By Mylika Scatliffe
The United States is generally considered to be one of the most powerful nations in the world both economically and in terms of military power. It’s also generally known to lag behind most other developed countries when it comes to health and health care– leading to significant racial health disparities.
Deputy Director for the Johns Hopkins Center for Health Equity, Deidra C. Crews, is a nephrologist and professor of medicine in the Division of Nephrology at the Johns Hopkins University School of Medicine. Her research program aims to advance equity in kidney disease and hypertension outcomes, by focusing on social drivers of health inequities. Nephrologists specialize in treating acute and chronic kidney disease and its associated high blood pressure.
When asked about the top five conditions that disproportionately affect the Black community, Crews listed, in no particular order, a range of cardiovascular disorders –to include heart disease and stroke, kidney disease, hypertension, diabetes, and obesity.
“They are all cardiometabolic conditions and the same root causes contribute to them, including lack of access to high quality health care, racial residential segregation, and intrapersonal discrimination,” said Crews.
Although the Affordable Care Act has increased health insurance options available to low- and middle-income households, where Black people are overrepresented, the large disparities in health insurance coverage related to race and ethnicity are a long-standing characteristic of health care in the United States, according to the National Institutes of Health.
Black people are still underinsured and uninsured at a higher rate than White people. Those who are uninsured and underinsured visit a doctor at a lower rate than those with health insurance coverage, perhaps only visiting urgent care centers and emergency rooms when faced with a dire health problem.
“The ability to benefit from early detection and preventive care is affected when there is no regular access to quality health care. For example, early detection of kidney disease can result in effective treatment with medication, so it doesn’t become severe enough to need dialysis or a transplant,” said Crews.
The traditional focus of research and public health intervention for cardiometabolic diseases and disorders has been on increasing physical activity, improving diet, and reducing alcohol and tobacco usage, according to the National Institutes for Health. Dietary and lifestyle changes are notoriously difficult to make, and they influence multiple risk factors for cardiometabolic diseases.
Racial residential segregation is a serious by product of historical discriminatory practices including Jim Crow and redlining. The practice of redlining restricted Black people from obtaining mortgages to live and operate businesses in desirable neighborhoods. “When a community has been continually disinvested, there are tremendous barriers to access services that promote good health – education, fitness and green space for exercise, and healthy food,” said Crews.
In addition, the stress caused by psychological effects of intrapersonal discrimination can be a major contributing factor in developing obesity and hypertension. Not only is the risk of obesity impacted by access to healthy food and fitness opportunities, but it is also frequently seen as a moral or personal failure.
“Even during medical visits, racism among providers is evident in their practice with patients and colleagues. There is a severe weight bias in the healthcare field and weight is often blamed on any issue without a thorough investigation of the cause,” said Angela Burden, a public health nurse in Baltimore for the last 30 years.
Obesity can be a primary driver of hypertension and diabetes, although all sufferers from these disorders are not overweight. In the United States, the leading cause of kidney disease is diabetes, followed by high blood pressure. Other causes of kidney disease include lupus, HIV, autoimmune disorders, sickle cell disease, and some genetic diseases. Black Americans have more than three times the risk of kidney failure than Whites, with the gap being larger than any other condition, according to Crews.
Hypertension is one of the most treatable health conditions, particularly when caught early. With early detection and intervention, treatment consists of effective medications that are widely available, and access to a primary care physician who will follow the most appropriate guidelines for treatment.
Just as these diseases share common root causes, they also share common remedies. African Americans can use the following tips to avoid, significantly reduce, or effectively manage these disorders and more:
- Get a primary care physician. If you don’t have insurance or are underinsured, many urgent care centers have primary care physician services. Make sure to visit them regularly and take advantage of all available routine screenings and preventive care services.
- Maintain a healthy weight. Quit smoking and reduce alcohol intake.
- Engage in regular physical activity, at least 30 minutes per day.
- Incorporate at least five servings of fruits and vegetables into your daily diet, especially green leafy vegetables. A serving size is one half of a cup.
Decrease stress. Engage in activities such as meditation, yoga, spending time with family. Determine the method of self-care that is most beneficial for you.