Health Disparity Among African-Americans
Melissa Swanson
Grand Canyon University
Family Centered Health Promotion
NRS-429V-0506
Sandi Coufal
February 8, 2015

Heath Disparity among African-Americans
The United States is a melting pot of cultural diversity. For a country that was founded by individuals fleeing persecution, it has taken us many years to grant African-Americans equal rights, and even longer for those rights to be recognized. Despite all the effort to eliminate inequality in this country, health disparity among this minority group remains a significant issue. Research in this area has pointed to several key reasons for this gap that center on differences in culture, socioeconomics, and lack of health literacy. The CDC Health Disparities & Inequalities Report of 2011 shows the average American’s life expectancy at 78.8 years, while the average African-American should expect to live only 75.3 years. The statistics gathered by the Center for Disease Control (CDC) are striking in painting the health status of African-Americans in this country. African-American infants have a mortality rate twice that of Caucasian infants. The CDC recognized that African-Americans lead the nation in death rates from heart disease and stroke, as compared to any other ethnicity. The United States Department of Health and Human Services Office of Minority Health presented data in 2012 showing that African-American adults have a 40% higher rate of hypertension and a 10% less incidence of controlled hypertension (CDC, 2011). The numbers prove an urgent need for primary, secondary, and tertiary health prevention for African-American communities.
African-Americans identify their culture as having origins from a variety of locations, such as Africa, Sub-Saharan Africa, and Aro-Caribbean (CDC, 2011). Over the lifespan of the United States, a distinctly African-American culture has been developed, which greatly influences their idea of health and well-being. Studies have shown, that when compared to Caucasian and other ethnicities, African American women experience less social pressure about their weight. “The correlation between body image size and ethnic and gender background for Americans, especially for standards of attractiveness, is a primary determinant of body size (Cowling, 2006, p9). African-American men value a woman with larger hips and body type. This contributes to African-Americans having one of the highest levels of obesity found in the United States. One 2006 report estimates that 69% of African-American women in the United States are overweight or obese (Cowling, 2006, p6).
A 2006 article Definitions of Health: Comparison of Hispanic and African-American Elders, further demonstrates the cultural differences between African American culture and Hispanic culture. In a study to determine the definition of health in Hispanic and African-American individuals, a clear difference in the two cultures definition of health was identified. Statements to a variety of questions demonstrate this fundamental difference. Hispanics were more likely to believe that health was something you can see in an individual’s outward appearance. African-Americans overwhelmingly stated the opposite by relating statements such as “You can’t tell if someone is healthy just by looking at them. Some people are healthy even if they aren’t walking around” (Collins, Decker, & Esquibel, 20060). Health promotion is popularly defined in terms of ones state of mind and reduction of stress levels. For example, if one experiences dizziness and headaches it is more apt to be attributed towards stress than signs of hypertension. African-Americans are more apt to define health as a state of well-being, while the Hispanic culture focuses more on the outward physical appearance as a standard of health. These cultural differences in the African -American population can account for the increase in obesity, being that their basic culture tends to value mental and spiritual well-being over a fit and healthy physical appearance.
African Americans have different dietary preferences influenced by their culture that contributes to the prevalence of obesity and coronary artery disease. Traditionally, the African American diet consisted of leafy green vegetables, fish, poultry, and beans. However, the cooking methods, such as deep frying, the heavy use of gravy, pork fat, and butter add a large amount fat and cholesterol to an otherwise heart-healthy diet. “Soul food” with its fried chicken, fried pork chops, and corn bread have become the traditional comfort food, and there is a large significant placed in the African-American culture on community and family gatherings centered around food. Historically, African-Americans lived a highly active lifestyle that compensated for a higher than average fat content in their diet. As modern trends swing toward a more sedentary lifestyle, the direct result is heart disease rising to be the leading cause of death among African-Americans (Cowling, 2006, p8).
The socioeconomic status of African-Americans also plays an important part in the health disparity present in this minority group. According to the 2010 U.S. Census Bureau, the largest state population of African-Americans is seen in New York at 3.3 million. In 2000, it was estimated that 88% of the United States African-American population lived in Metropolitan areas. A 2007 article in California Law Review entitled Fast Food: Oppression through Poor Nutrition, very plainly points out that the location of most predominantly African-American neighborhoods accounts for the rising rates of obesity, hypertension, and heart disease attributed to poor nutrition. The lack of grocery stores located in these traditionally low-income neighborhoods is surprising. The Author, Andrea Freeman, cites an example using West Oakland, California in 2007. At the time this article was written, West Oakland had 30,000 people, one grocery store, and 36 liquor/convenience stores. Most African-Americans, who primarily live in lower-income, urban areas, do not have a grocery store within walking distance, thus creating a lack of access to healthy, fresh foods (Freeman, 2007, p. 2221). With the explosion of cheap, fast food restaurants in these neighborhoods, it is not surprising that people are turning to lower cost, more readily available fast food restaurants, whose menus consist mainly of high fat, low nutrition food. Poor quality, lack of availability, and high cost of nutrition’s food is a significant barrier experienced by many African-American communities.
The history of African Americans in this country is plagued by racism and injustice. Historical components contribute to “social and psychological barriers” perceived or experienced by African Americans (Huntley & Heady, 2013, p. 23). “Feelings of persecution, racial prejudice, often precede or coexist with conspirator beliefs” (Huntley & Heady, 2013, p. 23). As a result, many African Americans choose to not seek out health care due to distrust of medical establishments. A real example of this being the Tuskegee syphilis study that took place from 1932-1972. Six hundred African American participants from poor urban areas were signed up for a study where they believed they were getting free health care for “bad blood.” In fact, a majority of the individuals were already infected with syphilis, and they were never treated, even though penicillin was readily available in 1947. Instead of treating the individuals, researchers told them nothing about their disease or treatment options, and continued to study the natural progression of untreated syphilis (Brandt, 1978). This incident is just one example of the mistrust many African-American individuals express toward health care institutions, and contributes to lack of health literacy, as well as a lack of primary, secondary, and tertiary health prevention.
Another socioeconomic factor relating to health disparity for African-Americans focuses on lack of physical activity. Low income, urban areas with a high population of African-Americans frequently lack parks and recreational activities to provide its residents with the required amount of exercise. Lower income schools lack the financial means to participate in physical education and sports activities. These lower income neighborhoods frequently are plagued with high crime rates, discouraging parents from allowing their children to play outside. Research has suggested that the environment in which African-Americans life is a significant predictor for long term health and increasing health disparity within the minority (Huntley & Heady, 2013, p. 23).
Researchers have studied many health care strategies for primary, secondary, and tertiary prevention of illness in the African-American community. One studied method looked at storytelling as a way of educating African-Americans who historically mistrust health care workers. Since many African-American individuals report significantly negative experiences due to disrespectful treatment and prejudices from medical personnel, the researched focused on community barbers as a means to dispense health information, and increase health literacy. Local barbers were educated in preventative measures such as healthy eating, weight loss, and appropriate physical activity. The barbers not only cut hair, but dispensed health information to individuals in a trusted manner. The barbers also were taught to check blood pressure, identify issues in individuals with hypertension and pre hypertension, educate on consequences of untreated disease, and encourage those individuals to seek appropriate medical intervention (Edelman & Kudzma, 2010, p12).
Using trusted individuals in the community allows African-American individuals to receive education in a culturally respected way, promotes trust between individuals and their health care providers, and promotes health seeking behaviors. Education and encouragement of health seeking behaviors is provided as primary intervention, blood pressure screening encourages secondary prevention, and education on consequences of untreated disease, as well as encouragement of adherence to medication regimens and healthy living to manage chronic conditions fulfills tertiary health preventions. An example of tertiary prevention could be key individuals, such as the barber, in the African-American community who could recognize adverse side effects of medication reported by individuals, and advise individuals to seek medical assistance for medication adjustment, instead of stopping medications.
Closing the gap in health disparity in this country is not an easy task. The United States is famous for its varying population of different culture and ethnicity, but the country has been plagued with intolerance and prejudices that have carried over to be a major barrier in health care delivery to minority groups throughout the country. It will take specific knowledge of individual culture and a customized approach to address each cultures unique needs.

References
2010 Census Shows Black Population has Highest Concentration in the South [Press Release]. (2011, September 29, 2011). Retrieved from www.census.gov/newsroom/releases/archives/2010_census/cb11-cn185.html
Allan M. Brandt. 1978. Racism and research: The case of the Tuskegee Syphilis study. The Hasting Center Report 8(6):21-29. Retrieved from http://nrs.harvard.edu/urn-3:HUL.InstRepos:3372911
CDC Health Disparities and Inequalities Report-United States, 2011. (2011). Retrieved from www.cdc.gov/mmwr/pdf/other/su6001.pdf
Collins, C. A., Decker, S. I., & Esquibel, K. A. (2006). Definitions of Health: Comparison of Hispanic and African-American Elders. Retrieved from www.redorbit.com/news/health/448110/definitions_of_health_comparison_of-hispanic_and_africanamerican_elders/?print=true
Cowling, L. L. (2006). California Food Guide: Health and Dietary Issues Affecting African Americans. Retrieved from www.dhcs.ca.gov/formsandpubs/publications/CaliforniaFoodGuide/17Healthand DietaryIssuesAffectingAfricanAmericans.pdf
Edelman, C., Kudzma, E., & Mandle, C. (2010). Health Promotion throughout the Life Span, 7th Edition. [VitalSourceBookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9780323056625/id/B9780323056625000103_s0085
Freeman, A. (2007, December 31, 2007). Fast Food: Oppression Through Poor Nutrition, 95, 2221-2260. Retrieved from http://scholarsip.law.berkley.edu/californiareview
Huntley, M., & Heady, C. (2013). Barriers to Health Promotion in African American Men with Hypertension. American Journal of Health Studies, 28, 21-26. Retrieved from http/www.va.ajhs.com/