In Black and White:

Health Disparities in America

Marc Imhotep Cray, M.D. .

From: Imhotep Virtual Medical School Minority Health Education Blog In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Among the disease-specific examples of racial and ethnic disparities in the United States is the cancer incidence rate among African Americans, which is 10% higher than among whites. In addition, adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.

Black and White: Health Disparities in America

By Marc Imhotep Cray, M.D.

Marc Imhotep Cray, M.D.

In the United States, health disparities are well documented in minority populations such as Blacks, Native Americans, and Latinos. When compared to Whites, these groups have higher incidence of chronic diseases, higher mortality (death rate), and poorer health outcomes. In this article I will briefly discuss three inter-related topics as they relate to present day racial disparities in American minorities in general and Blacks in particular. The first two being descriptive and the third prescriptive. First, I will review some historical reasons for racial disparities in Black health. Second, I will outline disease-specific examples of racial disparities in the United States, including cancer , diabetes, cardiovascular disease, HIV/AIDS, and infant mortality according to the CDC's Office of Minority Health & Health Disparities (OMHD) statistical data. And third, I will provide some suggested lifestyle changes one can make towards better personal health and disease prevention.

1) Historical reasons for racial disparities in Black health

See: Our Story in Brief-The Historical Relationship Between America, Blacks, Health and Medicine

Health disparities in Blacks is not just a health-care issue or a socio-economic status issue or a race issue. It is in part all of these factors working simultaneously. The historical reasons for racial disparities in health are well documented and beyond the scope of the article. Suffice it to say, it has only been a little over 50 years that Blacks have been able to participate fully in American society. The accumulated consequence of historical white supremacy/racism, i.e. slavery, aparthid, political disenfranchisment, social degradation and economic exploitation plays itself out in the racial health disparities data we see today. Our poor health status is a piece of the fallout of historical and present day oppressive condition for the masses of Black people in the United States, an outward manifestation. Historical abuse has forstered present day dsistrust. In other words, one of main reasons for racial disparities in Black health that we see today is under-utilization of the U.S. health care system resources in part because of historically broken trust.
See: IVMS Race Trust and Tuskegee-Med Ethics Broken Trust and Health Disparities

Historically white physicians and the U.S. health care system used Afrikans in America as research instruments and guinea pigs.
See: American Health Dilemma: Race, Medicine, and Health Care in the United States.

Today, many Blacks dont go to the doctor and are less compliant with treatment suggestions when they do go since we are less trusting of U.S. institutions like the health-care systems. So even when we have access to care, we underutilize it. Furthermore, access to care is largely a function of health-insurance status, which is largely a function of employment status, which is largely a function of educational attainment. So as a population with less education, Blacks have less access to health care. Wealth is important because we know that across all causes of morbidity (disease), economic status is the leading indicator of poor health. All these factors work together to produce poor health outcomes in Blacks. It is not possible to detangle Black health status as a group from historical, social, political, educational and economic factors. What is most, the interacting of these factors to result in our lagging health status raises a significant moral-legal issue. Namely, there is a seven-to-eight-year life span difference between Blacks and Whites. And the economic costs to us havent yet been quantified.
See: Race, Health Care and the Law, Dr.Vernellia R. Randall Prof. of Law

Racism in medicine and racial discrimination within the U.S. health-care system still exist to to this very day. Physician / health care provider bias continues to play a major role in racial health disparities. We know that the way the person is treated within the health system will influence

In Black and White: Health Disparities in America

Page 2

Marc Imhotep Cray, M.D.

whether they are compliant with treatment. If you feel you were mistreated or got poor quality care then youre less inclined to be compliant. And compliance to treatment is obviously an important part of determining health status outcomes.
See: IVMS Race Trust and Tuskegee-Med Ethics Broken Trust and Health Disparities

Most Black people dont have any health-care interaction during the year for the reasons explained above. The question becomes, to what extent is Black health really a function of what happens in the health-care system? Also, I think what is happening in the physical environment is going to have much more of an effect on Black health. The quality of housing, whether youre exposed to a lot of allergens and/or environmental toxins, the amount of stress you encounter, poor diet, smoking, excess alcoholthese factors have more to do with your health status than what happens in the health-care system. The U.S. health-care system can more accurately be described as a sick care system. That is to say, it is set up for curative not preventive medicine. This brief backdrop is why I say physicians alone wont solve the problem of racial health disparities. They are not in a position to do it. Therefore, I believe that the surest way for us as a group to begain to chip away at racial health disparities is by individually taking more responsibility for our own health through practicing healthier lifestyles and behaviors.
See:National Healthcare Disparities Report 2012

2) Disease-specific examples of racial disparities in the United States

According data from the CDC's Office of Minority Health & Health Disparities (OMHD) in 2005 the death rate for Blacks was higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and infant mortality. Cancer In 2005, Black men were 1.3 times as likely to have new cases of lung and prostate cancer, compared to white men. Black men are twice as likely to have new cases of stomach cancer as white men. Black men have lower 5-year cancer survival rates for lung and pancreatic cancer, compared to white men. In 2005, Black men were 2.4 times as likely to die from prostate cancer, as compared to white men. Black men have significantly higher lung cancer incidence rates and deaths than whites, even though they begin smoking at an older age and smoke fewer cigarettes per day. Blacks have the highest death rate from colon and rectum cancer of any racial or ethnic group in the US. In 2005, Black women were 10% less likely to have been diagnosed with breast cancer, however, they were 34% more likely to die from breast cancer, compared to white women. Black women are twice as likely to be diagnosed with stomach cancer, and they were 2.4 times as likely to die from stomach cancer, compared to white women. Among Black children, ages 1-14 years, cancer ranks third among the leading causes of death surpassed only by accidents and homicides.

Diabetes Black adults are twice as likely than white adults to have been diagnosed with diabetes by a physician.

In Black and White: Health Disparities in America

Page 3

Marc Imhotep Cray, M.D.

In 2002, Black men were 2.1 times as likely to start treatment for end-stage renal disease related to diabetes, compared to white men. Diabetic Blacks were 1.7 times as likely as diabetic Whites to be hospitalized. In 2005, Blacks were 2.2 times as likely as whites to die from diabetes. Heart Disease In 2005, Black men were 30% more likely to die from heart disease, as compared to white men. Blacks are 1.5 times as likely as whites to have high blood pressure. Black women are 1.7 times as likely as white women to be obese. HIV/AIDS Although Blacks make up only 13% of the total U.S. population, they accounted for 49% of AIDS cases in 2007. Black males had more than 7 times the AIDS rate of white males. Black females had more than 22 times the AIDS rate of white females. Black men were more than 9 times as likely to die from AIDS as white men. Black women were more than 20 times as likely to die from AIDS as white women, in 2005. Infant Mortality (Infant Health) In 2005, Blacks had 2.3 times the infant mortality rate of whites. Black infants were almost four times as likely to die from causes related to low birthweight, compared to white infants. Blacks had 1.8 times the sudden infant death syndrome mortality rate as whites. Black mothers were 2.5 times as likely as white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all. The infant mortality rate for Black mothers with over 13 years of education was almost three times that of White mothers in 2005. Stroke Black adults are 1.7 times as likely than their White adult counterparts to have a stroke. Black males are 60% more likely to die from a stroke than their White adult counterparts. Analysis from a CDC health interview survey reveals that Black stroke survivors were more likely to become disabled and have difficulty with activities of daily living than their white counterparts.

3) Lifestyle changes one can make towards health promotion and disease prevention.
Cardiovascular (Heart) Disease is the number one killer of adults in the United States, and as we see from the data above Blacks suffer and die from these conditions disproportionately when compared to our White counterparts. The risk factors include high cholesterol, smoking, high blood pressure, diabetes and obesity. One of the oldest and most important health related adages we have heard is that an ounce of prevention is worth a pound of cure. Most of chronic medical problems such as high blood pressure, heart disease and diabetes have treatments, but no cure. In other words, once you get it you will always have it. Nonetheless, the American health-care system is focused on cure as against prevention. Thus I would like to focus the remainder of this brief essay on the importance of healthy lifestyle and behavior in the prevention of disease. Cholesterol: Lifestyle Changes to Improve Your Levels

In Black and White: Health Disparities in America

Page 4

Marc Imhotep Cray, M.D.

What is cholesterol? Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues and produce certain hormones. Some cholesterol is essential for health. Your liver makes all the cholesterol your body needs. How much and what types of cholesterol your liver makes depends on 2 factors: what types of fats you eat and your inherited genetic tendencies. Your body may get cholesterol directly from the food you eat (such as eggs, meats and dairy products). Too much cholesterol in your blood can raise your risk of having a heart attack or stroke. What is the difference between good cholesterol and bad cholesterol? Low-density lipoprotein (LDL) is often called bad cholesterol. It delivers cholesterol to the body. High-density lipoprotein (HDL) is often called good cholesterol. It removes cholesterol from the bloodstream. This explains why too much LDL cholesterol is bad for the body, and why a high level of HDL cholesterol is good. For example, if your total cholesterol level is high because of a high LDL level, you may be at higher risk of heart disease or stroke. But, if your total cholesterol level is high only because of a high HDL level, you're probably not at higher risk. Triglycerides are another type of fat in your blood. When you eat more calories than your body can use, it turns the extra calories into triglycerides. When you change your lifestyle to improve your cholesterol levels, you want to lower LDL, raise HDL and lower triglycerides. What should my cholesterol levels be? Total cholesterol level Less than 200 is best. 200 to 239 is borderline high. 240 or more means you're at increased risk for heart disease. LDL cholesterol levels Below 100 is ideal for people who have a higher risk of heart disease. 100 to 129 is near optimal. 130 to 159 is borderline high. 160 or more means you're at a higher risk for heart disease. HDL cholesterol levels Less than 40 means you're at higher risk for heart disease. 60 or higher greatly reduces your risk of heart disease. Triglycerides Less than 150 mg/dL is best

What lifestyle changes can I make to help improve my cholesterol levels? Exercise regularly.

In Black and White: Health Disparities in America

Page 5

Marc Imhotep Cray, M.D.

Exercise can raise HDL cholesterol levels and reduce levels of LDL cholesterol and triglycerides. If you haven't been exercising, try to work up to 30 minutes, 4 to 6 times a week. Make sure you talk to your doctor before starting an exercise plan. Lose weight if you are overweight. Being overweight can raise your cholesterol levels. Losing weight, even just 5 or 10 pounds, can lower your total cholesterol, LDL cholesterol and triglyceride levels. If you smoke, quit. Smoking lowers your HDL cholesterol. Even exposure to second-hand smoke can affect your HDL level. Talk to your doctor about developing a plan to help you stop smoking. Eat a heart-healthy diet. Eat plenty of fresh fruits and vegetables. Fruits and vegetables are naturally low in fat. Not only do they add flavor and variety to your diet, but they are also the best source of fiber, vitamins and minerals for your body. Aim for 5 cups of fruits and vegetables every day, not counting potatoes, corn and rice. Potatoes, corn and rice count as carbohydrates. Pick good fats over bad fats. Fat is part of a healthy diet, but you need to know the difference between bad fats and good fats. "Bad fats, such as saturated and trans fats, are found in foods such as butter; coconut and palm oil; saturated or partially hydrogenated vegetable fats such as shortening and margarine; animal fats in meats; and fats in whole milk dairy products. Limit the amount of saturated fat in your diet, and avoid trans fat completely. Unsaturated fat is the good fat. Most fats in fish, vegetables, grains and tree nuts are unsaturated. Try to eat unsaturated fat in place of saturated fat. For example, you can use olive oil or canola oil in cooking instead of butter. Use healthier cooking methods. Baking, broiling and roasting are the healthiest ways to prepare meat, poultry and other foods. Trim any outside fat or skin before cooking. Lean cuts can be pan-broiled or stir-fried. Use either a nonstick pan or nonstick cooking spray instead of adding fats such as butter or margarine. When eating out, ask how food is prepared. You can request that your food be baked, broiled or roasted, rather than fried. Look for other sources of protein. Fish, dry beans, tree nuts, peas and lentils offer protein, nutrients and fiber without the cholesterol and saturated fats that meats have. Consider eating one meatless meal each week. Try substituting beans for meat in a favorite recipe, such as lasagna or chili. Snack on a handful of almonds or pecans. Soy is also an excellent source of protein. Good examples of soy include soy milk, edamame (green soy beans), tofu and soy protein shakes. Get more fiber in your diet. Add good sources of fiber to your meals. Examples include fruits, vegetables, whole grains (such as oat bran, whole and rolled oats and barley), legumes (such as beans and peas) and nuts and seeds (such as ground flax seed). In addition to fiber, whole grains supply B-vitamins and important nutrients not found in foods made with white flour. Eat more fish. Fish are an excellent source of omega-3 fatty acids. Wild-caught oily fish, such as salmon, tuna, mackerel and sardines, are the best sources of omega-3s, but all fish contain some amount of this beneficial fatty acid. Aim for 2 6-oz servings each week.

In Black and White: Health Disparities in America

Page 6

Marc Imhotep Cray, M.D.

Limit how much cholesterol you get in your diet. You should limit your overall cholesterol intake to less than 300 milligrams per day, or less than 200 milligrams if you have heart disease.

Add supplements to your diet. Certain supplements may help improve your cholesterol levels if changing your diet isnt enough. Some examples include: Plant sterols and stanols. Plant sterols and stanols can help keep your body from absorbing cholesterol. Sterols have been added to some foods, including margarines and spreads, orange juice and yogurt. You can also find sterols and stanols in some dietary supplements. Omega-3 fatty acids. If you have heart disease or high triglycerides, consider taking an omega-3 or fish oil supplement. Make sure the supplement has at least 1,000 mg of EPA and DHA (these are the specific omega-3 fatty acids found in fish). Red yeast rice. A common seasoning in Asian countries, red yeast rice may help reduce the amount of cholesterol your body makes. It is available as a dietary supplement. Talk to your doctor before taking red yeast rice, especially if you take another cholesterol-lowering medicine called a statin. The recommended dose of red yeast rice is 1,200 milligrams twice a day.
RESOURCES:

CDC's Office of Minority Health & Health Disparities (OMHD) Patient Education / Consumer Health Information American Academy of Family Physicians - Patient Information American Heart Association - Heart and Stroke Encyclopedia CDC - Disease Fact Sheets eMedicine - Consumer Health Merck - Merck Manual of Medical Information - Home Edition NLM - MedlinePlus

US Government - Consumer Health Information

Further Study: Imhotep Virtual Medical School Minority Health Education Blog Dr. Cray, is a Physician, Pharmacologist/Analytical Chemist, Basic Medical Sciences (BMS) and Clinical Medicine Teacher, Medical Infomatics Expert, Webmaster, and Undergraduate Medical Education Researcher He is an experienced Medical Web Developer, e-Professor/ Online Lecturer, and founder of The Institute for Minority Physicians of the Future, and Imhotep Virtual Medical School. www.imhotepvirtualmedsch.com.

In Black and White: Health Disparities in America

Page 7