Conversations about income inequality and pay equity have been elevated in recent years so much so that Democrats seeking the presidency have made the issues planks in their political platforms. But another chasm that is as yawning as ever, but doesn’t get nearly as much attention, is the health equity gap.
According to a recent study by the Center for Disease Control and Prevention’s National Center for Health Statistics, African Americans specifically are at greater risk for the seven deadly diseases, which include diabetes, asthma, stroke and high blood pressure. The disparity is no more apparent than around heart disease, the No. 1 killer of Americans. Overall numbers have declined in the last 20 years; in 1999, non-Hispanic black deaths per 100,000 were 337.4; in 2017, 208. But for whites, it was 156.5 and 85.5.
“The CDC’s info highlights the risk factors for heart disease, and that is predominantly hypertension, which is a big problem, and it also points out that diabetes is higher in African Americans, particularly African American women,” said Dr. Thomas Price, associate director of cardiology at Montefiore Mount Vernon Hospital, just north of New York City. “African Americans tend to be less proactive about their health. They’ll come in when they have a problem. But they don’t come in for check-up or maintenance. And like everything else, it’s always less complicated and cheaper to do maintenance than repair.”
There are socio-economic reasons for African Americans’ lack of aggression in monitoring their health, including not having the financial resources or comprehensive insurance to visit a physician regularly. Where you live is also a factor. Physicians point out that your zip code is an indicator of your likelihood of heart disease. According to a recent study in the Journal of the American Medical Association, if you’re a man in the top 1 percent of income, you can expect to live 13 years longer than someone in the bottom 1 percent.
In a statement, the New York state Department of Health said that while it cannot comment on the CDC study, “New York’s Prevention Agenda tracks targeted interventions to address health inequalities, including social determinants of health such as housing, educational attainment and insurance coverage, that contribute to health disparities statewide.”
There are cultural barriers, too. African Americans, who often don’t trust the medical establishment, are less likely to follow medical protocols.
“One of my favorite sayings is, ‘Don’t be afraid of the pill more than the problem’,” Price said. “I have patients who have been diagnosed with hypertension and I say, “Here’s the medication, let’s have you take this and come back in six to eight weeks.’ And how was the medication? ‘Well, I didn’t take it. I wanted to see how I would do with a little garlic and exercise.’”
Price also highlighted what he saw as a “physician problem,” meaning they may not always communicate with African American patients adequately. “As I’m involved with residency programs and teaching residents, one of the things I stress is the importance for them to have a perspective of, ‘Does the patient understand how important this issue is to their health and how important it is to comply?’” Price said.
Then there is also the issue of referrals and treatment. “African American patients may not be sent for the most invasive tests as often or as early; that may be an ethnic disparity issue that needs to be addressed as well,” he said.
Everyone seems to know what the problems are, and some are using novel solutions. To better connect with the African American community, the Association of Black Cardiologists at one point launched the grassroots Black Barbershop Health Outreach Program, which sends health professionals into barbershops to talk to men.
Of course, diet, exercise and cutting out bad social habits, like smoking, would help. But that’s just a start.
“Fighting back means genetic research,” said the African American Wellness Project, which addresses inequities in the health care system. “It means changing the system for testing new drugs. It means improving health education. It means investments targeted to the health of Black Americans.”