Cultural influences on African-American health care outcomes in New Jersey

Culture and Health Care

The examination of the influence of culture on health care in the African-American community identified major issues. Firstly, the rate of all major lifestyle diseases is higher in this community than other communities. Secondly, it is highly possible that cultural influences exert a powerful influence on the health care decisions made by individuals. Using secondary data from the Department of health and senior services New Jersey and the New Jersey State health assessment data it could be demonstrated that for every major indicator African-American communities fared worse than White communities did. What is necessary at this stage is a more complete examination of the mechanism through which culture works to influence health care practice and beliefs to reduce the impact of the problem.

African-American, Lifestyle diseases, New Jersey, Culture

The effects of culture on health care

The delivery of effective care to all citizens is an important consideration for the government. The quality of health care experienced by individuals is related to many factors that are often beyond the control of government agencies. Socioeconomic status, genetics, ethnicity, and other factors contribute greatly to the nature of the health care available as well as the access to health care. These factors however work in combination with the cultural components of the individual or group under examination. Culture consequently plays a moderating role in the discussion of health care. Culture has the capacity to improve of diminish the health of an individual as limit or increase opportunities for care. This assessment explores the influence of culture on the health care of African-Americans. The study examines existing statistical data from state and federal agencies. This data is used to compile a picture of the nature and quality of the health care received by the community.

Culture is a complex and nuanced concept. Thus when we speak of the culture of a people or an individual it relates to both the material and non-material elements of the shared experiences (Macionis & Plummer 2008). In terms of health care, the material elements would be the health care facilities that the individual has access to; hospitals and primary care facilities. These material components of the culture vary in terms of ease of access as well as the quality of staff at the sites. It is known that the hospitals that are in the poorer sections of any community usually do not attract the best staff and are not well supplied. These facilities are oversubscribed as it relates to patients, and underfunded. The physicians are overworked and their remuneration is not compatible with their peers in better-funded institutions. Other administrative issues such as case management and Medicare further complicate this. Consequently, the material health culture of some communities is not as vibrant or as effective as it should be and these individuals have less confidence in the service that is offered.

The non-material elements of the health culture relates to systems of behaviors, beliefs, norms and values that contribute to the reduction in health care for specific groups. These non-material elements influence decisions to seek health care and the understanding of what is a disease (Stowe 2004). Thus, male African-Americans are less likely to seek help for a medical condition and consequently live have a shorter life span (Ferraro, & Farmer, 1996). Many simple illnesses that could be treated in the early stages such as prostate cancer remain undiagnosed and untreated because of values and beliefs. Many men believe that having the examination is degrading and a challenge to their manhood (Lichtenstein, 2004). Under these conditions, it is highly unlikely that they will seek the necessary medical attention to prevent further debilitation and even the loss of life.

Culture therefore becomes implicated as a factor in the lower life expectancy of African-Americans as a community. The effect of culture is further amplified by the role of income and other socioeconomic factors. Wealthier persons live healthier lives and longer lives. This is not a genetic but a social dynamic. Wealthy persons are able to afford medical insurance and they can pay for better care. Additionally, they live in cleaner communities where they are not affected by factors that are connected to hygiene or the environment (Starfield, Shi & Macinko 2005). In many African-American communities, there is a challenge to provide medical care, the cost of which may be prohibitive for many individuals. They are also not employed in industries where a health plan exists so that they do not enjoy benefits that are company sponsored. In this manner, external factors expand the influence of culture beyond a normal range.

Education and ethnicty

When comparing ethnicities on income levels it can be observed that African-Americans earn less than White Americans. While 74.6% of the white respondents earn more than 35k annually, only 50.3% of the African-Americans earn the same amounts annually. This near 25% gap in terms of persons means that there are a lot of African-Americans who are not where they should be financially. They are most likely unable to afford adequate health care. This is tragic because 35k annually was the upper limit of the study. There are many individuals whose annual income are well below this value.

Income and Ethnicity

The life expectancy of African-Americans trail White Americans in all categories. Males and females live shorter lives when compared to their White counterparts. A White male American can expect to live to 73.4 years and a White female longer, 79.5 years. Black males and females have a shorter life expectancy. Black males can expect to live only 64.5 years this is almost ten years shorter than White males. Black females while outliving Black males, have a similar life expectancy as White males of 73.1 years. This life expectancy is however 6.4 years fewer than White females (See chart below)

Life expectancy and ethnicity

While African-Americans trail White Americans on may indicators they are ahead on religion. The Pew Foundation notes that African-Americans attend religious services more regularly than White Americans (A religious, 2009 ). They are also more likely to describe themselves as religious (A religious 2009). Religion has played a critical role in the African-American community and this role goes beyond the spiritual dimension. The cultural dynamincs that are associated with religious practice move from belief about fatih healing to civil rights.

Faith healing plays a critical role in the lives of many protestants. As the Pew study notes 74% of all African-Americans belong to a protestant denomination (See table below). This means that their socialization around the issue of health will contain a faith or belief dimension. This belief will include the acceptance of faith healing. Faith healing can be a hinderance to accessing effective medical attention if the individual believes that to do so would be a denial of their faith. In this manner religion can play a critical role in limiting the options available to individuals to addresss medical situations.

Religious affiliation and ethnicity

Another factor that is important in the discussion of culture and health care is diet. The media is replete with examples of African-Americans who are sterotyped as loving fried foods and soda. These two foods are very unhealthy and while the sterotype is inaccurate it invites some investigation into the cultural aspects of diet (Dowd 1996). The study used for this exercise showed that contrary to sterotypes most of the African-Americans had more that 5 servings of fruit and vegetables per day, 73.6% of the respondents stated that this was what they did. This number however is not reflected in lower numbers for life style disease and so it must be given greater scrutiny at another time (See table below).

Fruit and vegetable consumption by ethnicity

Lifestyle diseases

There are a number of diseases and health conditions that have been linked to life style behaviors and belief systems. The prevalence of these diseases demonstate that while persons may report a certain behavior emperical evidence suggests that another behavior may be taking place. This may occur principally because respondents may over estimate what they do on a daily basis since they are not taking active records of their behaviors.

On several indicators African-Americans have higher rates of the disease and death as a consequency than White populations. The data for diabetes shows that African-Americans are twice as likely to report having diabetes than white Americans. African-Americans also have higher rates of death associated with diabetes than White Americans (See Tables below).

Deaths due to diabetes by Race/Ethnicity

Smoking is a risk factor for multiple illnesses. African-Americans report slightly higher rates of smoking than white Americans. However when this is combined with other factors that are related to SES it becomes a powder keg. Twenty point seven percent of the African-American respondents reported that they engaged in smoking while, 19.7% of the White respondents did the same thing.

Smoking status and ethnicity

This picture is made clearer when the data on exercise and hypertension is included in the frame. Close to 30% of the African-American respondents stated that they did not exercise on a regular basis. The figures for hypertension is not encouraging as 35.3% stated that they have hypertension. The senario becomes more lethal when we add to the picture the figures for obesity. 19.3% of the respondents reported that a medical pracitioner reccomended that they lose weight for health reasons, while 68.3% of the respondents were overweight. The picture is not a pleasant one. When all the variables are combined the lifestyle factors to which there is a strong cultural component has the capacitiy to seriously diminsh health for this population (See tables below).

Exercise and Ethnicity

Hypertension and Ethnicity

Weight loss and ethnicity

Overweight and ethnicity

This population is prone therefore to specific kinds of illnesses. These illnesses can be linked to lifestyle or elements of the non-material culture. A little of 50% of the adults in a () study reported visiting the dentist annually. This action suggests that either they do not see this as necessary or they do not have the finance to do so. It may also be a combination of both factors simultaneously. However, it does suggest that an education program is necessary to deal with persons who do not believe that dental visits are necessary and, also to engage partners in the support of this action (See table below).

Adults >18 visited the dentist between 2002-2008

Deaths that are linked to drug use are demonstrable higher among black communites than any other community (See Table below). These deaths are an indication of the failure to access appropraite medical care when it became necessary. The individual may be too high to do so or more likely they lacked the appropraicte social network that would be able to ensure that they get the necessary care. Again a useful intervention at this point will be ensuring that there are programs in the neighbourhood that address drug useage. Controversal programs such as needle exchange may find disfavor with a highly religious and conservative population. These programs have worked in European countries to reduce the numbers of deaths assoicated with drug usage along with the reduction in the transmission of disease through shared needles.

Deaths due to drug related causes trend by race/ethnicity 1999-2005

Cervival cancer rates among African-American communites remain higher than all other communites (see chart below). Cervical cancer is linked to HPV. The steps necessary to combat the spread of cervical cancer include early vaccination of women and limiting the number of partners an individual has. Both steps have a relationship to SES and to cultural values. What may be necessary here is a multipronged approach to address these issues.

Cervical cancer rates

Possibly the most distressing element of the data is the data relating to HIV and AIDS. The data clearly shows that African-American populations have higher infection rates and higher death rates. The infection rates can be linked to practices within the community. These practices involve the failure to practice safe sex because of the lack of education on safe sexual practices. It is linked to the higher rates of drug use and consequently the sharing of contaminated needles that is prevelant in the community.

The death rates are disturbing because the incidences of death far outstrip all other ethnic groups and while there has been a decline the size of the problem is still disturbing. It is clear that there is an immediate need for some type of intervention that deals with sexual behavior and sexual education.

Incidence of HIV and AIDS by Race/Ethnicity

Deaths due to HIV disease and Race/Ethnicity

Summary and Analysis

The African-American community is a community plagued by multiple health concerns and lacking health solutions. The community has a lower life expectancy than the White population. This is combined with poorer health practices and less available income to make the necessary investment in diet and visits to a doctor. This means that the group may develop health care practices that are focused on staying alive rather than promoting good health. When the concept of faith healing is factored into the model, it is possible that individuals will depend heavily on the spiritual than on the medical.

This dependence on the spiritual in its multiple manifestations is not an act of defeat but rather a legitimate response to the challenging economic conditions. Faith communities develop a discourse that applauds what God does thorough the work of miracles. These miracles are considered to occur without the help of medical professionals and modern science. This subtle denial of the value of science can become a hindrance to finding suitable assistance but it is also a reaction to existing economic realities. The poor need to find a way to survive and be mentally sound. Religion provides that type of sedation and balance.

The implications for the medical profession is clear in that there will be greater numbers of persons who are resistant to certain types of treatment unless they receive the green light from a religious authority. The attempts to stem the tide of HIV and AIDS will be met with resistance since scientific evidence is seen as being at odds with directives from a divine source. Medical professionals need to be more sensitive to the role belief and poverty play in the decision making of individuals. It may also be critical that medical professionals find the time to give back to depressed communities through practice and lectures. These mechanism will provide avenues for the suspicion to be dispelled and for both groups to generate a greater appreciation of each other.