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The Health Crisis in The African American Community
In our age of "political correctness," many people consider it inappropriate to separate people on the basis of race. But, however unpopular it may be, when it comes to health, race really does matter. It matters because African Americans are more likely than people of other races to die a premature death. According to the statisticians, there is an 8.5-year difference in the median survival rate between white and black males and a 5.9-year gap between white and black females.
And our health status is getting worse. While the health profile of other ethnic groups is improving, the prognosis for African Americans is deteriorating. A study reported in the American Journal of Public Health found that the gap in the life expectancy between blacks and whites grew in the late 1980s. Since the turn of the century, life expectancy at birth in the United States has generally increased for all races. But from 1984 to 1989 life expectancy for whites increased, while life expectancy for blacks decreased. Never before had this pattern occurred in the United States over a sustained period. Why? For black males, the most significant factors were an increase in HIV infection and homicide. For black females, the spread of HIV infection, diabetes, and pneumonia contributed to the death toll.
In addition to the difference in death rates, African Americans also suffer more often than other races from both chronic and acute illness. Consider the grim statistics
* Heart disease: The age-adjusted death rates from heart disease were 27 percent greaterin black men than white men and a remarkable 55 percent higher in black women than white women.
* Diabetes: An estimated three million African Americans have diabetes, which adds up to one in every ten of us. We are 55 percent more likely than whites to have diabetes; the disease is especially prevalent in older black women.
* Lupus: Of the more than 500,000 people stricken with lupus, nine out of ten are women ages fifteen to forty-five-and three out of five are black.
* Sickle cell trait: This condition strikes one out of twelve of us; it occurs to a lesser degree among southern Italians, Greeks, East Indians, and Hispanic people.
* Infertility: African Americans are affected by infertility nearly 1 - 2 times more often than whites.
* AIDS: African Americans and Latinos together total 21 percent of the population, but they account for 46 percent of the U.S. AIDS cases so far. AIDS is now the tenth leading cause of death nationwide for people of all races.
* Hypertension: High blood pressure is twice as common in blacks as in whites, affecting one in three of us.
* Infant mortality: Our children are twice as likely as white children to die before their first birthday. For each 1000 black babies born in the United States, nineteen die by age one, compared with eight of 1000 white babies. That pattern has existed for more than forty years.
* Cancer: African Americans develop cancer about 10 percent more often than the general population, and our mortality rates are 20 to 40 percent higher. One of the key reasons for our poor mortality rate is that our cancer is often undetected until it reaches a more advanced-and less curable-stage. At each stage of discovery, African Americans don't do as well as their white counterparts. Our overall poor diet also plays a major role in our high cancer rate.
* Addiction: African Americans accounted for 39 percent of the doing abuse- related emergency room visits reported to the Drug Abuse Warning Network of the National Institute on Drug Abuse in 1988. Fully 70 to 75 percent of the nation's 2 to 2 million heroin addicts are black.
These numbers can be numbing, but, as we have seen time and again through our work with African Americans, such statistics are more than abstractions: They represent real people. Every day patients enter our offices with illnesses and medical conditions that can-and should-be prevented or controlled.
Some studies have actually estimated that at least 75,000 African Americans die each year of manageable diseases. In 1985, the U.S. Department of Health and Human Services released The Report of the Secretary's Task Force on Black and Minority Health, an eight-volume work based on the federal government's study of the health status of American minority groups. These reports documented what had been presumed for a long time: The gap in health status between white and black Americans was very significant. This led the secretary to conclude that more than 60,000 excess deaths occurred per year for blacks compared to the general population. (Follow-up research found that the number had jumped to 75,000 deaths by 1993.) While researchers have proved that being African American brings myriad health problems with it, the most significant question for the individual becomes, What can I do about it?
BEATING THE ODDS
Fortunately, you can change the odds-and perhaps even beat the odds-by taking care of yourself. However, we have found that in the past twenty-five years or so, the lifestyles of blacks in this country have actually become more unhealthy. African Americans tend to exercise less and eat more junk foods than we used to; we drink sugared soda rather than pure water; we structure our lives so that we have many stresses and few avenues to relieve that stress.
While the current health statistics look depressing, we believe that if we don't take better care of ourselves, African Americans (as well as people of other races) will soon experience an epidemic of cancer, fibromyalgia, chronic fatigue, and other degenerative diseases. It's inevitable: The years of unhealthy living will someday take their toll on people now in their thirties and forties. Such comments, of course, apply to the population in general. As an individual, you have the ability to make healthy food choices, to exercise regularly, to practice stress reduction techniques, and to improve your overall lifestyle.
Even relatively minor changes can make a major difference in your overall health. Consider the example of Thelma, a fifty-one-year-old with high blood pressure who came to us for help managing her condition. Her blood pressure averaged 160/100, she was thirty-two pounds overweight, and she had a family history of diabetes. She craved sugars and starches, though her blood sugar levels remained normal. We designed a diet program for her that eliminated sugar and white flour without limiting her calories significantly. She participated in an exercise program and ate a low-sodium diet; she lost an average of two pounds per week and within several months her blood pressure dropped to 130/86-within the normal range-without resorting to the use of antihypertensive drugs. As Thelma reminds us, a healthier lifestyle doesn't have to entail great hardship and deprivation, just the establishment of new, more healthful lifestyle choices.
Chances are good that you have a long list of lifestyle changes that you know you should make but you haven't put them into effect quite yet. You know you should eat at least five servings of fruits and vegetables a day. You know you should eat a high-fiber, low-animal fat diet, and give up junk foods. You know you should exercise regularly, give up the cigarettes, limit the alcohol. You know you should find healthy ways of letting go of stress and relaxing when tensions arise. You know you should avoid excessive sun exposure, get plenty of rest, and drink plenty of water every day.
But the chances are good you aren't doing all the good things you should to take care of yourself. The problem: motivation.
When it comes to motivation and sticking to a program for health, we have found that our patients tend to fall into one of three categories. One group-about 15 percent of our patients-immediately apply the health information, even if it requires making difficult lifestyle adjustments. A second group of 15 percent or so never will embrace the information and put it into practice, no matter what you tell them. (These are the people who refuse to quit smoking even after they've been diagnosed with lung cancer. Of course, we each have the right to make our own choices about how we will care for our own body.) The third group, the 70 percent in the middle, want to do the right thing but need a little extra motivation. Our challenge as physicians is not just to introduce our patients to natural medicine and to offer prescriptive advice, but also to use our experience as healers to help encourage people to put the knowledge into action.
While there is often a temptation to use fear of disease as a motivator, it rarely works as a powerful enough incentive to support lifelong change. Sometimes fear can help get someone started eating right or exercising or meditating, but fear diminishes over time. It is difficult for a person to internalize the message and firmly establish good habits before finding a way to rationalize changing back to their old ways.
Rather than using negative energy, we have found that the best motivator for healthful change is self-love. To embrace a healthy lifestyle, you must see yourself as valuable and worth "fixing." Each time you nourish your body with healthy foods, meditate to a state of emotional serenity, or stretch and use your muscles in sports or exercise, you are affirming yourself. In addition, your health-affirming behaviors allow you to serve as a living example of positive health to your coworkers, family, friends, and neighbors. As African Americans, we can change our health profile, but we must do it one person at a time.
LEARNING TO TRUST
It's a classic self-fulfilling prophecy: People who suspect that they are sick refuse to seek medical care when they first detect a medical problem because they worry that the doctor will confirm their fears. Then, when they finally get around to contacting a doctor, their fears are realized: Their conditions have progressed to the point that their prognosis is much worse. Regrettably, this pattern of delayed care and poor prognosis is classic in the African American community.
One patient who illustrates the point quite well is a woman who came into the office complaining of pain and abdominal distension. She did not contact a doctor until the pain was unbearable and she had no other choice. Upon examination, we learned that she suffered from a rectal mass so large that it had totally blocked her bowel function. If she had been treated earlier, we probably could have saved her life, but since she came to us after the cancer had spread, there was little we could do. When asked why she had taken so long to see a doctor, she said, "The hospital is where you go to die, and I am not ready to die yet." Both her sister and her mother had died in the hospital, and she had a strong association between hospital care and death. Ironically, her fear and distrust of the medical establishment is what ultimately killed her.
We have found that a lot of patients have the same reaction to treatment for HIV and AIDS. Many African Americans who live in the inner city have friends who have taken the drug AZT and newer medications as part of their treatment for the disease, only to see them die a few months later. It was not the AZT or other medication that killed the patient, but rather the deadly delay in seeking help. Of course, if they had taken the drug and received treatment earlier, many lives would have been extended. These stories and others like them create a distorted perception about what medical science can do. Unfortunately, such scenarios are all too common in our community.
This distrust of Western medicine is one of the reasons for the bad health statistics for African Americans. We must learn to overcome our fears and take charge of our health; we should start by getting accurate and complete information about our health.
One of the biggest problems is denial: Denial will not make us well. Denial will not help the man with chest pains who doesn't want to go to the hospital when he knows good and well that he is experiencing a heart attack. Denial won't help the woman who refuses to take an HIV test because she suspects she is HIV positive.
While some of us may have a fear of dealing with the medical establishment, we must take responsibility for our health care. That may mean finding a medical doctor who is informed and sensitive to the unique health needs of African American patients, and it may mean consulting with practitioners of natural medicine who can offer a complementary approach to healing. Keep in mind, however, that both conventional and complementary healers cannot make you well if they do not know that you are sick.
BEING GENTLE WITH OURSELVES
If you are challenged with fears or resist taking steps to care for yourself, that's okay. You should simply start with small steps. The key to moving in this direction is to just start moving. Begin with something yoll know you can do, then build on that. The key is to be gentle with yourself while you are learning to honor and nurture yourself.
If you run into your own resistance along the way, use some of the following affirmations to inspire you. Write them out and put them in a place where you can see them during the day. Changing a habit takes time, so be patient with yourself. After working with thousands of people, we know that you can make positive changes for yourself.
Start with these affirmations (or write one of your own). Read your favorite one every day for a week, then switch to another:
* I am worthy of my own attention.
* It is okay for me to take care of myself as well as others.
* Doing for myself, I am learning how to really care for others.
* How many times I fall down doesn't matter. The fact that I get back up is what counts.
* God don't make no junk. The fact that I am here means that I am somebody.
* When I take care of myself and love myself, I start to see the meaning of who I am.
THESE TESTS CAN SAVE YOUR LIFE
One of the best ways to take care of ourselves-and to catch illnesses at the early stages-is to undergo routine medical screening tests. These procedures, while sometimes uncomfortable or bothersome, do save lives. It's always heartbreaking to receive a diagnosis of a serious illness, but it is particularly distressing when the problem could have been controlled or reversed if only it had been caught at an earlier stage.
While natural remedies can be helpful in the treatment and management of disease, you must know you have a health problem before you can treat it. We recommend the following screening tests.
SCREENING TESTS AND EXAMS FOR AFRICAN AMERICANS
These tests should be routinely performed; others may be necessary if recommended by your physician or if your medical history dictates:
* Blood pressure measurement. Annually after age fifty; more often if under treatment for hypertension. Blood pressure is taken as part of a routine physical exam. Between physicals,you may want to test your blood pressure yourself. Many pharmacies and grocery stores have machines available for public use; stop in twice a year and have your blood pressure checked.
* Breast exam (women). Monthly at home; annually by your doctor.
* Cholesterol. Begin testing at adolescence. Test every five years, or more often if you have a history of atherosclerosis or coronary disease. You should look for both your total cholesterol levels as well as your high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels.
* Complete physical. Every five years before age forty; every two years between ages forty and sixty, and annually thereafter.
* Dental exam and tooth cleaning. Every six months; more often if periodontal disease is present
* Dental X rays. Every one to two years.
* Electrocardiogram. Every three years after age forty; more often if there is evidence of heart disease.
* Eye examination. Every one to two years.
* Mammography (women). Every one to two years between ages forty and forty-nine; annually age fifty and older. If you have a family history of breast cancer, a mammogram may be recommended even earlier.
* Occult blood in stool. Annually after age forty.
* Pelvic exam (women). Annually, including a Pap smear and digital rectal exam.
* Prostate exam (men). Annually at age forty and above; annually after age thirty-five if there is a family history of the disease. We rely on both a physical exam and the prostate-specific antigen test, which can detect prostate cancer early. The PSA test can provide helpful information, but it is not a substitute for a physical exam.
* Rectal exam/digital. Annually after age thirty-five.
* Sigmoidoscopy. Every three to five years after age forty.
* Skin exam. Once a month, using a mirror or asking a friend for help, check every square inch of your skin for abnormalities, including moles, rashes, or scaling. Annually, have a primary care physician or dermatologist perform a skin check, starting at age forty, or earlier if you have a lot of sun-related skin damage.
* Testicular exam (men). This should be done as part of a physical. Monthly self-exams are highly recommended. (An ideal time is when you are in the shower.)
FOR MORE INFORMATION
For general information on disease prevention and treatment for African Americans, contact the Office of Minority Health Resource Center, P.O. Box 37337, Washington, DC 20013-7337; (800) 444-6472 or (301) 587-1938. The Internet address is http://www.ombrc.gov. The resource center operates a library, provides written materials, offers referrals, and answers questions regarding minority health issues.
Posted July 22, 2002
I have used this book for my family and in my computer classes. If people aren't healed from the inside out...they are unable to be productive in a career and life-long aspirations. This book gave wonderul information for issues of African-American issues.
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