As we conclude the celebration of Black History Month, we were once again reminded of the social conditions that served as antecedents to many of the disparities seen in our great nation – including health disparities. While battles rage over the current quality and structure of our health care system and talking heads debate the nuances of one solution versus another, the stark reality is that in order to improve the overall health of the nation we must enable people to act to promote their own health. This is particularly true with respect to preventive health care for African-Americans.
African-Americans are disproportionately burdened by a number of serious illnesses and health conditions. While the top three causes of death for African-Americans and whites are the same – heart disease, stroke, and cancer – the risk factors, incidence, morbidity, and mortality rates for these diseases and conditions are greater among blacks than whites. In 2003, African-Americans were 31% more likely to die from heart disease, 43% more likely to die from stroke, and 23% more likely to die from cancer than their white counterparts. Diabetes – the fourth ranked cause of death for African-Americans – is a killer in and of itself, but it is also a precursor of heart disease and stroke. Roughly 13% of the African-American population over 20 years of age suffers from either Type I or Type II diabetes, where one-third is undiagnosed. On average, African-Americans are two times more likely to have diabetes than whites of similar age. The occurrence of these four diseases and conditions could be decreased and the severity lessened by improved use of preventive care.
Because health disparities do not recognize socioeconomic divides among African-Americans, all African-Americans should be attuned to the importance of preventive health care and take personal responsibility where possible for their own health. Adhering to health care guidelines from the U.S. Preventive Services Task Force or from disease associations regarding regular doctor visits and receiving appropriate and timely screening are among the most effective ways to take charge of and monitor one’s own health.
For example, the American Heart Association has specific guidelines for stroke and heart disease prevention that recommends beginning risk factor screening as early as 20 years of age. These screenings include testing and checking blood pressure, cholesterol level, body mass index, and waist circumference at least every two years. For both of these conditions, having diabetes is a significant risk factor.
Anyone with a risk factor for high blood pressure or excess body weight should screen for diabetes every three years. Diabetes, the “silent killer,” gradually damages blood vessels throughout the body, causing the aforementioned diseases. Individuals can live for years without knowing they have the disease. Lack of monitoring and preventive treatments can lead to serious complications caused by the disease such as: blindness, nerve damage that may require amputations, and kidney failure. African-Americans are 2 to 3 times more likely to suffer these diabetes complications, which again points to the importance of preventive health care.
Cancer screenings vary depending on diagnosis. African-American women are far more likely to die from breast cancer than white women. Research is not conclusive on the cause, but some have hypothesized that tumors are found at a more advanced stage in African-American women so there are fewer treatment options. While there is not conclusive evidence as to how to prevent breast cancer, the average African-American woman should begin to practice monthly breast self-examinations at age 20 and have clinical breast examinations by a health professional every year. After age 30, African-American women should have a mammogram every one to two years until 50 years of age. After 50, all women should get a mammogram each year. These tests and screenings increase the likelihood of early detection and prevent the disease from progressing to a level that is less amenable to treatment.
For African-American men, prostate cancer is the deadliest form of cancer. African-American men are 1.5 times more likely to develop the disease and 2 to 3 times more likely to die from it than white men. Current evidence is insufficient regarding the effectiveness and benefits of prostate cancer screening. However, the Center for Disease Control and Prevention recommends that adult male patients discuss the pros and cons of prostate cancer screening with their physician to make an informed decision about prostate cancer screening.
Screening is not the only tool available for managing individual health. The incidence of these conditions may also be affected through lifestyle changes such as proper diet, moderate or no alcohol consumption, no smoking, moderate levels of exercise, and stress reduction.
Making the necessary strides to eliminate health disparities that still burden the African-American community and the nation must be embraced as a daily responsibility. Taking a more active role in the health care decision-making process, increasing the utilization of preventive care, and taking more responsibility for appropriate lifestyle choices are just a few of the ways to shrink the health disparities gap. Any system of care that hopes to really make improvements in the nation’s overall health should place an emphasis on preventive care, and any individual who hopes to be healthy must do their part to assure healthy outcomes.
George L. Askew is a practicing pediatrician, the executive director of Doc-for-Tots, and a Senior Fellow at the Center for American Progress. Meredith L. King is the Health Policy Research Analyst at the Center.