African American Health Care Analysis
Cheryl Robinson
Capella University
CST5500
Multi-Cultural Issues in Health Care

Crobinson82@capellauniversity.edu
Dr. C Vaugh

Abstract
It is a cliché of health education that programs and interventions will be more effective when they are culturally appropriate for the populations they serve. In practice, however, the strategies used to achieve cultural appropriateness vary widely. This paper briefly describes African American history and how it relates to health care services. It explains the culture, value and belief of African American when it involves health promotion and disease prevention. Some major health concerns and barriers are noted within the black communities and population as well as way to promote health and disease prevention throughout the African American communities.

History of African American population African Americans first arrived to the United States as a crew on a pirate ship in the year 1619. The American population saw these new immigrants as an opportunity and captured many of the six million African immigrants and sold them as slaves (Bennett, 1992 as cited in Edelman & Mandle, 2002). The African American community suffered through a history of slavery and discrimination which has led to their current health and wellness problems. Many of their current problems have been linked to the segregation and cruel treatment that they were subjected to in the past, but African Americans have made significant achievements in overcoming these obstacles in the last number of years.
Engagement, submersion and crisis were considered the history of black health care three main phases. Community health became a national government targeted resource for health care programs for needy black (Kline & Huff, 2007). This was the beginning of neighborhood health centers converting to community health centers involving multidisplinary services. During the submersion phase government started to reduce resources for the poor communities. By the time of the crisis phase, leaders of the black community pointed out that disease problems and access need of blacks intertwine with other stresses of the black community such as unemployment, fear and violence in the community, single family households, and drug abuse.
In 2011, the population of African Americans including those of more than one race was estimated at 43.9 million, making up 13.6% of the total U.S. population (CDC, 2011). Those who identified only as African American made up 12.8% of the U.S. population-over 39 million people (CDC, 2011). The health issues among African Americans have become an ongoing debate. Why is it that African Americans have a higher mortality rate than the average Americans? According to statistics in 2009, Americans could expect to live 78.5 years while the life expectancy of an African American was approximately 74.5 (CDC, 2011). African Americans have become susceptible to many diseases and health problems throughout the last number of years.
African American Culture Value Belief
Culture is one of the most basic elements that makes up the identity and personality of each individual. Every individual has their own culture rooted from the community they lived in and the family they grew up making up the personal identity people have in the general society Personal views, aspects of reasoning and judgment and the general logical thinking of an individual are affected significantly by the culture he or she has. In this aspect, the entire well-being of a person depends greatly on his or her culture. Becoming aware of how your actions and cultural beliefs affect the patients that you deal with is important. Thus, a person must regularly assess himself because an action or a mere word done or spoken by a nurse can be misunderstood by these patients coming from different cultures.
African-American is more inclined to visit a healthcare center if he believed providers would cater to more than just his physical health concerns. One study states that African Americans identify self-empowerment through education and communication as an important health maintenance strategy (Carteret, 2011). African-Americans value health education and health maintenance which suggests that they are interested in their health, and may be receptive to prevention and health promotion interventions. Prayer, spirituality and church are important to African-Americans and play a key role in the lives of many of their lives.
African Americans have traditional health and illness beliefs. They also are known to use folk medicine; the folk healers are root workers. Some African Americans, particularly of Haitian background, may believe in sympathetic magic. Sympathetic magic assumes everything is interconnected and includes the practice of imitative and contagious magic. Contagious magic entails the belief that once an entity is physically connected to another, it can never be separated. This type of belief is seen in the practice of voodoo, when an individual will take a piece of the victim’s hair or fingernail and place a hex, which they believe will cause the person to become ill (Campinha-Bacote, 2009).
Black American churches have been the most important social institution in the black community and serves as a center for health screening, promotion and counseling. Many blacks hold their church with high esteem, therefore being an important coping resource for the African Americana community. To African Americans God is thought to be the spiritual healer.
Health Concerns of African Americans
According the Centers for Disease Control and Prevention (2010) the top health concerns among African Americans include:

(Source: NCHS, NVSS, Mortality Data, Deaths, Final Data for 2010).

African Americans are at greater risk for many diseases, especially those associated with low income, stressful life conditions, lack of access to primary health care, and negating health behaviors (Campinha-Bacote, 2009). The greatest risk factor for cardiovascular disease and heart attacks amongst African Americans is hypertension. High blood pressure is much more common among blacks of both genders than among the total population (Kline & Huff, 2008). Compared with hypertension in other ethnic groups, hypertension among African Americans is more severe, more resistant to treatment, and begins at a younger age, and the consequence is significantly worse, including organ damage (Brewster, Van Montfrans, & Kleijnen, 2004). African Americans also have an overall higher cancer incidence and mortality rate than any other race African Americans suffer from certain genetic conditions. Sickle cell disease is the most common genetic disorder among the African-American population, affecting one in every 500 African Americans. African Americans also metabolized certain drugs differently such as immunosuppressant, antihypertensive, cardiovascular, antiretroviral, psychotropic drugs.
Obstacles Obtaining Care Everyone should have the opportunity to achieve a healthy life and have comprehensive health care services available to them. To achieve this healthy life, people need to have access to the health care system and to a health care provider with whom they can develop a trusting relationship. However, existing barriers to attaining health care services often lead to disparities which in turn lead to differences in life expectancy, health status and a higher prevalence of certain chronic diseases (HealthyPeople.gov, 2012). Barriers to health care can be defined as conditions that can restrict or prevent the access of necessary health care for vulnerable populations. In their study on public health insurance programs, (DeVoe, et al., 2007) report that low-income families identified lack of insurance coverage, poor access to services, and unaffordable costs as the 3 major barriers to accessing health care. Even when families are able to obtain insurance, they still face obstacles such as unaffordable co-pays for office visits, deductibles, and prescriptions. Lack of insurance coverage and inability to pay for out-of-pocket expenses were also cited as the most common barriers by families.
Barrier that affects most vulnerable populations is a geographic barrier. Geographic barriers can affect people living in rural areas as well as inner cities. Patients are affected by the lack of services and health care professionals. Inner cities as well as rural areas are affected by barriers such as problems with transportation, insufficient health care providers, and lack of quality health care and financial limitations. Culture barriers can include values and beliefs, language and race and ethnicity. Health beliefs and behavior can become a barrier when patients decide not to seek medical treatment and instead turn to home remedies and healers when treating illnesses. Horton and Johnson (2010) stress the importance of communication in reducing disparities and increasing the trust of patients in the health care system.
Disparities
Barriers in health care can lead to disparities in meeting health needs and receiving appropriate care, including preventive services and the prevention of unnecessary hospitalizations (HealthyPeople.gov, 2012). In their 2008 annual report, the Agency for Healthcare Research and Quality lists several disparities’ in health care. They report that racial and ethnic minorities in the United States are more likely than non-minorities to receive lower quality of care (Copeland, 2005). This often leads to a higher death rate among minorities from preventable diseases. A 2005 report from the Centers for Disease Control and Prevention relates that more African-Americans died from heart disease, cancer and stroke than any other ethnicity. This report also states that African-Americans and Hispanics are less likely than Caucasians to receive influenza vaccines and other preventive forms of health care like wellness check-ups and colonoscopies. Many of the patients affected by barriers to health care are also afflicted by certain diseases in disproportionate numbers. Lillie-Blanton, Maleque, and Miller (2008), report that adults with higher incomes have a better health status and live longer than the poor. They also cite a higher rate of diabetes and heart disease among the poor (Lillie-Blanton, Maleque, & Miller, 2008). Barriers to health care and the disparities they produce are a continuing problem in our health care system. As future health care providers we can begin to look for ways to improve the quality of care and reduce disparities in clinical practice.
Conclusion
One way to provide health promotion information to a variety of communities is through a wellness promotion fair. Health fairs allow you to work within a specific community to identify unique needs for health promotion as well as provide basic education and preventive information. Screenings and presentations are great ways to deliver basic health information to a large population—and they can inspire a community to make better health choices. Wanting to improve health is simply not enough. A person needs the education and support to make smarter decisions, and health fairs can provide important information that can ultimately save lives. A well prepared health fair can support more effective health promotion activities, education, and assessments. There are several important issues to address when planning a wellness promotion fair. Qualified individuals need to be enlisted to provide accurate screenings and reliable information. It is important that individuals organizing these events properly train the screeners and educators regarding the services they are providing to build trust between the workers and the population. It is particularly important to establish a trusting relationship between the health care provider and African Americans.
It is also important to remind those attending the health fair that the information and screenings provided do not replace the need to seek further follow-up from a physician. Simple screenings on blood pressure or cholesterol and basic information on health changes are great ways to identify health concerns. However, they should never replace a primary care physician. It should be a goal of the health fair to direct the African American population to health care providers practicing in their area because continuity care with patients can improve trust among African Americans. The goal is not to teach but rather to mentor those who do not have the tools to make better choices about their health.

References
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