Health Disparities in African-American Communities

Introduction

As is the case with all precious commodities, good health is not distributed equally throughout the population. Profound disparities exist between genders, ethnic groups, religious groups, and also between races. While some of these differences may be attributed to genetics, environmental and social trends as well as epigenetic factors—the interaction between environment and one's genetic makeup—are also influential. This paper focuses specifically on the current health status of African-Americans relative to whites and to the American population at large and suggests interventions to improve that status.

Current Health Status and Obesity Epidemic

Overall, the health status of African-Americans as a group is considerably worse than that of the general population based on a wide array of health indicators. African-Americans are disproportionately more likely to suffer from and die from chronic illnesses like heart disease and high blood pressure. African Americans have the highest death rates from heart disease and stroke compared with all other racial and ethnic populations; this disparity is found in age groups younger than 85 years of age as well as in older Americans. Hypertension rates are also higher for African American adults.

One of the primary reasons the prognosis for African-Americans regarding health status is so poor is the prevalence of obesity within this demographic. Although the U.S. as a whole is heavier than it has been in the past, obesity rates among African-Americans are considerably higher. Obesity is linked to a number of chronic conditions and negative long-term health outcomes, including diabetes. The prevalence of diabetes among African Americans is nearly twice as high as among whites. Obesity among African-American women is particularly severe: 50 percent of African-American women develop Type 2 diabetes in their lifetime.

While it might be assumed that higher rates of poverty and lack of access to safe places to exercise are partially responsible for this trend, these factors alone cannot explain these statistics. Among African-American women, increasing levels of education and higher economic status do not mitigate the risk of obesity to the same degree as with Caucasian women. Issues of food and recreation justice, high levels of racial and environmental stress, genetic factors, and cultural considerations are creating conditions for rising rates of obesity. The psychological stresses of racism may also play a significant role.

High rates of fast food consumption further contribute to high obesity rates, coupled with low availability of supermarkets in many African-American communities. Additional contributing factors include the finding that African American women who have children young, are overweight at the time of pregnancy, or gain an excess amount of weight during pregnancy have a higher prevalence of obesity compared to white women. In other words, factors that compound obesity in all demographics have a particularly notable impact on raising an African-American woman's risk for obesity. Obese mothers are more likely to give birth to children who face high risk of obesity, and in the African-American demographic, rates of childhood obesity are far higher than in the general population.

At present, 35.9 percent of African-American children are overweight or obese, compared to 31.7 percent of all children. The sooner a child becomes obese, the more difficult it is to change ingrained eating habits. Currently, 11.4 percent of African-American children are already obese. African-American children have fewer opportunities for physical activities than white children in their environments. African-American parents are more likely to report logistical challenges—such as conflicts between school and work schedules—in getting children to activities.

This limited amount of outdoor and recreational time may explain why African-American youths spend more time watching television compared with Hispanic or white youths. African-American children and adolescents watch an average of five hours and 54 minutes of television daily, while their Hispanic peers watch five hours and 21 minutes and their white peers watch three hours and 36 minutes. Excessive television viewing is positively associated with lower physical activity, exposure to advertising for highly caloric products, and excessive caloric intake due to snacking.

Primary Prevention Interventions

Preventing obesity and engaging in early screening for health-related conditions are the best ways to prevent many of the illnesses currently affecting African-Americans. Given the extent to which lower-income children rely upon school lunches for providing the majority of their daily calories, improving the quality of school lunches has been an important component of anti-obesity initiatives. Keeping physical activity in schools through physical education and recess is also essential, despite pressure to cut these parts of the school day in the interest of preparing students for high-stakes testing.

As part of the Affordable Care Act, access to health insurance and preventative screening for chronic diseases like heart disease and hypertension can be facilitated to a greater degree than ever before. Patients must be made aware of their elevated risk factors. Even patients without disease markers should be encouraged to engage in appropriate disease mitigation efforts, including eating a healthy diet, smoking cessation, and exercise.