey and Jacqueline Watson examine current practices and trends regarding complementary and alternative health in the Black community. In Chapter 36, Vernetta Young and colleagues, not only speak about the disproportionate numbers of African Americans in prisons, but also address the experience behind bars and its relationship to ill health and disease. In Chapter 37, Sheila Foster, address the issue of environmental racism by reporting instances of its occurrence over the years, as well as its implications for poor health in minority communities. In Chapter 38, Brian Gibbs and Deborah Prothrow-Stith, show the importance of a working relationship between universities and people in the community to study and contain a variety of health related problems.

In Part V, "Ethics, research, Technology and Social Policy Issues," there are nine chapters that appear under this section. Chapters under this section deal with issues surrounding ethics, research, technology and social policy. In Chapter 39, Samuel Brown provides information on the evolution of American society, landmark social and political achievements and ways of closing the gap, thereby, reducing racial and ethnic disparities. In Chapter 40, Llewellyn Cornelius addresses the conditions that impact utilization and the implications for African Americans’ health. In Chapter 41, Sterling King and Richard Enochs, show how staffing, hiring and having adequate numbers of personnel in medical and related programs contribute to health disparities. In Chapter 42, Joseph Oppong and Sara Garcia, use geographic information system’s technology to identify and assess selected areas of disease disparities in the United States with an emphasis on Texas. In Chapter 43, Georgia Dunstan and Charmaine Royal explores how knowledge of the human genome can have beneficial consequences for diseases associated with African Americans. They also explore the ethical, legal and social ramifications of genomic research. The National Health Genome Center (NHGC) at Howard University is used as the focal point of the discussions. In Chapter 44, Clyde Callender and his colleagues discuss issues related African Americans need to have organ transplantation. They also discuss the problems associated with the transplantation process and ways of intervening to reduce risk factors both associated with the need for surgery, as well as with the transplantation process itself. In Chapter 45, Collins Airhihenbuwa and colleagues speak about the structural and other barriers that exist that contribute to health disparities and they identify strategies to successfully intervene. In Chapter 46, Oscar Streeter, along with his colleagues, discuss the complex issues surrounding clinical trials focusing on four selected conditions that have a high incidence in the African American community: heart disease, cancer, end-stage renal disease (ESRD) and HIV/AIDS. In the Chapter 47, Ivor Livingston and J. Jacques Carter provide the wrap-up information pertaining to the previous chapters and provide some insights, along with a conceptual framework/model, as to where we go in the future in addressing the complex issues surrounding the elimination of racial and ethnic health disparities.

This volume identifies a wide variety of conditions, issues and policies that both directly and indirectly influence the health of African Americans (or all Blacks living in the United States). It also offers prospects for the future. Consistent with the theme of the book, most of the chapters not only discuss the respective conditions, issues and policies that are detrimental to the health of African Americans, but they also offer information, guidelines and/or recommendations to remedy the problem. In many of the chapters (e.g., Chapters 2, 9,14, 17, 23, 27, 40, 47) original models are introduced as frameworks for action. Sixty-thousand plus excess deaths a year for African Americans is an excessive, unjust and immoral price to pay, especially when, as the richest nation on the earth, the "tools" exist to prevent this problem from occurring. Therefore, it is hoped that the vast array of information presented in this second edition will serve to further inform and reawaken the need to use these "tools" to achieve parity in health for all people of color in the United States, especially African Americans.

References

-   Minino, A.M., & Smith, B.L. (2001). Deaths: Preliminary data for 2000. National Center for Health Statistics, National Vital Statistics Reports,  49(12).

-   National Center for Health Statistics. (2002). Health, United States with chartbook on trends in the health of Americans. Hyattsville, MD: Department of Health and Human Services.

-   Smedley, B.D., Stith, A.Y., & Nelson, A.R. (Eds.). (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academy Press.

-   U.S. Bureau of the Census. (2000). Available at http://www.census.gov (Accessed March 15, 2003).

-   U.S. Department of Health and Human Services. (2000). Understanding and improving health (2^nd Edition). Washington, DC: U.S. government Printing Office.

-  U.S. Department of Health and Human Services. (2003). A Public Health Action Plan to Prevent Heart Disease and Stroke. Atlanta, GA: US Department of Health and Human Services, Center for Disease Control and Prevention