Black people in America are at increased risk to develop certain health conditions or have worse prognosis or outcomes for certain health conditions. The cause for this consists of combination of social, genetic and economic factors.
There are many medical conditions that affect the Black communities more than other races or ethnicities. Some of these health conditions are often seen in African Americans or Black people; and in some the Black individuals will have worse outcomes or develop certain diseases earlier than white people.
There are different causes for these disparities and they are often intertwined and complex. In this article, we will talk about conditions that disproportionately affect African Americans; the causes behind it and what can be done to shorten this health gap for the health problems in black people.
What are the Causes of Racial Disparities in Health System?
First of all, let’s try to understand why some of these disparities exist. Some of them occur because of genetics and biology; however, majority of the times, the disparities are attached to various systemic problems.
Nonmedical factors known as social determinants (SDOHs) are responsible for affecting the health outcomes. According to experts SDOHs is grouped into five categories(1):
- Economic Stability: Unemployment or lack of income can present as a significant barrier in stable housing along with access to nutritious foods and medical care.
- Education Access: The level of education is often linked with income, but education also plays a role in having a longer and healthier life (2).
- Healthcare Access and Quality: Black people in America are more likely to be underinsured or uninsured when compared to their white counterparts. Not only this, they also report to receiving a reduced standard of care.
- Social and Community Context: There can be mistrust of the medical community embedded deeply in some sections of the Black communities.
- Neighbourhood and Environment: When you live in an area having high rates of violence or pollution, then it significantly impacts the health. One might also work in a job that exposes them to higher health risks.
The theme underlying through all the SDOH categories is the effect of systemic racism. There have been noted cases where racist policies and attitudes have caused health disparities in black Americans.
Now let us discuss 11 conditions that disproportionately affect black Americans and how health disparities can occur in them due to the above factors.
1. OBESITY in African Americans
Black people in America are about 30% more likely to suffer from obesity than their white counterparts.
This disparity is seen more in teens and children (50%) and females (50%). Obesity is a major risk factor for many health conditions and easily contributes to worse outcomes for others. The cause for this disparity is commonly geographic and economic reasons. Disparities in income impacts the ability of the people to afford healthy food. Some individuals can live in food deserts or spaces where any physical activity is unsafe or challenging.
What can be done to manage OBESITY in African Americans
- It is important to teach black children about good and healthy eating habits early on in life.
- Perform daily physical activity.
- Provide support to community efforts to have better access to nutritious and affordable food.
2. HEART DISEASE in African Americans
Black Americans have a reduced risk to develop heart condition and despite this they are at 30% increased risk for die from heart disease. Heart disease is more likely to affect Black Americans at a younger age too.(3)
The cause is complex with regards to the conditions having health disparities; however, it is important to make note that Black Americans have increased rates of the major risk factors for heart disease, such as obesity, hypertension, smoking and diabetes.
The genetics and SDOHs do impact the ability to control these risk factors, they can be modified and give an opportunity to lessen the health gap.
What can be done for Reducing Heart Disease in African Americans
- Lose excess weight and maintain a moderate weight.
- Regularly check your blood pressure and make sure it is within the normal range.
- Be aware of your family history.
- Adopt habits that are heart-healthy.
3. HYPERTENSION or High blood pressure in African Americans
According to the American Heart Association (AHA), about 55% of African adults residing in America suffer from high blood pressure and it is one of the highest rates all over the world (4). A black person has higher risk for having hypertension earlier in life than white people. The American Heart Association also lists diabetes and obesity as two major contributing factors to high blood pressure. However, racial discrimination and stress can also play a role in this disparity.
The steps taken for cardiovascular risk factors apply for decreasing the risk of hypertension or keeping a high blood pressure within the normal range.
What can be done to reduce HYPERTENSION in African Americans
Lifestyle changes go a long way in preventing hypertension or high blood pressure in African Americans and these consist of consuming a balanced diet, regular exercise; keeping the weight in a healthy range; managing stress; limiting salt and alcohol intake and regular monitoring of blood pressure.
4. DIABETES in Black Adults in the United States
Black Americans are at twice the risk when compared to white adults for developing type 2 diabetes (5). This disparity occurs mostly because of genetics, socioeconomic factors and increased rate of obesity. The complications from diabetes, such as kidney disease, are also more common among Black Americans. To avoid this, efforts should be made to control risk factors, such as sedentary lifestyle and obesity.
What can be done for DIABETES in Black Adults
- Exercise regularly and consume balanced diet.
- Maintain a moderate weight.
- When suffering from diabetes, monitor and manage levels of blood sugar to avoid complications.
5. STROKE in African Americans
A stroke occurs when there is insufficient blood supply to the brain and the cause is often blockage in an artery. Just like other conditions associated with cardiovascular health, Black adults in America are at increased risk to have strokes and more likely to result in death (6).
Hypertension and diabetes are major risk factors for stroke. Other contributing risk factors of stroke are high smoking, high cholesterol and stress. Following a heart-healthy lifestyle helps in reducing the risk of stroke, despite having family history for it.
What can be done to reduce STROKE in African Americans
- Following heart-healthy habits.
- Cutting down on salt; alcohol and quitting smoking.
- Understanding the signs and symptoms of a stroke.
6. CANCER in Black People
According to the American Cancer Society (ACS), Black people in America have shorter survival rates and higher death rates than any other racial group for most of the cancers (7).
The American Cancer Society also acknowledges that these disparities are more commonly from socioeconomic factors and access to health care than any biological cause.
Some of cancers which black people are more at risk for include:
Prostate Cancer: Black men are 73% more likely to develop prostate cancer when compared to white men and are at a twice of a risk to die from it.
Breast Cancer: Black women are about 41% at increased risk to die from breast cancer than white females.
Colorectal Cancer: Majorly because of the disparities in screening, Black individuals are 20% more at risk to develop colorectal cancer and this disparity was only developed in the last three decades.
Multiple Myeloma: This is a blood cancer which carries twice the risk of affecting Black people than white people.
Lung Cancer: Black men are at 12% more risk for lung cancer than white men. Both black men and women are at higher risk for getting diagnosed at younger age.
What can be done to reduce CANCER in Black People
- Go for regular cancer screenings recommended for your age and level of risk.
- Get vaccinations available for certain cancers (8).
- Stopping smoking completely helps in preventing about the 19% cancers resulting from tobacco use (9).
- Make lifestyle adjustments to cut down the cancer risk.
7. KIDNEY DISEASE Among Black Americans
According to the National Kidney Foundation (NKF), Black people in America are thrice more likely to suffer from kidney failure than white people (11). This is attributed to the increased rates of risk factors in People of Color and these include obesity, diabetes and hypertension.
The key to management of kidney disease is early detection and as higher percentage of People of Color lack quality healthcare access or are uninsured, this leads to kidney disease not being detected until its late stages.
What can be done for KIDNEY DISEASE Among Black Americans
- It is advised to get an eGFR test if you have risk factors for kidney disease.
- Always stay active to cut down the risk of kidney problems and other conditions that increase this risk.
- Follow a diet which supports kidney health.
- Become more knowledgeable in finding quality care for kidney disease as a Black adult.
8. SICKLE CELL ANEMIA in Black Adults in America
Sickle cell anemia is a rare genetic disease affecting the hemoglobin present in the red blood cells. It affects the ability of the red blood cells in carrying and delivering the oxygen to tissues and organs in the body.
There is only 1 in every 16,300 Hispanic American babies who are born with Sickle cell anemia; however, this condition affects 1 in every 365 newborns who are Black (11). Around 1 in every 13 Black babies have this gene and it can be passed to the next generation.
However, the disparities in quality of healthcare and its access can also affect people suffering from sickle cell anemia. Most of them have difficulty in getting pain medications required for managing their conditions because of concerns over opioid misuse or racist beliefs about Black people’s perception of pain.
Sickle cell anemia is a lifelong condition with the initial symptoms seen in childhood. It makes a great difference if the doctor treating is culturally competent and who understands the impact of this condition on Black families.
What can be done for Sickle Cell Anemia in Black Adults in America
- Understanding the triggers for sickle cell crisis and avoiding them.
- Being up to date on vaccinations.
- Taking the recommended medications for preventing infections.
9. HIV and AIDS in African Americans
Black Americans felt the force of the AIDS and HIV epidemic in the 1980s. This disparity is even more prominent today, with Black American comprising of 42% of all the new HIV diagnoses in America.
This impact is seen more in young people, women, and men having sex with men. (12) Around two-thirds of Black American adolescents and adults who are having HIV stay in the southern states.
The treatments for HIV have significantly improved since the 1980s. There is antiretroviral therapy which helps in decreasing the amount of virus present in the body to an almost undetectable level. This helps in cutting down the risk of transmitting the virus to another person.
What can be done for HIV and AIDS in African Americans
- Always have protected sex to prevent contracting or transmitting the HIV to others.
- If you are at risk for HIV exposure, then consider taking the PreP or pre-exposure prophylaxis.
- Educate yourself on what are the contributing factors to the high rates of HIV in Black men.
- If you have contracted HIV, then follow the treatment plan strictly to prevent the virus from becoming resistant to the drugs.
10. ASTHMA in Black Americans
Asthma occurs when there is narrowing of the airways of the lungs causing difficulty in breathing. Asthma disproportionately affects children in communities living in poor air quality and Black communities have been the target of environmental racism leading to exposure of increased levels of air pollution.
According to the Asthma and Allergy Foundation of America, asthma is about 50% more common in Black individuals in America than white people (13). Black people are also at five times increased risk to visit the emergency department because of asthma and three times more likely to die from asthma.
What can be done for ASTHMA in Black Americans
- Quit smoking and avoid second-hand smoke exposure.
- Make a plan if you suffer from asthma to keep the symptoms under control.
- Consult your doctor regarding an asthma education program and educate yourself on the risk factors for asthma.
11. COVID-19 in Black People
The initial months of the COVID-19 pandemic emphasised the impact of racial disparities in the American healthcare system and the country as whole.
In May 2020, Black people were thrice at risk for getting admitted for COVID-19 when compared to white people. The death in Black Americans were almost twice as much from covid-19 than white people. (14)
This was because of the already prevalent health conditions in the Black community, such as obesity and sickle cell disease, which increased the risk of getting acutely ill from the covid virus (15). Problems with access to healthcare and environmental racism only increased the impact. (16)
After a year into the pandemic, Black Americans were still less likely to get vaccinated when compared to white Americans. It took about 2 years into the pandemic for Black Americans to get vaccinated at the same rate as white Americans.
What can be done for COVID-19 in Black People
- Be up to date with the COVID vaccinations and boosters (17).
- Always wear a mask when in crowded places.
- Management of underlying conditions which increase the risk of serious illness from COVID is of utmost importance.
Conclusion
The cause of why black people are more likely or are at increased risk for certain health conditions is complex and interconnected. There needs to be major change in the social, economic, political and medical systems before this gap can really close or at least reduce significantly. Till then, there is a lot one can do to take control of one’s personal health, which includes following healthy life choices and understanding the risk and acting in the right manner to prevent or manage these conditions prevalent in black Americans.
- https://health.gov/healthypeople/priority-areas/social-determinants-health
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880718/
- https://newsroom.heart.org/news/young-black-adults-had-a-higher-risk-of-heart-disease-worse-hospital-outcomes
- https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/high-blood-pressure-and-african-americans
- https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans
- https://www.stroke.org/-/media/Stroke-Files/Lets-Talk-About-Stroke/Prevention/Lets-Talk-About-Black-Americans-and-Stroke-Sheet.pdf
- https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-cff-aa.pdf
- https://www.cdc.gov/cancer/prevention/vaccination.html?CDC_AAref_Val=https://www.cdc.gov/cancer/dcpc/prevention/vaccination.htm
- https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-cff-aa.pdf
- https://www.kidney.org/kidney-topics/race-ethnicity-kidney-disease
- https://www.cdc.gov/sickle-cell/data/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/sicklecell/data.html
- https://www.kff.org/hivaids/fact-sheet/the-impact-of-hiv-on-black-people-in-the-united-states/
- https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/
- https://blackcoalitionagainstcovid.org/wp-content/uploads/2022/03/2022-Report-State-of-Black-America-and-COVID-19-A-Two-Year-Assessment-3292022.pdf
- https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
- https://www.nature.com/articles/d41586-020-01453-y
- https://www.cdc.gov/covid/vaccines/stay-up-to-date.html?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html