Healthcare Disparities and Barriers to Health

African Americans: State of Health Compared with National Average

African Americans suffer significant health disparities when compared with their non-Black counterparts. According to Chinn, Martin & Redmond (2021), health equity among African Americas has suffered because of institutional and individual racism and discrimination, both in terms of socioeconomic discrimination in employment and education, and also because of healthcare provider discrimination, as providers may give insufficient weight to higher risk factors for this demographic in areas such as heart disease, stroke, and even mental health issues.

This is particularly manifest because of a long history of African American mistrust of the healthcare establishment, perhaps most notably exemplified in the Tuskegee Syphilis study, whereby participants were denied appropriate healthcare treatment for the sexually transmitted disease, against their knowledge, but also as well as statistics which indicate higher postpartum mortality among Black women, up to four times more than their white counterparts (Chinn et al., 2021). African Americans make up approximately 13.3% of the US population, the second most populous minority groups after Hispanics/Latinos (Carnethon et al., 2017). Yet life expectancy of African Americans is measured as 3.4 years shorter than f whites (Carnethon et al., 2017).

Healthcare Disparities

African Americans have significantly higher rates of heart disease and stroke compared with other groups, as well as higher rates of disease factors that contribute to heart disease and stroke such as hypertension and obesity (Carnethon et al., 2017). Mortality from cardiovascular diseases is also higher for African Americans than for whites (Carnethon et al., 2017). Overall, although coronary heart disease has declined overall in the American population, these declines have been smaller in African Americans versus other groups (Carnethon et al., 2017). African Americans are also more apt to experience stroke at younger ages than whites. For example, in the 55 -74 age demographic, African Americans are 1.8 times more likely to experience an intracerebral hemorrhage, although the difference is more negligible at age 75 or older (Carnethon et al., 2017).

African Americans are also twice as likely to develop type 2 diabetes than white Americans, particularly at younger age demographics (ages 18-30 years), despite the fact that type 2 diabetes was once predominantly considered a disease of middle age or older patients (Bancks et al., 2017). Once again, obesity contributes to a heightened risk for diabetes, as well as to heart disease and stroke, and elevated BMI is more pronounced in African Americans as a demographic.

Barriers to Health

Socioeconomic disparities, not simply genetic disparities, are a factor in these poorer health outcomes. Lower socioeconomic status can result in less access to healthy, fresh, and minimally processed foods, as can living in lower income food deserts, where access to supermarkets and farmer’s markets is limited. Similarly, a lack of access to safe spaces to exercise and leisure time for physical activity can contribute to higher BMI, stress levels, and overall poorer health outcomes. In the United States, where under-insurance or a lack of insurance can result in a lack of access to primary healthcare and regular monitoring by healthcare professionals, wellness promotion support and the beginnings of chronic illnesses may be poorly managed.

All of these factors are more apt to be present in African Americans population-wide, as a group. For example, in a study of African American women, Chinn (et al., 2021) reported that Black women an average of $5,500 less per year than their white counterparts, and are more apt to be the sole head of household, which effectively means supporting more dependents with lower income. America’s history of redlining, or discriminating against African Americans in terms of housing has led to segregation which affects health-related issues (access to supermarkets, exercise facilities, and health clinics) even for middle-class African Americans (Chinn et al., 2021).

Common Health Promotion Activities

One significant issue which may contribute to negative health outcomes in African Americans may be a paradoxically higher level of acceptance of obesity than in other demographic groups. According to one study, African Americans have a higher age-adjusted prevalence of obesity than other racial and ethnic demographics (an estimated 34% to 50%) Chinn et al., 2021). Although an acceptance of higher BMIs may be seen as a positive psychologically for individual self-esteem, this can also reduce motivation to alter eating and exercise habits. Even in higher income demographics, increased income is less protective than in comparable ethnic groups (Chinn et al., 2021). Exposure to racism on a daily basis itself can be a stressor with a negative impact upon mental health and physical health in terms of increased blood pressure and using eating as a coping mechanism (Chinn et al., 2021).

Approaches to Health Promotion

With this in mind, one significant health promoting activity from a provider standpoint is to stress the importance of maintaining a healthy body weight, even in not-currently overweight patients. Patients must understand obesity’s negative consequences for blood sugar, heart health, and potential stroke and that being overweight is not a question of vanity, nor is being slightly overweight a sign of heartiness and good health.