BLACK HEALTH PROFESSIONAL FAMILIES: ASSESSMENT OF STRENGTHS AND STABILITY James H. Carter, MD Durham, North Carolina
Despite pernicious racism, most black health professionals achieve professional success and most have stable marriages. A 19-item questionnaire was designed to assess this hypothesis following a lecture on the strengths and weaknesses of black health professional families to physicians, dentists, and their spouses (n = 38) at the 1990 annual meeting of the combined Old North State Medical and Dental Societies of North Carolina. Surprisingly, these families seemed eager to disclose feelings about themselves, their professions, and their marriages. Major preliminary findings were that these health professionals were more prone to indicate unhappiness than their spouses and less likely to see racism as an impediment to careers, and more willing to acknowledge that they would like to correct something in their lives. (J Nati Med Assoc. 1 992;84:31 -35.) Key words * black health professionals * families * middle class Black families, both professional and nonprofessional, have been defined historically in the same biological and social context as their white American counterparts.' It is generally assumed that a family consists of two adults-a male and a female-who accept full responsibility for the needs of their children. From the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Excerpts presented at the Combined Annual Meeting of the Old North State Medical and Dental Societies General Session, June 30, 1990, Myrtle Beach, South Carolina. Requests for reprints should be addressed to Dr James H. Carter, Dept of Psychiatry, Box 3106, Duke University Medical Center, Durham, NC 27710. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
However, over the past 30 years and especially during the 1960s, sociologists began calling attention to the profound changes noted among American families of all races and ethnic groups in terms of function, gender, composition, and the family as a social institution. Today it becomes necessary to redefine the ideal black American family that is able to survive in a complex Anglo-dominated racist society, replete with greed, avarice, materialism, selfishness, and dishonesty. Some black American families are rendered dysfunctional and are in a state of disintegration. There is evidence suggesting that unless the plight of the black male is reversed, black men are at risk of becoming an endangered species in the not-too-distant future. The erosion of the role of black men in contemporary black families and in society carries drastic implications for future generations of black men. It is no secret that more than 50% of all black families are headed by single black women. Although out-ofwedlock births are disproportionately observed among black households (and blamed on welfare, food stamps, and Aid to Families with Dependent Children by some politicians), out-of-wedlock births are not confined to black populations. In fact, the number of single-parent households in America with children below the age of 15 had grown from 197000 in 1960 to 802000 in
1988.2 Another important issue impacting black families is that black Americans are dying at higher rates from nearly every cause of death, including heart disease, stroke, cancer, accident, homicide, and AIDS. It is ironic that the life expectancy of blacks is declining at a time when modern medicine has made such significant strides in diagnosing and treating diseases. The life expectancy of black Americans dropped from 69.7 years in 1984 to 69.4 years in 1986. Meanwhile, during the same period the life expectancy of the general 31
STRENGTHS/STABILITY OF BLACK HEALTH PROFESSIONALS
population reached 75 years.3 The despair among black families and black communities is underscored by the report that approximately 60 000 black Americans who died would have lived if the death rates for black Americans were at parity with white Americans.4 Today it is a difficult decision for middle-class black professional Americans to choose to live in predominantly black communities or to choose to live in predominantly white middle-class communities, where it remains problematic to find acceptance, notwithstanding civil rights gains. An analysis of 1988 housing data indicates that most cities and their inner suburbs remain segregated, and since 1970, little progress has been made toward residential integration.5 Real estate agents continue to steer middle-class black Americans away from middle-class white areas. So-called "red lining" in which banks and mortgage institutions prescribe lending in certain neighborhoods is a common practice. Based on information collected by the Federal Home Loan Bank Board, Congress is considering legislation that discourages banks from rejecting loan applications from black Americans, who have a rejection rate twice that of whites.6 To live in many predominantly black communities is to survive under conditions of violence, crime, and the escalation of crack cocaine. With regard to drug-related violence, black-on-black homicide and drugs are intertwined.7 Black-on-black homicide increased by 8% from 1985 to 1989. The rate of homicide increased more rapidly than any other leading cause of death. The rate of death from homicide among black Americans was almost six times higher in 1986 than the rate for homicide in white populations.8 These statistics suggest that there may be no future generations of black health professionals unless present trends are reversed. Black health professionals must become proactive in the movement to restore black pride and to bring black culture to prominence. Regrettably, some black health professionals have a false sense of security and incorrectly assume a personal involvement is unnecessary, perhaps because they do not witness homelessness, domestic violence, or black children trafficking drugs. It is apparent that black health professionals should articulate the health and psychosocial needs of people of color. Justifiably, we ask, "Who is more competent to address issues of infant mortality than the black pediatrician?" Similarly, should not black health professionals concern themselves with the crisis of acquired immunodeficiency syndrome (AIDS), alcoholism, and substance abuse-diseases that are disproportionately destroying black Americans? 32
Unquestionably, black health professionals must possess a mental toughness and a competency that exceeds all expectations-and therein lies a dilemma. Black health professionals must not only dispel the media's created and perpetuated myths that all black health professionals are supermen and superwomen; but more importantly, black health professionals must guard against believing or behaving as if it is possible to single-handedly meet all health, social, and environmental needs of black patients. Furthermore, black health professionals must avoid neglecting their own health and emotional needs, and disregarding concerns for family. When health professionals neglect themselves and their families, they become at risk for suffering impairment.9 Black health professionals are frequently the first generation of families to attend professional school and many have personally experienced poverty, which can contribute to an over-identification with black suffering. Having gone from "rags to riches" and judged by society to be partakers of the "American dream," black health professionals justifiably expect to be granted all the rights, privileges, and respect afforded all middleclass Americans. Yet, all black Americans, regardless of income or professional achievements, are occasionally reminded that because of race there are things in society that wealth cannot provide.
DREAMS GONE ASTRAY Considerable media attention has been focused on the plight of the urban minority underclass, with an occasional positive profile of the life of black American athletes, politicians, and businessmen. Seldom does the black health professional make news in a world that thrives on sensationalism and degradation. Parenthetically, it is health professionals who have historically made noteworthy contributions that are overshadowed by reports of unemployment, drugs, homelessness, and violence. The richness and diversity of the black experience is ignored in favor of daily television coverage of drug-infested, inner-city ghettos that spew black bodies across the urban landscape. Such images turn many people away from knowing and associating with black Americans. Thus, ignored are the masses of religious and hard-working black people who love and care for their families and society, and whose lives are built on generations of black culture and communal support. I0 This selective news coverage destroys the dreams of achieving recognition from the public at large and from professional colleagues. Unlike black health profesJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
STRENGTHS/STABILITY OF BLACK HEALTH PROFESSIONALS
sionals of earlier generations, today's black health professionals are not limited to providing care to minority patients and neither are they confined to minority communities. Contemporary black professionals may be found in all health specialties, subspecialties, and in various health delivery systems. To the young and uninitiated black health professionals, these gains were achieved only from hard-fought battles of black health professional pioneers who must not become mere forgotten heroes. "I Professional privileges are supposedly granted today on the basis of training, experiences, and professional competency, but too often there are hidden quotas that usually can be readily uncovered. In fact, white health professionals have failed to grant black health professionals empowerment, which minimizes the opportunity for black professionals to provide care from a black perspective. Historically, it has been the black health professional who treated poor blacks; consequently, the constant readjustments and uncertainties of federal programs that finance health care for the poor have left some black health professional families in financial limbo. This is particularly true in the rural south where there is a disproportionately large number of infirm black elderly Americans who depend on Social Security benefits for at least 50% of their incomes and supplementary security income for an additional 10%; providing health care can lead to financial disaster for the provider.12"13 It is no coincidence that the only two nations without national health insurance are South Africa and the United States. Black health professional sacrifices are minimized by black communities, particularly the enormous financial expense for training, and many black Americans are unaware of the years devoted to achieving professional competence. A recent report by the American Medical Association indicates that 82% of all 1987 medical school graduates were in debt, owing an average of $35 621-60% higher than the average debt for 1986; 17% of all 1986 and 1987 medical school graduates were in debt, owing more than $50 000. The study affirmed that students were heavily indebted and more likely to be older, female, and black.'4"15
ASSESSING THE HAPPINESS OF BLACK PROFESSIONAL FAMILIES To validate the hypothesis that most black health professional families are reasonably happy and welladjusted, at the conclusion of this author's lecture, "Strengthening the Black Professional Family," a 19-item questionnaire was presented to black profesJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
sional families (ie, physicians, dentists, and their spouses) at the 1990 annual meeting of the Old North State Medical and Dental Societies of North Carolina at Myrtle Beach, South Carolina (Figure). The adult attendees (n = 38) were asked not to identify themselves by name, specific profession, age, or sex, believing the greater the anonymity the more candid the responses. The number of professional couples were not differentiated because of their small representations. Likewise, the small sample of female professionals yielded meaningless (n = 3) results. The number of professionals (men and women) responding were 22 and the number of responses from spouses were 16. A total of 10 questionnaires were discarded because respondents failed to properly identify their respective categories, perhaps suggesting the need to redesign that portion of the questionnaire. The following preliminary findings were noted. Professionals were more likely to be unhappy (n = 7 of 22 versus their spouses n = 1 of 16, X2= 3.64, df= 1, P
Despite pernicious racism, most black health professionals achieve professional success and most have stable marriages. A 19-item questionnaire was designed to assess this hypothesis following a lecture on the strengths and weaknesses of black health professional families to physicians, dentists, and their spouses (n = 38) at the 1990 annual meeting of the combined Old North State Medical and Dental Societies of North Carolina. Surprisingly, these families seemed eager to disclose feelings about themselves, their professions, and their marriages. Major preliminary findings were that these health professionals were more prone to indicate unhappiness than their spouses and less likely to see racism as an impediment to careers, and more willing to acknowledge that they would like to correct something in their lives. (J Nati Med Assoc. 1 992;84:31 -35.) Key words * black health professionals * families * middle class Black families, both professional and nonprofessional, have been defined historically in the same biological and social context as their white American counterparts.' It is generally assumed that a family consists of two adults-a male and a female-who accept full responsibility for the needs of their children. From the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Excerpts presented at the Combined Annual Meeting of the Old North State Medical and Dental Societies General Session, June 30, 1990, Myrtle Beach, South Carolina. Requests for reprints should be addressed to Dr James H. Carter, Dept of Psychiatry, Box 3106, Duke University Medical Center, Durham, NC 27710. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
However, over the past 30 years and especially during the 1960s, sociologists began calling attention to the profound changes noted among American families of all races and ethnic groups in terms of function, gender, composition, and the family as a social institution. Today it becomes necessary to redefine the ideal black American family that is able to survive in a complex Anglo-dominated racist society, replete with greed, avarice, materialism, selfishness, and dishonesty. Some black American families are rendered dysfunctional and are in a state of disintegration. There is evidence suggesting that unless the plight of the black male is reversed, black men are at risk of becoming an endangered species in the not-too-distant future. The erosion of the role of black men in contemporary black families and in society carries drastic implications for future generations of black men. It is no secret that more than 50% of all black families are headed by single black women. Although out-ofwedlock births are disproportionately observed among black households (and blamed on welfare, food stamps, and Aid to Families with Dependent Children by some politicians), out-of-wedlock births are not confined to black populations. In fact, the number of single-parent households in America with children below the age of 15 had grown from 197000 in 1960 to 802000 in
1988.2 Another important issue impacting black families is that black Americans are dying at higher rates from nearly every cause of death, including heart disease, stroke, cancer, accident, homicide, and AIDS. It is ironic that the life expectancy of blacks is declining at a time when modern medicine has made such significant strides in diagnosing and treating diseases. The life expectancy of black Americans dropped from 69.7 years in 1984 to 69.4 years in 1986. Meanwhile, during the same period the life expectancy of the general 31
STRENGTHS/STABILITY OF BLACK HEALTH PROFESSIONALS
population reached 75 years.3 The despair among black families and black communities is underscored by the report that approximately 60 000 black Americans who died would have lived if the death rates for black Americans were at parity with white Americans.4 Today it is a difficult decision for middle-class black professional Americans to choose to live in predominantly black communities or to choose to live in predominantly white middle-class communities, where it remains problematic to find acceptance, notwithstanding civil rights gains. An analysis of 1988 housing data indicates that most cities and their inner suburbs remain segregated, and since 1970, little progress has been made toward residential integration.5 Real estate agents continue to steer middle-class black Americans away from middle-class white areas. So-called "red lining" in which banks and mortgage institutions prescribe lending in certain neighborhoods is a common practice. Based on information collected by the Federal Home Loan Bank Board, Congress is considering legislation that discourages banks from rejecting loan applications from black Americans, who have a rejection rate twice that of whites.6 To live in many predominantly black communities is to survive under conditions of violence, crime, and the escalation of crack cocaine. With regard to drug-related violence, black-on-black homicide and drugs are intertwined.7 Black-on-black homicide increased by 8% from 1985 to 1989. The rate of homicide increased more rapidly than any other leading cause of death. The rate of death from homicide among black Americans was almost six times higher in 1986 than the rate for homicide in white populations.8 These statistics suggest that there may be no future generations of black health professionals unless present trends are reversed. Black health professionals must become proactive in the movement to restore black pride and to bring black culture to prominence. Regrettably, some black health professionals have a false sense of security and incorrectly assume a personal involvement is unnecessary, perhaps because they do not witness homelessness, domestic violence, or black children trafficking drugs. It is apparent that black health professionals should articulate the health and psychosocial needs of people of color. Justifiably, we ask, "Who is more competent to address issues of infant mortality than the black pediatrician?" Similarly, should not black health professionals concern themselves with the crisis of acquired immunodeficiency syndrome (AIDS), alcoholism, and substance abuse-diseases that are disproportionately destroying black Americans? 32
Unquestionably, black health professionals must possess a mental toughness and a competency that exceeds all expectations-and therein lies a dilemma. Black health professionals must not only dispel the media's created and perpetuated myths that all black health professionals are supermen and superwomen; but more importantly, black health professionals must guard against believing or behaving as if it is possible to single-handedly meet all health, social, and environmental needs of black patients. Furthermore, black health professionals must avoid neglecting their own health and emotional needs, and disregarding concerns for family. When health professionals neglect themselves and their families, they become at risk for suffering impairment.9 Black health professionals are frequently the first generation of families to attend professional school and many have personally experienced poverty, which can contribute to an over-identification with black suffering. Having gone from "rags to riches" and judged by society to be partakers of the "American dream," black health professionals justifiably expect to be granted all the rights, privileges, and respect afforded all middleclass Americans. Yet, all black Americans, regardless of income or professional achievements, are occasionally reminded that because of race there are things in society that wealth cannot provide.
DREAMS GONE ASTRAY Considerable media attention has been focused on the plight of the urban minority underclass, with an occasional positive profile of the life of black American athletes, politicians, and businessmen. Seldom does the black health professional make news in a world that thrives on sensationalism and degradation. Parenthetically, it is health professionals who have historically made noteworthy contributions that are overshadowed by reports of unemployment, drugs, homelessness, and violence. The richness and diversity of the black experience is ignored in favor of daily television coverage of drug-infested, inner-city ghettos that spew black bodies across the urban landscape. Such images turn many people away from knowing and associating with black Americans. Thus, ignored are the masses of religious and hard-working black people who love and care for their families and society, and whose lives are built on generations of black culture and communal support. I0 This selective news coverage destroys the dreams of achieving recognition from the public at large and from professional colleagues. Unlike black health profesJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
STRENGTHS/STABILITY OF BLACK HEALTH PROFESSIONALS
sionals of earlier generations, today's black health professionals are not limited to providing care to minority patients and neither are they confined to minority communities. Contemporary black professionals may be found in all health specialties, subspecialties, and in various health delivery systems. To the young and uninitiated black health professionals, these gains were achieved only from hard-fought battles of black health professional pioneers who must not become mere forgotten heroes. "I Professional privileges are supposedly granted today on the basis of training, experiences, and professional competency, but too often there are hidden quotas that usually can be readily uncovered. In fact, white health professionals have failed to grant black health professionals empowerment, which minimizes the opportunity for black professionals to provide care from a black perspective. Historically, it has been the black health professional who treated poor blacks; consequently, the constant readjustments and uncertainties of federal programs that finance health care for the poor have left some black health professional families in financial limbo. This is particularly true in the rural south where there is a disproportionately large number of infirm black elderly Americans who depend on Social Security benefits for at least 50% of their incomes and supplementary security income for an additional 10%; providing health care can lead to financial disaster for the provider.12"13 It is no coincidence that the only two nations without national health insurance are South Africa and the United States. Black health professional sacrifices are minimized by black communities, particularly the enormous financial expense for training, and many black Americans are unaware of the years devoted to achieving professional competence. A recent report by the American Medical Association indicates that 82% of all 1987 medical school graduates were in debt, owing an average of $35 621-60% higher than the average debt for 1986; 17% of all 1986 and 1987 medical school graduates were in debt, owing more than $50 000. The study affirmed that students were heavily indebted and more likely to be older, female, and black.'4"15
ASSESSING THE HAPPINESS OF BLACK PROFESSIONAL FAMILIES To validate the hypothesis that most black health professional families are reasonably happy and welladjusted, at the conclusion of this author's lecture, "Strengthening the Black Professional Family," a 19-item questionnaire was presented to black profesJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 1
sional families (ie, physicians, dentists, and their spouses) at the 1990 annual meeting of the Old North State Medical and Dental Societies of North Carolina at Myrtle Beach, South Carolina (Figure). The adult attendees (n = 38) were asked not to identify themselves by name, specific profession, age, or sex, believing the greater the anonymity the more candid the responses. The number of professional couples were not differentiated because of their small representations. Likewise, the small sample of female professionals yielded meaningless (n = 3) results. The number of professionals (men and women) responding were 22 and the number of responses from spouses were 16. A total of 10 questionnaires were discarded because respondents failed to properly identify their respective categories, perhaps suggesting the need to redesign that portion of the questionnaire. The following preliminary findings were noted. Professionals were more likely to be unhappy (n = 7 of 22 versus their spouses n = 1 of 16, X2= 3.64, df= 1, P
