Black History Month Part 1 - American Heart Month

February is Black History Month - a time to recognize the incredible contributions that Black Americans have made.  If you are like me, you wish we didn't need a specific month to do this, but instead recognized Black History all year round.  However, as that is not yet the case, Emily and I want to use the remaining 3 posts this month, to tackle health disparities through the lens of Black History Month.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

February is also American Heart Month which works well with our theme as Black Americans are 2 to 3 times as likely to die from cardiovascular disease than White Americans.  Part of this is due to disparities in risk factors for heart disease and part is due to disparities in access to appropriate care after heart disease or those risk factors are present.

Risk Factors for Heart Disease

According to the National Heart, Lung and Blood Institute, risk factors for Heart Disease include:

1.) High blood pressure - African Americans are much more likely to have high blood pressure than any other race.  High blood pressure can be caused or exacerbated by high sodium diets, smoking, lack of exercise and stress.  All of which are common in communities of color.

Race of Ethnic Group	Men (%)	Women (%)
African Americans	43.0	45.7
Mexican Americans	27.8	28.9
Whites	33.9	31.3
All	34.1	32.7

2.) High blood cholesterol - African Americans are also more likely than White Americans to have high cholesterol.  According to the CDC, “People with high total cholesterol have approximately twice the risk of heart disease as people with optimal levels.”

Race or Ethnic Group	Men (%)	Women (%)
Non-Hispanic Blacks	34.4	27.7
Mexican Americans	41.9	31.6
Non-Hispanic Whites	30.5	32.0
All	32.5	31.0

3.) Diabetes - According to the National Diabetes Information Clearinghouse, “Compared with non-Hispanic white adults, the risk of diagnosed diabetes was 18 percent higher among Asian Americans, 66 percent higher among Hispanics/Latinos, and 77 percent higher among non-Hispanic blacks”

Diagnosed and Undiagnosed Diabetes among People Ages 20 Years or Older, United States, 2010

Group	Number or percentage who have diabetes
Non-Hispanic whites	15.7 million, or 10.2 percent, of all non-Hispanic whites ages 20 years or older
Non-Hispanic blacks	4.9 million, or 18.7 percent, of all non-Hispanic blacks ages 20 years or older

4.) Smoking - Not only is smoking more prevalent in Black communities than in White, but also there is evidence that African Americans and Hispanics are less likely to be offered cessation services than white patients.

Group	Percent Who Smoke
American Indian/Alaska Native	34.1%
Black	21.3%
White	19.6%
Hispanic	14.9%
Asian/Pacific Islander	9%

Access to Care and The Determinants of Health

Black Americans also tend to have reduced access to appropriate care - whether that is actual medical care (primary and specialist) or access to social and economic opportunities (income, appropriate physical environment, etc).  The Affordable Care Act will reduce some of the disparities in health insurance rates, but it won’t necessarily address issues of access to primary care doctors or high quality specialists.  If those physicians aren’t accepting patients or are not located in communities of color, health insurance won’t help.

Poverty also contributes to a lack of access to care.  35% of Black Americans and 33% of Hispanic Americans live in poverty (compared to 13% of White Americans).  Even with insurance, most people must pay something for prescription medications which often results in low-income sufferers of heart disease to ration their medication to save money.  Living in a low income neighborhood also can reduce the likelihood that an individual will live an active lifestyle - this could be because of high crime, poorly maintained or non-existent sidewalks or lack of public transportation options.  Where an individual lives can also affect his/her ability to buy fresh produce rather than highly processed foods which contributes to heart disease.  Finally, living in poverty increases an individual’s stress level (the presence of racism does as well), which can exacerbate high blood pressure.