African-Americans in Louisiana & Type 2 Diabetes Rates The poor will be always with us, we are biblically admonished. And for Americans we might add to this ancient maxim that the African-American poor will be always with us. Despite the many gains that they have made in the past 30 years African-Americans remain far more likely to be poor than are white Americans. This has a number of different consequences for African-American populations, including higher rates of certain diseases as well as less access to healthcare for those conditions. This paper examines the conjunction of the economic, social, and cultural status of African-Americans in Louisiana and their rates of Type 2 diabetes. African-Americans in Louisiana - as is true across the South and indeed across the nation - suffer from diabetes at least seemingly disproportionately high rates. However, once economic, social and cultural factors are taken into account, those rates no longer seem disproportionate. They are tragic, but comprehensible.

Before proceeding we should provide an overall picture of the seriousness of the rate of Type 2 diabetes in the African-American community and especially for African-American women:

2.8 million African-Americans have diabetes.

On average, African-Americans are twice as likely to have diabetes as white Americans of similar age.

Approximately 13% of all African-Americans have diabetes.

African-Americans with diabetes are more likely to develop diabetes complications and experience greater disability from the complications than white Americans with diabetes.

Death rates for people with diabetes are 27% higher for African-Americans compared with whites (http://diabetes.niddk.nih.gov/dm/pubs/africanamerican/).

It must be noted that despite the terrible conditions under which many African-Americans continue to live that they are in general much better off than were their grandparents. We all know that beginning in the early 1960s the Civil Rights brought to the nation's conscience the terrible conditions under which the majority of black Americans were living and helped begin the steady, if painfully slow, progress toward fuller civil rights and full inclusion in the promise of American citizenship. In large measure as a response to the Civil Rights movement, a number of federal, state, and local government programs were developed and implemented to help combat poverty and the effects of racism on African-Americans (Polednak, 1997, p. 38). While these programs were not directed primarily at diabetes reduction, of course, or even specifically toward improving the health of African-Americans, they tended to do so overall. One of the most important risk factors for early death and for a range of illness from diabetes to cancer to AIDS is poverty. By alleviating poverty, a society also alleviates unnecessary suffering from diseases.

However, by the beginnings of this brand-new shiny millennium, despite the many government anti-poverty programs and equal-opportunity laws that have outlawed discrimination in education, housing, and employment, African-Americans remain unequal partners in U.S. society. Their median (and mean) income and education are below those of whites, and their average rate of unemployment is far greater (www.census.gov).This is true despite the fact that blacks as a group and African-Americans as individuals have made important advances in gaining a larger share of higher paying jobs, raising their median income in both real terms and in relationship to that of whites, and in increasing their college enrollment and overall rates of education (Harris, 1999, p. 21).

Thus despite the current in many ways depressing statistics, it must be remembered that both politically and economically, blacks have made substantial strides in the post-Civil Rights era. Given this fact, it is somewhat surprising that rates of poverty-correlated diseases such as diabetes have not decreased.

This may be explained locally in terms of the higher rates of poverty in Louisiana vis-a-vis the nation as a whole (for both African-Americans and other groups of Louisianans) but this is not a complete explanation. This research proposes that there are cultural factors that extend beyond the strictly economic - that tend to increase rates of Type 2 diabetes in African-Americans.

The economic situation of African-Americans cannot be understood without looking at some specific sets of figures. For example, in 1997, the number and poverty rate of African-Americans was 9.1 million and 26.5%, compared with 24.4 million and 11.0% for whites; 1.5 million and 14.0% for Asians and Pacific Islanders; and 8.3 million and 27.1% for Hispanics (statistically the same as for blacks) (www.census.gov).

For families, the number and percentage of poor in 1997 was 2.0 million and 23.6% for African-Americans; 5.0 million and 8.4% for whites; 244,000 and 10.2% for Asians and Pacific Islanders; and 1.7 million and 24.7% for Hispanics...

Although the racial disparity in poverty rates has narrowed only slightly overall, the black middle class has grown substantially and about 43% of African-Americans now own their homes (Harris, 1999, p. 61).
However, approximately one-third of the African-American population lives in poverty, a rate three times that of white Americans, a fact that can be explained both by the unemployment gap between blacks and whites, which has over the past decade actually grown larger: In 1973 African-Americans were 2.2 times as likely to be unemployed as whites while in 1997 the unemployment rate among African-Americans was 2.3 times the rate for whites (Harris, 1999, p. 67).

Blacks are not only less likely to be employed than whites but they are also likely to be paid less for the same jobs (and of course this is exacerbated for black women who are paid in general much less than black men). The income gap between black and white families also continues to widen in large measure because of these wage and employment gaps: Employed blacks earn only 77% of the wages of whites in comparable jobs, down from 82% in 1975 (Polednak, 1997, p. 84). African-Americans are also less likely to receive full health benefits with their jobs. Thus they are more likely to get sick (at least from certain illnesses) while at the same time they are also less likely to have the resources to seek medical care.

The economic problems of African-Americans can also be linked to education rates and family structure: 12.2% of blacks earned bachelor's degrees in 1993, down from 14.5% in 1975, and in contrast to 22.6% of whites who had finished their undergraduate education in 1993. Although rates of births to unwed mothers among both blacks and whites have risen since the 1960s, the rate of such births among African-Americans is three times the rate of whites. Single-parent households are more likely to be poor simply as a result of there being fewer possible hands to work (Harris, 1999, pp. 27-9).

The higher rates of poverty for blacks take their toll in terrible ways: African-Americans have shorter life expectancies than the national average and suffer disproportionately from heart disease, AIDS, hypertension, and stroke, in addition to diabetes (Harris, 1999, p. 34). The poor may be always with us, but this does not make their condition any less terrible.

Orem Self-Care Deficit Model useful theoretical model through which to view the dynamics of diabetes in the African-American community is the Orem Model (Saucier 1984, Mulkeen 1989, Bracher 1989, Bowers & Patterson 1986). This model emphasizes the importance for both mental and physical health of a person's being able to learn to take responsibility for himself or herself. The Orem model underscores the importance of each individual's using his or her capabilities to learn to be more self sufficient through taking care of - and responsibility for - themselves. Orem's model for responsibility includes the following points:

The individual should participate in learned, goal-oriented activity directed by individual to regulate factors that affect their own functioning

The individual should be goal-directed, and should pursue goal-directed and purposeful

The individual should engage in self-care, which for some individuals may be psychologically tantamount to taking care of the members of his or her family as well http://web.odu.edu/webroot/orgs/hs/nurs/nursing.nsf/files/n610orem.pdf/$FILE/n610orem.pdf).

Orem's model emphasizes that self-care is complex and that it is a set of skills that can and in many cases must be taught. Orem argues that the ability to care for oneself - to be an agent in one's own self-care - allows an individual to do the following:

To meet continuing needs

To maintain the physical and psychological health of the human structure

To allow for normal human development

To promote will-being http://web.odu.edu/webroot/orgs/hs/nurs/nursing.nsf/files/n610orem.pdf/$FILE/n610orem.pdf).

One of the key dynamics in terms of using the Orem model is that of gender, for it allows us to understand the connection between negative stereotypes of black women and their high level of diabetes. The first of these stereotypes is the "Mammy" figure, a female who is dedicated to the welfare of children (either her own or her owner's) while at the same time dominating her husband:

Although she treated whites with respect, the Mammy was a tyrant…