Health Issues in the Black Community

Health Issues in the Black Community

by Ronald L. Braithwaite

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Health Issues in the Black Community

Third Edition

Ronald L. Braithwaite I Sandra E. Taylor I Henrie M. Treadwell

Health Issues in the Black Community

"The outstanding editors and authors of Health Issues in the Black Community have placed in clear perspective the challenges and opportunities we face in working to achieve the goal of


Health Issues in the Black Community

Third Edition

Ronald L. Braithwaite I Sandra E. Taylor I Henrie M. Treadwell

Health Issues in the Black Community

"The outstanding editors and authors of Health Issues in the Black Community have placed in clear perspective the challenges and opportunities we face in working to achieve the goal of health equity in America."
— David Satcher, MD, PhD, 16th Surgeon General of the United States and director, Satcher Health Leadership Institute at Morehouse School of Medicine

"Eliminating health disparities must be a central goal of any forward thinking national health policy. Health Issues in the Black Community makes a valuable contribution to a much-needed dialogue by focusing on the challenges of the black community."
— Marc Morial, Esq., president, National Urban League

"Health Issues in the Black Community illuminates comprehensively the range of health conditions specifically affecting African Americans, and the health disparities both within the black community and between racial and ethnic groups. Each chapter, whether addressing the health of African Americans by age, gender, type of disease, condition or behavior, is well-detailed and tells an important story. Together, they offer practitioners, consumers, scholars, and policymakers a crucial roadmap to address and change the social determinants of health, reduce disparities, and create more equal treatment for all Americans."
— Risa Lavizzo-Mourey, MD, MBA, president, Robert Wood Johnson Foundation

"I recommend Health Issues in the Black Community as a must-read for anyone concerned about the future of the African American community. Health disparities continues to be one of the major issues confronting the black community. This book will help to highlight the issues and keep attention focused on the work to be done."
— Elsie Scott, PhD, president of the Congressional Black Caucus Foundation

"This book is the definitive examination of health issues in black America—issues sadly overlooked and downplayed in our culture and society. I congratulate Drs. Braithwaite, Taylor, and Treadwell for their monumental book."
— Cornel West, PhD, professor, Princeton University

Editorial Reviews

Library Journal
This review of African American health concerns brings together 25 original essays by leading experts in the field. Introductory essays present a grim statistical portrait of current black health status and needs. Other essays deal with women's health issues, AIDS, substance abuse, chronic diseases, homicide and violence, lead poisoning, sickle cell anemia, child health issues, health of the aged, health education, reproductive rights, and health policy concerns, among other issues. This much-needed work is essential for most academic and health science collections, as well as public libraries with subject demand.-- Judith Eannarino, Washington, D.C.
Updating and revising the 1992 first edition, this volume addresses the social, political, and economic factors that contribute to the many health issues faced by black Americans. A foreword by the Reverend Jesse Jackson is followed by 26 essays, organized into five sections: health status across the life span; social, mental, and environmental challenges; chronic disease; lifestyle behaviors; and ethical, political, and ecological issues. Contributors include physicians, sociologists, public health workers, psychologists, epidemiologists, administrators at the Centers for Disease Control and Prevention, and others. Annotation c. Book News, Inc., Portland, OR (
Doody's Review Service
Reviewer: Janine Lewis, BS, MPH, PhD (cand)(University of Illinois at Chicago School of Public Health)
Description: This book provides a composite of black health in the United States, over the lifespan, and uses a socio-ecological approach to present the current state of affairs and provide direction on best practices in addressing the persistent disparities. It also frames health as a result of a dynamic relationship between individual risk/facilitative behaviors and the environment in which people live, work, and play.
Purpose: The purpose is to 1) provide "a forum for debate and discussion for the prevention of disease," 2) "influence opinion leaders and provide a futuristic perspective on black health issues," and 3) "document selected unhealthy conditions and advance viable strategies for ameliorating them." Given the disparities that continue to exist in black health, especially black male health, these are certainly worthy objectives. Until we can see the true extent of the problem, we cannot seek to address it in any sustainable way. The book meets these objectives with comprehensive and thoughtful chapters by authorities in the fields.
Audience: The authors suggest a broad audience that includes "students, academicians, public policymakers, and administrators in public health and related disciplines." The book will be of most use to students, for example, enrolled in a health disparities course. The information also could be of practical use to practitioners such as public health officials at state or local agencies, or representatives at community-based organizations seeking to write a needs assessment as part of a grant proposal with blacks as a target population. The three editors have collaborated on previous editions.
Features: The book provides an overview of the major causes of morbidity and mortality among blacks in the U.S., insight into risk factors related to lifestyle choices, and a review of emerging methods to address health disparities. The best features are the discussions of how community health workers can be employed as a cost-effective way to infuse culturally relevant health messages and practices into the community, and how social marketing is an important methodology that can be used to reduce disparities. The book could have incorporated more social justice points within chapters, instead of focusing such language in the preface and afterword. It also should have included some mention of the stark disparities in black birth outcomes (i.e., infant mortality, low birth weight, preterm birth). On a minor note, the front cover picture of a shopping district with high-end stores does not correlate well with the content.
Assessment: The chapters are relevant, cutting-edge, thoughtful, and well researched by experts in the field. The information is clearly presented and could easily be used for proposals and policy documents as well as research papers. Unfortunately, there has not been as much improvement in black health as public health researchers and practitioners would have liked since the previous edition seven years ago. Thus, a new edition and a new approach focused on the individual-community interaction are required.
From the Publisher
"This is an important book—a vital source for policy makers and for all citizens concerned with issues of importance to the nation and to the black community." —John E. Jacob, president and CEO, National Urban League, Inc.

"This timely, well-researched book will provoke discussion and clarify the thoughts of all who are grappling with the health problems of African Americans. Community health workers will find it a user-friAndly compAndium that offers practical solutions to problems they encounter." —John M. Last, past president, American College of Preventive Medicine

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Chapter Two: The Health Status of Children and Adolescents


Approximately 2.7 million children and adolescents in this country have asthma (Gergen & Evans, 1988). In addition to being the leading chronic disease among youths, asthma is responsible for the majority of days lost from school (Fowler, Davenport, & Garg, 1992) and contributes significantly to the number of emergency room visits and hospitalizations. Data from the 1987 National Medical Expenditure Survey reveal that annually children with asthma obtain 3.1 times as many prescriptions, make 1.9 times as many ambulatory provider visits, have 2.2 times as many emergency room visits, and are hospitalized 3.5 times as often as children without asthma. On average, children with asthma incur about $1,129 in annual health care costs as compared to $468 for children without asthma (Lozano, Sullivan, Smith, & Weiss, 1999).

Minority children, particularly those who are poor and living in urban environments, are disproportionately affected by asthma. African Americans and Hispanics have five times more hospitalizations than whites and are four to five times more likely to die from asthma (Gergen & Weiss, 1990; Weiss, Gergen, & Crain, 1992).

Exposure to indoor allergens and pollutants such as dust mites, tobacco smoke, and cockroaches (Malveaux & Fletcher-Vincent, 1995) may contribute to the exacerbation of asthma. A study of 611 asthmatic children from eight cities found that 85 percent of them lived in homes with detectable cockroach antigen (Rosenstreich, Eggleston, & Kattan, 1997). Cockroach populations are highest in crowded urban areas (Sarpong, Wood, & Eggleston, 1996). African American race is an independent predictor of cockroach exposure and sensitization (Sarpong et al., 1996), suggesting either that African Americans are likely to have been exposed to a particularly potent cockroach antigen or that they have a specific genetic predisposition to sensitization that may initiate an immunological cascade resulting in asthma (Miller, 1999).

Although indoor allergens and pollutants are significant, the presence of external environmental toxins is also important to mention. Compared to nonurban children, children living in urban areas may be greatly exposed to higher levels of air pollution, in part fueled by the exhausts of cars, buses, trucks, and factories (Northridge et al., 1999).


National Health and Nutrition Examination Survey (NHANES) III data reveal that 4.4 percent (or 930,000) of the children in the United States between the ages of one and five have elevated lead levels (> 10 ug/dl). Children one to two years old have the highest rates of lead poisoning (5.9 percent). Poor children are eight times more likely than affluent children to have elevated lead levels. African American children are five times more likely than white children to have elevated lead levels. A primary reason for this disparity is the clustering of poor families, often African American, into substandard housing, where water damage-and moisture often cause deterioration of the walls leading to peeling and cracking of paint. About 64 million homes still contain lead paint, and about 15 percent of homes have lead in pipes, faucets, or well pumps (Spake & Couzin, 1999). Younger children may ingest lead directly by drinking water contaminated by lead in the pipes or by eating paint chips or indirectly by playing with toys contaminated by lead dust particles (CDC, 1997).

Ingested lead from any source can affect the developing brain, leading to hyperactivity, attention-deficit disorder, and aggressive behaviors. It is estimated that 20 to 30 percent of children in special education have been affected by significant lead exposure. Children with elevated lead levels are six times more likely than others to have learning disabilities and seven times more likely to drop out of school (Spake & Couzin, 1999). Aggressive children may grow up to become bullying adolescents and to engage in antisocial activities such as vandalism, arson, and shoplifting.

Adolescent Sexuality

The 1997 Youth Risk Behavior Survey (YRBS) indicates an 11 percent decrease in the number of teenagers who are sexually active by the age of nineteen. Although African American teenagers are more likely than white teenagers to be sexually experienced, similar declines in sexual activity have also been noted among African American teenagers (from 81 percent to 73 percent).

Although there has been significant improvement overall in the use of contraception, much of that gain has been due to use of condoms. Use of condoms increased 23 percent overall from 1991 to 1997. The percentage of African American adolescents using condoms at last intercourse (64 percent) exceeded that of whites (56 percent) and Hispanics (48 percent) (CDC, 1998b).

It is important to note, however, that the rates of use of other contraceptive methods have fallen. The use of oral contraceptive pills (OCPs), for example, decreased by 4 percent between 1982 and 1995, with the largest decline noted among young African American women less than twenty-five years of age (Abma, Chandra, Mosher, Peterson, & Piccinino, 1997). The percentage of teenagers using OCPs fell by 15 percent (from 59 percent to 44 percent) between 1988 and 1995. Among young women aged twenty to twenty-four, the percentage dropped from 68 percent to 52 percent during the same time period. Over the same period, OCP use decreased by 60 percent among African American teenagers and decreased by 36 percent among young women aged twenty to twenty-four (CDC, 1998c).

Gonorrhea and chlamydia are two sexually transmitted diseases (STDs) that disproportionately affect African Americans. Although both can be easily treated with a short course of antibiotics, there are serious, long-term consequences for both males and females if these infections go undetected and untreated. Complications for females include pelvic inflammatory disease, ectopic pregnancy, and sterility, and males are at risk for orchitis and sterility. These potential dangers underscore the need for widespread screening for these diseases, particularly among adolescents of color, who suffer the highest rates of infection (Neinsten, 1996).

Although pregnancy rates have also decreased (CDC, 1998a), about one million teenagers become pregnant annually (Moore, 1996). Forty percent of adolescent females of color will become pregnant at least once before age nineteen, as compared to 21 percent of white females (Henshaw, 1997). Almost 90 percent of all teen pregnancies are unintended (Moore, 1996). In general, about 51 percent of teen pregnancies end in live births, 35 percent in induced abortions, and 14 percent in miscarriages or stillbirths (Moore, 1996).

Between 1992 and 1995, birthrates dropped for teens fifteen to nineteen, with the largest percentage decline (24 percent) noted among African American teens, compared to 17 percent for white teens (Ventura, Martin, Curtin, & Mathews, 1999). Rates have stayed constant for younger teens (Moore, 1996). The U.S. teen birthrate in 1997 (52.3 per 1,000) is still higher than the rate in 1980 (50 per 1,000) and is higher than in any other industrialized nation. Rates for African American adolescents (90.8 per 1,000), although lower than the rates for Hispanic adolescents (97.4 per 1,000), are about twice that of white adolescents (36 per 1,000) (Ventura et al., 1999).

Once a teen is pregnant, she is at increased risk for a subsequent pregnancy. Twenty-two percent of births to teens are not first births (Moore, Papillo, Williams, Jager, & Jones, 1999), although the live birthrate has declined by 16 percent since 1991 (Ventura et al., 1999).

Eighty-three percent of teens who give birth and 61 percent who have abortions are from poor and low-income families. One-third are products of teen pregnancies themselves. Between 50 and 60 percent of teens who become pregnant have a history of physical or sexual abuse (Alan Guttmacher Institute, 1994)...

What People are saying about this

From the Publisher
"The truth hurts but silence kills. Braithwaite, Taylor, and the contributing authors of Health Issues in the Black Community have issued a wake up call to us all. All nations must wake up and deal with the health disparity gap with truth, dignity, and equity."—Desmond Tutu, Archbishop Emeritus, Cape Town, South Africa, Nobel Peace Laureate, 1984

"Drs. Braithwaite and Taylor have done it again with the Second Edition of Health Issues in the Black Community. This book examines the specific health care needs of African Americans at the same time that it offers practical solutions and recommendations to ensure the wellbeing of members of this population. A must-read for health care professionals of all races."—Kweisi Mfume, president and CEO, NAACP

"In an era in which new scientific advances seem to occur on a daily basis, the continuing disparities in physical and mental health that exist in our country are particularly disheartening. It is for this reason that publications such as Health Issues in the Black Community are a necessity. We must continue to conduct and disseminate research necessary to combat this problem and to improve the lives of our people."—Congresswoman Donna Christian-Christensen, Chair, Congressional Black Caucus Health Braintrust

"This book is the definitive examination of health issues in black America—issues sadly overlooked and downplayed in our culture and society. I congratulate Drs. Braithwaite and Taylor for their monumental book!"—Cornel West, Alphonse Fletcher Jr. University Professor, Harvard University

Meet the Author

The Editors

Ronald L. Braithwaite, PhD, is a professor in the Department of Community Health and Preventive Medicine, director of research in the Department of Family Medicine, and a professor in the Department of Psychiatry at Morehouse School of Medicine, Atlanta. He is the coeditor of Prisons and AIDS from Jossey-Bass.

Sandra E. Taylor, PhD, is a professor and chair in the Department of Sociology and Criminal Justice at Clark Atlanta University, Atlanta. Taylor and Braithwaite are coeditors of the first and second editions of Health Issues in the Black Community from Jossey-Bass.

Henrie M. Treadwell, PhD, is a professor in the Department of Health and Preventive Medicine and director of Community Voices and the Men's and Reentry Health Initiative at the National Center for Primary Care at the Morehouse School of Medicine, Atlanta. Dr. Treadwell served for 16 years as program director at the W.K. Kellogg Foundation.

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