CLOSING THE GAP: THE ROLE OF THE AFRICAN-AMERICAN COMMUNITY Bruce W. Randolph, MD, MPH Oklahoma City, Oklahoma
Over the past 25 years, Americans have experienced improvement in their overall health. However, disparities still exist between the health status of whites and other minority groups, eg, African-Americans.' For instance, as a group, European-Americans live 5.6 years longer than African-Americans. African-American infants die at a rate twice that of European-American
infants.' These differences in health status have existed since 1900 and have not changed despite improvement in overall health. In 1900, the life expectancy of European-Americans was 47.3 years compared to 33 years for African-Americans.' In terms of overall life expectancy and infant mortality, African-Americans today have reached levels reached by European-Americans 30 years ago.' In addition to the disparity in life expectancy and infant mortality, African-Americans experience 60 000 "excess deaths" each year. "Excess deaths" are deaths that would not have occurred if African-Americans died at the same rate as European-Americans. Factors contributing to 80% of these "excess deaths" include: cardiovascular disease, cancer, chemical dependency, homicide, unintentional injuries, diabetes, and infant
mortality.' In the 1990s, the challenge facing the United States in general, and the African-American community in From the Chronic Disease Service, Oklahoma State Department of Health, Oklahoma City, Oklahoma. Request for reprints should be addressed to Bruce W. Randolph, MD, MPH, Medical Consultant, Chronic Disease Service, Oklahoma State Department of Health, PO Box 53551, 1000 NE 10th St, Oklahoma City, Oklahoma 73152. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
particular, is the correction of these disparities in health status. African-Americans must play a major and leading role in correcting these disparities. AfricanAmericans must develop strategies for intervention and prevention of the above health problems. Two major considerations must be made when developing strategies for intervention and prevention. First, one must understand the composition, nature, and function of the health sector in this country. Vicente Navarro states that "to understand and explain the composition, function, and nature of the health sector, one must look outside the health sector and first ask who owns and who controls the income and wealth of that society."2 Once this question has been answered, one can better understand the nature of the health sector and the health status of the people within that society. The health sector and health status indicators in this country are reflections of who owns and controls income and wealth in this country. Secondly, one must understand the nature of health and illness, and have knowledge of the determining factors of both. These factors are multiple and include, but are not limited to: genetic, biological, environmental, dietary, behavioral, social, economic, and political factors. However, the major determining factors of health status for a given population are political, social, and economic factors. Studies have shown a relationship between socioeconomic status and health status.3-6 The higher the socioeconomic status, the better an individual's health will be; the lower the socioeconomic status, the poorer an individual's health will be. This relationship has been known to exist since the 12th century.4 According to a report by the Institute of Medicine of 123
THE ROLE OF THE AFRICAN-AMERICAN COMMUNITY
the United States' National Institutes of Health on the future of Public Health, two factors determine how problems are solved: 1. The level of scientific and technical knowledge and 2. The content of public values and popular opinion.7 The report goes on to state that "decision making in public health is driven by crises, hot issues, and the concern of organized interest groups; decisions are often made on the basis of competition, bargaining and influence rather than comprehensive analysis.7 Given this reality and the relationship of politics and economics to health status, African-Americans must become more involved in public policy, legislation, business, and economic development. One can not fully address the differences in health status that exist today without addressing the political, social, and economic disparities that also exist. To do so would be similar to a physician treating the symptoms of an illness and not the underlying cause. I would like to recommend five basic approaches that the African-American community can take in solving its health problems: 1. Enhance and strengthen individual awareness, knowledge, and skills concerning health and the contributing factors of health and illness. African-Americans must take primary responsibility for their health. 2. Disseminate this knowledge and awareness throughout the African-American community via community education programs. These programs must be Afro-centric in scope and culturally relevant. 3. Become more involved in health promotion and disease prevention activities, as well as address the socioeconomic factors that contribute to health. In addition, encourage more African-Americans to pursue careers in health care. 4. Build coalitions and networks throughout the community to achieve empowerment. This community strength must involve economics as well as politics. African-Americans must actively seek economic empowerment within their community by working, producing, saving, investing, and consuming wisely. 5. Strive to influence public policy and legislation by voting, lobbying, and seeking public office on the
124
local and state levels as well as the national level. The following acronym-ISEP-summarizes the five approaches African-Americans must take to improve their health status and close the gap between themselves and European-Americans. I-Intellectual transformation-becoming aware, knowledgeable, and skillful. S-Social changes-changes in behavioral practices and lifestyles as a result of changes in values, principles, and norms. E-Economic empowerment-resulting from economic growth and development. P-Political involvement-influencing public policy and legislation. The African-American community, as well as this nation, must set as its goal the World Health Organization's definition of health, "a state of complete well-being, physically, socially, and mentally, not merely the absence of disease or infirmity."8 Acknowledgements The author thanks Nancy Powell for typing this manuscript, and Mildred Randolph, Donna Johns-Sullivan, Ollie Haskins, and Patrick Morgan for proofreading and critiquing. Literature Cited 1. Report of the Secretary's Task Force on Black & Minority health. US Dept of Health and Human Services; Executive Summary, Vol. 1; 1985:1-8. 2. Navarro V. Social policy issues: an explanation of the composition, nature, and functions of the present health sector of the United States. Bull N YAcad Med. 1975;51:199-234. 3. McQueen DV, Siegrist J. Social factors in the etiology of chronic disease: an overview. Soc Sci Med. 1982;1 6:353-367. 4. Syme SL, Berkman LF. Social class, susceptibility and sickness. Am J Epidemiol. 1976;1 04:1-6. 5. Slater CH, Lorimor RJ, Lorison DR. The independent contributions of socioeconomic status and health practices to health status. Prev Med. 1985;14:372-378. 6. Brenner H. Relation of economic change to Swedish health and social well being, 1950-1980. Soc Sci Med. 1987;25:183-195. 7. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988:1-18. 8. Hanlon JJ, Pickett GE. Public Health Administration and Practice. St Louis, Mo: Times Mirror/Mosby College Publishing; 1 984;3-21.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
Over the past 25 years, Americans have experienced improvement in their overall health. However, disparities still exist between the health status of whites and other minority groups, eg, African-Americans.' For instance, as a group, European-Americans live 5.6 years longer than African-Americans. African-American infants die at a rate twice that of European-American
infants.' These differences in health status have existed since 1900 and have not changed despite improvement in overall health. In 1900, the life expectancy of European-Americans was 47.3 years compared to 33 years for African-Americans.' In terms of overall life expectancy and infant mortality, African-Americans today have reached levels reached by European-Americans 30 years ago.' In addition to the disparity in life expectancy and infant mortality, African-Americans experience 60 000 "excess deaths" each year. "Excess deaths" are deaths that would not have occurred if African-Americans died at the same rate as European-Americans. Factors contributing to 80% of these "excess deaths" include: cardiovascular disease, cancer, chemical dependency, homicide, unintentional injuries, diabetes, and infant
mortality.' In the 1990s, the challenge facing the United States in general, and the African-American community in From the Chronic Disease Service, Oklahoma State Department of Health, Oklahoma City, Oklahoma. Request for reprints should be addressed to Bruce W. Randolph, MD, MPH, Medical Consultant, Chronic Disease Service, Oklahoma State Department of Health, PO Box 53551, 1000 NE 10th St, Oklahoma City, Oklahoma 73152. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
particular, is the correction of these disparities in health status. African-Americans must play a major and leading role in correcting these disparities. AfricanAmericans must develop strategies for intervention and prevention of the above health problems. Two major considerations must be made when developing strategies for intervention and prevention. First, one must understand the composition, nature, and function of the health sector in this country. Vicente Navarro states that "to understand and explain the composition, function, and nature of the health sector, one must look outside the health sector and first ask who owns and who controls the income and wealth of that society."2 Once this question has been answered, one can better understand the nature of the health sector and the health status of the people within that society. The health sector and health status indicators in this country are reflections of who owns and controls income and wealth in this country. Secondly, one must understand the nature of health and illness, and have knowledge of the determining factors of both. These factors are multiple and include, but are not limited to: genetic, biological, environmental, dietary, behavioral, social, economic, and political factors. However, the major determining factors of health status for a given population are political, social, and economic factors. Studies have shown a relationship between socioeconomic status and health status.3-6 The higher the socioeconomic status, the better an individual's health will be; the lower the socioeconomic status, the poorer an individual's health will be. This relationship has been known to exist since the 12th century.4 According to a report by the Institute of Medicine of 123
THE ROLE OF THE AFRICAN-AMERICAN COMMUNITY
the United States' National Institutes of Health on the future of Public Health, two factors determine how problems are solved: 1. The level of scientific and technical knowledge and 2. The content of public values and popular opinion.7 The report goes on to state that "decision making in public health is driven by crises, hot issues, and the concern of organized interest groups; decisions are often made on the basis of competition, bargaining and influence rather than comprehensive analysis.7 Given this reality and the relationship of politics and economics to health status, African-Americans must become more involved in public policy, legislation, business, and economic development. One can not fully address the differences in health status that exist today without addressing the political, social, and economic disparities that also exist. To do so would be similar to a physician treating the symptoms of an illness and not the underlying cause. I would like to recommend five basic approaches that the African-American community can take in solving its health problems: 1. Enhance and strengthen individual awareness, knowledge, and skills concerning health and the contributing factors of health and illness. African-Americans must take primary responsibility for their health. 2. Disseminate this knowledge and awareness throughout the African-American community via community education programs. These programs must be Afro-centric in scope and culturally relevant. 3. Become more involved in health promotion and disease prevention activities, as well as address the socioeconomic factors that contribute to health. In addition, encourage more African-Americans to pursue careers in health care. 4. Build coalitions and networks throughout the community to achieve empowerment. This community strength must involve economics as well as politics. African-Americans must actively seek economic empowerment within their community by working, producing, saving, investing, and consuming wisely. 5. Strive to influence public policy and legislation by voting, lobbying, and seeking public office on the
124
local and state levels as well as the national level. The following acronym-ISEP-summarizes the five approaches African-Americans must take to improve their health status and close the gap between themselves and European-Americans. I-Intellectual transformation-becoming aware, knowledgeable, and skillful. S-Social changes-changes in behavioral practices and lifestyles as a result of changes in values, principles, and norms. E-Economic empowerment-resulting from economic growth and development. P-Political involvement-influencing public policy and legislation. The African-American community, as well as this nation, must set as its goal the World Health Organization's definition of health, "a state of complete well-being, physically, socially, and mentally, not merely the absence of disease or infirmity."8 Acknowledgements The author thanks Nancy Powell for typing this manuscript, and Mildred Randolph, Donna Johns-Sullivan, Ollie Haskins, and Patrick Morgan for proofreading and critiquing. Literature Cited 1. Report of the Secretary's Task Force on Black & Minority health. US Dept of Health and Human Services; Executive Summary, Vol. 1; 1985:1-8. 2. Navarro V. Social policy issues: an explanation of the composition, nature, and functions of the present health sector of the United States. Bull N YAcad Med. 1975;51:199-234. 3. McQueen DV, Siegrist J. Social factors in the etiology of chronic disease: an overview. Soc Sci Med. 1982;1 6:353-367. 4. Syme SL, Berkman LF. Social class, susceptibility and sickness. Am J Epidemiol. 1976;1 04:1-6. 5. Slater CH, Lorimor RJ, Lorison DR. The independent contributions of socioeconomic status and health practices to health status. Prev Med. 1985;14:372-378. 6. Brenner H. Relation of economic change to Swedish health and social well being, 1950-1980. Soc Sci Med. 1987;25:183-195. 7. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988:1-18. 8. Hanlon JJ, Pickett GE. Public Health Administration and Practice. St Louis, Mo: Times Mirror/Mosby College Publishing; 1 984;3-21.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
