Health disparities in Louisville, Kentucky

Health Disparities in Louisville KY

Health Disparities

Health inequities have become a major problem in the United States. Hofrichter stresses in Tackling Health Inequities Through Public Health Practice:

A Handbook for Action ( 2006) that, "The awareness of the existence of inequities in health, health status and health outcomes between racial and ethnic groups in America is as old as the nation itself" (Hofrichter, 2006,P. vii). As will be discussed in this paper, these inequalities have a wide range of repercussions, including social and psychological implications. A definition of health disparity is: "... The difference in the incidence, prevalence, morbidity, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups" ( Samuels, 2005).

There is also a consensus in the literature that inequalities in health and healthcare throughout the world are on the increase. This is largely due to the increasing gap between rich and poor within many industrialized countries. This is especially the case with regard to the United States, where "...income inequality in the U.S. is greater than in any other industrialized country in the world"(Hofrichter, 2006, p. 15). The above facts are linked to the widening gap in healthcare and access to healthcare in the country. Statistics also tend to support this view; for example, "... The U.S. ranks 29th in life expectancy for men, 21st for women; it ranks 28th in infant mortality (Hofrichter, 2006, P. 15).

As a result of these findings there has been a greater sense of concern and urgency in the country about addressing these inequalities and disparities in healthcare. This need for change and to rectify the present imbalances is stressed by the fact that "...severe health inequities are increasing significantly, with serious implications for the nation's well-being" (Hofrichter, 2006,P. vii). As a recent federal health report on the issue of health disparities states, there is little doubt that "Differences in income, gender and race influence Americans' likelihood of being healthy, sick or dying prematurely..." (Health disparities persist in U.S., report shows, 2011)

Taking the above into account, Hofrighter goes on to sketch the importance of recognizing social inequalities that can be linked health issues. He notes for instance that this has implications for local health departments (LHDs).

Health inequities -- which result from an unequal structuring of life chances -- are systemic, avoidable, unfair and unjust differences in health status and mortality rates, as well as in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals.

(Hofrichter, 2006, p. vii)

There is a general consensus that these "unjust differences" therefore need to be rectified and the disparities reduced. Hofrichter goes on to state that these inequalities are the result of persistent and accumulating social practices. These include negative aspects such as economic and social insecurity, racial and gender inequality, lack of participation and influence in society, as well as, "…unfavorable conditions during childhood, absence of quality and affordable housing, unhealthy conditions in the workplace and lack of control over the work process, toxic environments, and inequitable distribution of public goods" (Hofrichter, 2006, p. vii).

The following discussion of the situation in Louisville will explore and expand on these views and insights. The analysis will focus on the African-American population of the city and on the prevalence of diabetes among the people of West Louisville.

2. Overview: Louisville

The city of Louisville is the largest metropolitan area in the state of Kentucky. More than 700,000 residents of the state live in Louisville (Troutman, 2006, p. 186). The minority demographics of the city are as follows: about nineteen percent of the residents of the city are African-American and five percent are Latino. (Troutman, 2006, p. 186).

In reality the city can be divided into two distinct sections. The east end of the city is more affluent and prosperous, while the west section of the city is largely composed of "economically deprived" African-Americans (Troutman, 2006, p 186). This distinction of location can be translated into differences or disparities in healthcare and access to healthy living standards. As Troutman emphasizes, " Because of the socioeconomic status of Louisville's west end, the people that live there are not getting the healthcare that they need to live long healthy lives" (Troutman, 2006, p. 186).

This disparity in terms of race and class is not, as Troutman, and other researchers point out, is not an exception to the rule and similar disparities and inequalities can be found in many other American cities. However, another concern that further problematizes the situation in Louisville as well as in many other areas is gender prejudice and the health problems that women face. Gender differences therefore further compound the disparities based on race and class.

The following discussion will therefore revolve around the disparities between those residents of lower social and economic class compared to those in the higher social and economic brackets of the community. Furthermore, the psychological as well as the social aspects of these disparities as they are reflected in treatment and access to health care will be discussed. Following on from this will be an exploration of the role of physical exercise and how this can help to reduce these differences and disparities of health between these different groups.

Before discussing these selected variables in depth one first has to establish the extent of the disparity in health care between the western and the eastern parts of Louisville. Troutman's analysis of health disparities in the city produces the following results:

The age adjusted death rate from all causes for African-Americans was 1209.5/100,000 compared to 941.3/100,000 for whites

African-Americans had higher death rates for four of the six leading causes of death in Louisville.

(Troutman, 2006, p. 186)

In terms of specific ailments and health conditions it was found that heart diseases among African-Americans in the city were 357.6 compared to 297.4 for whites (Troutman, 2006, p 187). The rate for diabetes among African-Americans living in the West side of the city was an alarming seventy-four percent higher than for whites. Other figures that attest to the disparity in health between the two sections of the city included the fact that, "The infant mortality rate was twice the rate for African-American babies as compared to whites"(Troutman, 2006, p 187-188). It was also found that, "Age adjusted death rates from cancer among African-Americans was almost twice the rate of whites at 92.8/100,000 vs. 55.9/100,000" (Troutman, 2006, p 187-188).

An interesting aspect of Troutman's study was the link between lower rates for health and healthcare and other negative social factors, such as crime. For example, Troutman found that the homicide rate for African-Americans was six times higher the rate of homicides among whites and that African-Americans in the city had much higher rates of diseases such as syphilis, gonorrhoea and HIV / AIDS "(Troutman, 2006, p.188). There are of course many other variables that contribute to these figures but what they also imply is that people who feel marginalized and who do not receive equitable health support are more likely to deviate in a social sense. One could also link these facts to the finding that African-American men had the highest smoking rate in Louisville, and this is in a state with the highest smoking rate in the nation. (Troutman, 2006, p.188)

3. Diabetes among African-Americans in Louisville.

A number of reports and studies attest to the fact that African-Americans as an ethnic group ".... disproportionately experiences illness, violence-related injuries and premature death" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity). This is a view that is consistent with the findings from studies of Louisville and particularly with regard to the western and mainly African-American section of the city. These include serious diseases such as cancer and diabetes, among others.

The health disparities are also linked to social and other inequalities, for example, in the mainly African-American neighborhood of the city "..., 39% of residents 25 years and older have not earned a high school diploma. The median household income is $21,906, compared to Louisville's $40,793" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity).

There is also a high level of alcohol abuse in this area, which in turn has serious health and sociological ramifications. For example, studies have found that alcohol abuse contributes to violent crime in the area; this in turn has the concomitant effect of impeding proper access to healthcare. As one expert notes, " Violence or the fear of it makes it harder for Louisville residents to eat healthful food and be active and also undermines efforts to create and sustain health-promoting food and activity environments" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity). Therefore, one could speak of a cycle of negative factors beginning with marginalization which leads to poor health outcomes.

A major health issue linked to deprived communities is diabetes. Diabetes and particularly type two diabetes has reached alarming proportions in many developed societies today. As one study notes; "…approximately 4,110 people are diagnosed every day with diabetes. In 2005, 1.5 million new cases of diabetes were diagnosed in people age 20 years or older" (Galvin, 2006, p. 157).

Diabetes in Louisville is of particular concern in terms of the disparities in access and treatment opportunities. The statistics in this regard for Louisville as well as in other area of the country are alarming. " Compared with white adults, American Indians and Alaska Natives are 2.3 times, African-Americans are 1.6 times, and Hispanics are 1.5 times more likely to have diagnosed diabetes" (Racial and Ethnic Approaches to Community Health (REACH). Addressing Disparities in Health).

In Kentucky the statistics in terms of the disparity in diabetes is as follows: 6.3% White, 10.4% African-American ( Samuels, 2005). The following statistics represent a breakdown of the figures for diabetes in the region.

Eastern Kentucky: 60,938 7.3

Western Kentucky: 42,763 6.1

Louisville: 33,554 5.7

Central Kentucky: 25,037 4.9

Northern Kentucky: 16,360 5.2.

( Samuels, 2005),

As is clear from these figures, Louisville has a comparatively high rate of diabetes. One also has to take into consideration that the high number of diabetes sufferers in the city is to be found in the western section of the city.

Diabetes can be an extremely debilitating disease and one that requires a great deal of medical support and assistance. It is therefore obvious that where there is a disparity of health services and support, as is the case in Louisville, then this tends to exacerbate the suffering of the patient and to reduce the possibility of successful treatment.

Diabetes is a disease in which approximately seventy percent of those who suffer from the illness have some degree of nerve damage; which in turn often results in lower limb amputations. This again is a costly and rehabilitative intensive procedure which requires extensive health and medical support. This is one of the reasons for the high death rate in the area and among African-Americans. As one report emphasizes: "African-Americans in Louisville suffer and die more frequently from heart disease, stroke and diabetes. Poor nutrition increases risk for all these health problems" (GradNation - Making the Connection: Health & Student Achievement).

Psycho- Sociological Aspects and Physical Exercise

Hofrighter (2006) makes a number of important assumptions in his study of Louisville. The following apply to the present study.

Health is a social concept, not only a medical one

Health is a collective public good, actively produced by institutions and social policies.

(Hofrichter, 2006, p. 12)

While social factors such as racism and prejudice determine health conditions through policy among the disenfranchised, psychological factors to a great extent prefigure and instigate negative social outcomes. The psychological experience of being marginalized and neglected can lead to feelings of neglect and outrage particularly when it involves unequal access to healthcare; which in turn can be translated into negative social actions.

To compound the situation psychological stressors have been positively correlated with poor health and a propensity for various immune- system related illnesses. As Hofrichter states, "Communities, for example, with higher rates of economic disinvestments…. poor quality of housing, decreased access to nutritious foods, and other multiple stressors, will be more likely to have populations with higher blood pressure and other chronic illnesses" (Hofrichter, 2006, p. 15).

One factor that has been found to be extremely helpful in stress reduction is regular exercise. As one study notes; "Exercise can decrease 'stress hormones' like cortisol, and increase endorphins, your body's 'feel-good' chemicals, giving your mood a natural boost" ( Scott, 2011).

Furthermore, exercise has physical as well as psychological benefits. In terms of managing diabetes studies have found that,

Regular exercise can help your body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication.

(Glucose Control -- Exercise)

Stress has also been found to be beneficial in improving blood circulation, which is an important factor in diabetes as those who suffer fro the disease often experience problems in their limbs. The importance of exercise in the controlling and management of diabetes through regular exercise is emphasized by the following statement: "…exercise combined with a meal plan, can control Type 2 Diabetes without the need for medications"(Glucose Control -- Exercise). It therefore follows from the above that exercises is positively linked to diabetes and other conditions -- but facilities for regular exercise are often not catered for in lower income neighborhoods like the west side of Louisville

Prevention

As Hofrichter (2006) states"…addressing health inequities will demand a supportive environment for and collaboration with staff as well as community-based organizations ( Hofrichter, 2006,P. vii) This study also notes the important fact that in order to adequately address the problem of health disparities in the region one has to focus on the root causes such as social prejudice and injustice. (Hofrichter, 2006, p. 12). In other words, awareness of the fact that these inequalities have social and even political foundations is an essential aspect of any prevention program.

To this end in recent year there have been a number of local as well as regional initiatives to combat health marginalization and inequality in the Louisville area, and elsewhere in the country. For example, with regard to disparities in cancer treatment, a major focus of the NCCCP or the National Comprehensive Cancer Control Program has been to help reduce "... The cancer burden among underserved populations, such as African-Americans, Hispanic/Latino-Americans ..." (Norton Cancer Institute Joins National Cancer Institute Program to Enhance Cancer Research and Care at Community Hospitals, 2010)