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Following the #BlackLivesMatter movement (which called attention to the extrajudicial killings of African Americans), a new movement — #BlackHealthMatters — is picking up steam, bringing to light an important conversation that’s not talked about enough: the health disparities that black Americans face.
Sure, a variety of elements — family history, environmental factors, and lifestyle choices — all affect disease risk. But time and again, research and empirical evidence suggest that if you’re black, you’re more likely to have certain conditions such as heart disease and fare worse if diagnosed with specific cancers. There’s even evidence that the African American community faces different treatment from health care professionals in hospitals.
But what are the biggest diseases and health issues you may be at an increased risk for as an African American — and why do they exist in the first place?
Yahoo Health asked experts on the topic to explain the health disparities, the factors that could be at play, and what we can all do (regardless of race) to help close the gaps.
Heart disease is the leading cause of death in the United States — and the risk is even greater for African Americans, Lisa Angeline Cooper, MD, director of Johns Hopkins’ Center to Eliminate Cardiovascular Health Disparities, tells Yahoo Health. And not only that, cardiovascular disease is “the leading contributor to disparities in death rates between whites and African Americans.”
The Centers for Disease Control and Prevention (CDC) reports that nearly half of African American adults have some form of the disease. “One of the biggest contributors to this is uncontrolled hypertension (high blood pressure),” says Cooper. “African Americans have higher rates of hypertension — and although they have higher levels of awareness and treatment, they have lower rates of control even when treated.”
Why? Certainly, a lot of different factors are at play — many of which cannot be readily explained. But there is one major factor that’s been unearthed by research: access — or lack thereof — to healthy food, which impacts cardiovascular health.
What we know: Access to healthy food is a huge part of actually eating a healthy diet — and a
healthy diet is a large factor in keeping chronic conditions like high blood pressure at bay (or under control). And while overall poverty is a big factor in having access to healthy foods, research shows that race still appears to be an issue.
For example, research generally suggests the poorer a neighborhood, the fewer grocery stores it will have. But research from the Food Trust, a non-profit that works to ensure universal access to healthy and affordable food, also found that while just three out of 10 food stores in a high-poverty, mostly African American section of Los Angeles lacked fruits and vegetables, almost all food stores in a low-poverty, mostly white neighborhood had fresh produce stocked. Research from Johns Hopkins also found that poor black neighborhoods had fewer grocery stores than poor white neighborhoods.
According to the American Cancer Society, African Americans have the highest death rate and the shortest survival rate (the percentage of people still alive after a given amount of time) of all racial and ethnic groups in the United States for most cancers. This disparity is especially true as it relates to breast and prostate cancers, says Cooper.
As an African American man, you’re not only 1.6 times more likely to develop prostate cancer than a white man (and develop the disease at a younger age), according to the Prostate Cancer Foundation, you’re also more than 2.4 times more likely to die from it.
“We know African Americans as a group have lower access to and use of screenings than other racial groups,” Cooper says. And this may play a role in why — if you’re black — you tend to be diagnosed with cancer at later stages (and therefore have less opportunity to benefit from treatment), she says.
But with breast cancer, disparities in screening have improved: Recent research from the American Cancer Society suggests that within the past two years, 66.4 percent of white women and 66.1 percent of black women 40 or older have had a mammogram.
The problem: As an African American woman, you’re more likely to suffer from more aggressive forms of breast cancer and die from the disease — even though you may be less likely to get the disease than someone who is white, says Cooper.
Why? It’s not well understood: Some blame could be attributed to later diagnoses, but genetic and environmental factors could also be responsible, Cooper says.
A lot of cancer research, for example, has been focused on the genetic level, Kenneth Davis, Jr., MD, a professor of surgery and clinical anesthesia at the University of Cincinnati College of Medicine, tells Yahoo Health. In fact, a study out last year in The Journal of Clinical Oncology found genetic differences between the breast cancers in black and white women. Other research has suggested that African American men may experience a slightly different form of prostate cancer.
These differences may impact both how your respond to treatment and how aggressive a form of cancer is, Davis says.
Mental Health Conditions
African Americans are 20 percent more likely to report psychological distress than Caucasian people, according to the U.S. Department of Health and Human Services. “That’s another problem we think is multi-layered,” says Cooper. While it could have to do with environmental issues, other underlying health conditions, or access to screening and treatment, she notes that attitudes and behaviors could also play a role.
For example, Cooper says that in African American culture, mental health may be thought about in a different way. “As a group, African Americans tend to describe depression more as a stress-related problem or as related to spirituality as opposed to as a medical issue,” she says. This could lead people to not bring up symptoms during doctor’s appointments — or not seek treatment in general.
In turn, doctors might misinterpret many of depression’s symptoms, like fatigue or trouble sleeping, as something else.
The Issue of Race in Hospitals
Last year, “A Silent Curriculum” — a piece written by Brown University medical student Katherine C. Brooks — was published in JAMA. Davis explains that the essay “[spoke] volumes for the need for intentionality in addressing racism in medicine,” she says. “It is a call to continue with our efforts toward developing deeper understanding and addressing bias in all its forms both inside and outside of the classroom.”
Unfortunately, race may impact one’s experience within the walls of a health care setting. Take a recent study in The Journal of Pain and Symptom Management: It found that when both black and white actors portrayed dying patients, they received different care from docs. When speaking with white patients, physicians usually stood close to the patient and were more likely to touch them; with black patients, doctors more often stood in the doorway. The research concluded that doctors exhibited “significantly fewer positive, rapport-building nonverbal cues with black patients.”
That’s a huge issue, considering patient-doctor relationships can be a key factor in how involved a patient is in his or her own health care.
Even more: “Studies show that when seen in primary care visits, African Americans participate less in decisions — the visits tend to be more dominated by physicians talking,” says Cooper. She adds that these visits also tend to focus more on biological issues — not psychosocial issues like stress, relationships, or job-related concerns, all of which can have an impact on overall health.
Yet, Cooper says that most patients, regardless of race, prefer conversations to be both about biological issues and other psychosocial issues that could affect their health.
Why the difference in treatment? At least in terms of conversation matter, it could come down to a subconscious bias on the behalf of health care providers, says Cooper. “Maybe providers don’t realize they are doing it or maybe they are doing it because they are more comfortable talking about biological issues than psychosocial ones,” she says.
How to Close the Gap
Both patients and providers have to play a role in addressing these health disparities, says Cooper. For example, programs that focus on communicating with patients from different backgrounds and teaching health care professionals how to discuss issues that can impact health — like social and financial problems — should be in place.
There are also measures you can take on your own. Start with these four.
Consider your lifestyle. Changes in what you eat and how much you move can make an enormous impact not only on health, but also disease risk. After all, medicine isn’t just about treating illnesses, it’s about preventing them. And when it comes to issues like blood pressure, which can transform into more serious illnesses like heart disease, small changes can go a long way.
Prepare for your appointment. Knowing what to ask — should you be getting a certain test? A particular medication? Should you see a specialist? — is important advice for any patient, regardless of race. But being able to self-advocate in the health care system is especially important for African American patients, says Cooper.
Find a doctor you’re comfortable with. “In general, if you’re not comfortable with your physician, there should be nothing that prevents you from changing to another physician,” says Davis. Find a doc who practices culturally sensitive medicine — and is in-tune with how your views of the world may impact your health.
Finding someone who understands you — much like finding a partner who does the same — can help with complying to medical advice, Davis says. Some research even suggests, at least within the mental health industry, that people not only tend to prefer therapists of their same race, but also see slightly better results from choosing a therapist who is the same race.
Whoever you choose, do some digging online before you go in, suggests Davis. “Researching the background of a particular physician is a good way to take a more active role in your health.”
Stay up-to-date with screenings. When it comes to diseases like cancer, early detection is crucial. And given the increased risk African Americans face when it comes to specific kinds of cancer, sometimes the screening advice is different. The American Cancer Society suggests most men ask their doctor about screening for prostate cancer at age 50 — but that for African American men, this talk should happen at age 45.
They also suggest that at age 40, women should have the choice to start annual screening for breast cancer if they want to — and otherwise, to begin mammograms at 45.
Not sure about your risk factors or when to start screening? Your best bet is to talk with your doc.
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