More African American men and women aged between 35-64 are dying due to heart failure compared to people the same age in other racial groups, the Journal of the American College of Cardiology said this month. Heart failure means that the heart is not pumping blood around the body the way that it should. Research has shown that institutional racism is one of the reasons African Americans acquire and die from cardiovascular diseases such as heart failure.
Every year, noncommunicable diseases (NCDs) kill 41 million people globally. In low- and middle-income countries, NCDs account for premature deaths of 15 million people aged between 30-69. NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes account for 80 percent of these deaths.
Based on 2016 estimates, NCDs killed above 2.8 million people in America (this is equivalent to approximately the population of the State of Kansas). Recently, John Singleton, the renowned African American movie director, died at age 51, from a stroke blamed in part on high blood pressure.
Nationally, the leading causes of deaths among African Americans are heart disease, cancer and stroke, according to the US Centers for Disease Control (CDC). Based on the CDC’s 2013-2016 estimates, 40.5 percent and 44 percent of African American men and women aged 20 years and above respectively were diagnosed with high blood pressure.
These figures are high and underscore the fact that NCDs disproportionately affect African Americans. One of the risk factors for NCDs is obesity. Compared to other groups in the United States, African American women have the highest rates of being overweight or obese. About 80 percent of African American women are overweight or obese.
As a Nigerian doctor, these numbers surprise me. The comparative rates of high blood pressure among Nigerian men and women are 30.7 percent and 25.2 percent respectively based on 2010 modeling. Obesity, while a growing problem, is at 8 percent to 22 percent. Many of my patients come from economic backgrounds that, in absolute terms, are poorer than their African American counterparts.
But one thing they have not had to grapple with is institutionalized racism.
Indeed, it is decades of institutional racism that exposed African Americans to many health inequities that have led to the current crisis, according to Michael C. Lu and Heal Haftyon, the authors of "Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective." They said that disparities in birth outcomes begin early and lead to different life spans.
Among all ethnicities in the United States, African Americans have some of the worst child health indices: 2.89 percent very low birth weight babies; 13.4 percent preterm live births and 3 percent of live births born before 32 weeks’ gestation. Babies born with low birth weight (below 5lbs) have greater odds for coronary heart diseases, hypertension and insulin resistance syndrome (The Barker Hypothesis), according to Lu of George Washington University’s Milken School of Public Health. Simply put, African Americans have the odds stacked against them from birth and these inequities continue throughout life for most.
There are three ways to reverse this ugly trend and ensure African Americans enjoy better healthcare.
Twenty-one percent of African Americans are poor. Based on 2017 estimates, 34 million non-elderly African Americans were uninsured, according to the Henry J Kaiser Family Foundation. America is the wealthiest country on earth and spends the most per capita for health care.
The United States should move to a publicly financed health system which ensures that everyone is not denied health-care due to their address, ability to pay or race. Evidence already shows that African Americans face some of the most inequitable health challenges. Universal health care in the United States should include full spectrum of care — preventative, palliative, curative, rehabilitative and health promotion.
We know risk factors for high blood pressure and stroke. Providing the right information which enables individuals to make informed decisions to protect themselves in African American communities would serve to reduce the incidence of NCDs.
African American community groups must become their brothers’ and sisters’ keepers. Community groups such as Black Lives Matter and the NAACP must work harder to prevent African Americans from having NCDs. After all, the NACCP’s mission statement ends with “ensure the health and well-being of all persons." The African American community groups are trusted by members of the community. Therefore, any government intervention must involve the leadership of these organizations to gain entry into black communities
Eighty-three percent of African Americans “believe absolutely” in God and 94 percent of historically black churches’ members are African Americans, according to PEW Research Centre. It is time to mix faith with health promotion and roll-out of preventative services targeted at NCDs within historically black churches. Imagine the impact that could be achieved if once a week, messages on preventing high blood pressure were preached from pulpits in these churches.
To be sure, removing the health inequities faced by African Americans in the United States will not be easy and would not happen overnight, particularly when institutional racism is so closely linked to the health disparities.
It is time to reverse institutional racism and ensure that no African American should die prematurely from a preventable disease in world’s wealthiest nation.
Dr. Ifeanyi M. Nsofor M.B.B.S is the CEO of EpiAFRIC and director of policy and advocacy at Nigeria Health Watch. He is a current 2019 Atlantic Fellow for Health Equity at George Washington University and a 2018 New Voices Fellow at the Aspen Institute. He has written opinion pieces for Devex, African Arguments, AllAfrica and Vanguard Nigeria. Follow him on Twitter: @ekemma.