African Americans are affected disproportionately by the leading causes of death in the U.S., including cancer, obesity, diabetes, heart disease, hypertension, and HIV/AIDS.

 

NOTE: Understanding the role culture plays in health care is essential. Still, patients are individuals – each person’s preferences, practices, and health outcomes are shaped by many factors, a concept known as intersectionality. Advancing whole-person health empowers individuals to improve their health and well-being in multiple interconnected biological, behavioral, social, spiritual, and environmental areas.

 

African American coupleBlack and African Americans

Providing culturally responsive care to members of Black and African American communities will greatly contribute to addressing health disparities because people in these communities are disproportionately affected by leading causes of disease, disability, and death in the U.S.

Culturally responsive care brings an asset-based view of people and the community. Understanding values, beliefs, trusted sources of information, and resources (both formal and informal) contribute to better care and health outcomes.

When disparities are discussed, there needs to be a strong acknowledgment that Black and African American people and communities’ health and health care are impacted by past and present inequities and discrimination. There is greater acknowledgment and science supporting racism being a public health crisis.

Black and African-American Populations
Each state has its own unique makeup of Black, African American, and African communities. For example, Minnesota is home to hundreds of thousands of people who identify as Black and/or African American or African. They comprise the second-largest racial group in Minnesota and have been part of the fabric of Minnesota since the 1800s. In 2022, 27% of Minnesota’s foreign-born residents were from Africa, compared to about 5% nationally. Descendants of enslaved African American people migrated from the South between 1916 and 1970. This shifted the population from 90% of all African Americans living in the rural South to 47% living in the urban North and West.

The top countries of origin for foreign-born African-American Minnesotans include Ethiopia, Liberia, and Somalia.

Distinguishing between Black, African American, and African can be important. The experiences of Black and African Americans (U.S.-born, descendants of slaves) and African-born immigrants and refugees are different. There are African-born immigrants and refugees who do not consider themselves to be African-American, and some don’t want to be called Black. There is diversity within each cultural community. When populations are aggregated into broad categories, there is a risk of losing the focus on individual identities and cultural beliefs and practices.

Racial identity is very personal, so it is respectful and important to be aware of patient preference(s). African American, African, and Black are not interchangeable. For example, some people prefer the term Black because they do not identify as African, while others prefer the term Black because they do not identify as American. Or individuals may identify as African, Afro-Caribbean, Afro-Latino, or something else.

“To reduce racial and ethnic health disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care.”

From In Focus: Reducing Racial Disparities in Health Care by Confronting Racism

To learn more

Although most U.S.-born Black and African Americans speak English (96%) and/or African American Language (AAL), some speak native languages at home. The most common African languages spoken at home in Minnesota, for example, are Cushite, Amharic, Igbo, and Kru. This varies by state and region, with roughly one in five Black and African Americans in the U.S. identifying as immigrants or children of Black immigrants.

“The moment AAL is viewed as grammatically inferior, people feel justified in considering its speakers less articulate and intelligent.”

– Oliver Shoulson,

On African American Language and Grammatical Diversity in 2020

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Black and African Americans face many disparities in health outcomes and care delivery compared to the overall population. While disparities in life expectancy for Black and African Americans compared to Whites have narrowed over the past three decades, the COVID-19 pandemic has reversed some of that progress. A June 2022 study in the journal Annals of Internal Medicine “underscores the need for further examination of how structural racism, including housing and health care, plays a role in harming the health of Black people.”

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”
– Dr. Martin Luther King, Jr.

  • African Americans are more likely to die at early ages for all causes.
  • Compared to their white counterparts, African Americans are generally at higher risk for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS.
  • For most cancers, African Americans have the highest death rate and shortest survival.
  • Black and African Americans are 20% more likely to report psychological distress and 50% less likely to receive counseling or mental health treatment due to underlying socioeconomic factors.
  • Black women are three times more likely to die from a pregnancy-related cause than White women.
  • Black and African Americans can suffer from kidney failure at as much as three times the rate of Caucasians. Black patients represent as much of a third of all patients in the U.S. receiving dialysis for kidney failure, though they make up only about 12.7% of the U.S. population.
  • Black/African American patients had poorer health care outcomes than Whites for five of the seven Minnesota quality measures: Optimal diabetes care, optimal vascular care, optimal asthma control-A, optimal asthma control-C, and colorectal cancer screening.
  • Black/African Americans are twice as likely to develop Alzheimer’s or related dementia when compared to their White counterparts.

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Social determinants of health (SDOH) are economic and social conditions that influence the health of people and communities. Black and African Americans often experience discrimination, which may impact housing, employment, legal status, and violence and bullying. Dealing with discrimination is associated with higher reported stress and poorer reported health.

“Access to health care remains limited in many communities. Routine blood pressure and cholesterol screening and using inexpensive medications to treat those risks would substantially reduce health disparities if that kind of intervention could be made available in every community for every person.”

– Gregory Roth, MD, MPH

Using Minnesotans as an example of SDOH (2018 numbers; sources below under “learn more”):

  • 27% of Black or African American people are below the federal poverty level, compared to 7% of White people.
  • The median household income for Black or African American people is $37,000, compared to $73,000 for white people.
  • 8% of Black or African American people were unemployed, the second highest rate for any cultural group, compared to 5% of White people.
  • 19% of Black or African American people did not have a high school diploma or GED, compared to 5% of White people.
  • The teen birth rate for Black and African American people is 142/1,000 compared to 29/1,000 for White people. Teen births are a key indicator of future poverty, low educational achievement, and poor health.

To learn more

Black and African Americans’ social standing in the U.S. has been shaped by a long history of racism in laws, policies, and practices that have built racist institutions (including health care) and created and exacerbated inequality. This inequality is built into the infrastructure of our country and has formed the foundation for structural racism. Taking social structure into account enables healthcare professionals to deliver more culturally sensitive care.

“Examining the six key areas of social determinants of health and the layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.”

CDC: What is Health Equity?

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The traditional diet of Black and African Americans often varies by U.S. region. Typical “soul foods” include fried chicken, barbecued ribs, red beans and rice, collard greens, cornbread, baked macaroni and cheese, sugary drinks, and sweet potato pie. Today, many Black and African Americans also eat a variation of the “American diet” high in processed foods, carbohydrates, protein, and fat, which contributes to obesity, heart disease, and other health conditions. African American women have the highest rates of obesity or being overweight compared to other groups in the United States, with about 4 out of 5 being overweight or obese.

It’s important to note that eating unhealthy foods is not always a choice. A lack of food availability due to food deserts and cost are also factors.

“It would be a mistake to judge a person based on your own personal situation without fully understanding all that goes into the food choices and health status of Black people. Our communities tend to not only have fewer full-service grocery stores, more liquor stores, and fast-food outlets, but we also have fewer safe spaces to engage in intentional physical activity.”

4 Things Black Dieticians Want You to Know About Nutrition and Wellness

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Numerous studies have identified a pattern of implicit bias toward Black and African Americans in care delivery. Perception of bias can result in patients being less engaged and less likely to follow through with treatment plans and medication prescriptions. “Every day, Black Americans have their pain denied, their conditions misdiagnosed, and necessary treatment withheld by physicians. In these moments, those patients are probably not historicizing their frustration by recalling Tuskegee, but rather contemplating how an institution sworn to do no harm has failed them.”

Limited access to quality medical care is the top reason Black and African Americans see contributing to generally worse health outcomes in the U.S. Large shares also see other factors as playing a role, including environmental quality problems in Black and African American communities and hospitals and medical centers giving lower priority to the well-being of Black and African American people. The majority (56%) say they’ve had at least one or several negative experiences, including having to speak up to get the proper care and being treated with less respect than other patients.

Chronic pain is an area where substantial racial and ethnic differences in the management and treatment of Black individuals’ pain have been well documented. In some cases, Black and African Americans are less likely to be prescribed medications, especially for pain, considering false beliefs about how Black and African Americans experience pain. Research has consistently documented inequities in the quality of pain-management care experienced by Black and African American patients, with negative downstream effects on patient outcomes.  

“Segregation and racism within the medical profession have, and continue to, profoundly impact the African American community.”

American Medical Association

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Approximately one in five of all adults in the U.S. experiences mental illness each year. African Americans use mental health services at about one-half the rate of Whites. Slavery, loss of cultural practices and languages, eras of second-class legal status, substandard public education, racism, and other barriers have resulted in historical trauma for Black and African American people, the effects of which continue today. Carried across generations, this trauma needs to be considered in mental health treatment.

“Negative attitudes and beliefs toward people who live with mental health conditions are pervasive within the U.S. and can be particularly strong within the Black community.”

National Alliance on Mental Illness

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Older Adults
For Black and African American older adults, the cumulative effects of race-related stress experienced over the course of a life can increase the risk for mental and physical health problems. Here are some findings from a 2022 Issue Brief from The Commonwealth Fund, examining experiences of racial discrimination in healthcare settings among Latinx/Hispanic and Black older adults:

  • Older adults in the U.S. are more likely to report racial and ethnic discrimination in the health system exists, compared with their peers in 10 other high-income countries.
  • In the U.S., one in four adults aged 60 and older reported that they have been treated unfairly or have felt that their health concerns were not taken seriously by health professionals because of their racial or ethnic background.
  • More than a quarter of U.S. older adults said they did not get the care or treatment they felt they needed because of discrimination.
  • U.S. older adults who have experienced discrimination in a healthcare setting were more likely to have worse health status, face economic hardships, and be more dissatisfied with their care than those who did not experience discrimination.

“Black participants in Alzheimer’s disease research studies were 35% less likely to be diagnosed with Alzheimer’s and related dementias than white participants, despite national statistics that indicate that Black Americans are overall about twice as likely to develop dementias than Whites.”  

NIH National Institute on Aging

Findings from two national surveys appearing in the Alzheimer’s Association 2023 Alzheimer’s Disease Facts and Figures report reveal that discrimination is a barrier to Alzheimer’s and dementia care. Race, Ethnicity and Alzheimer’s in America examines perspectives and experiences of Asian, Black, Hispanic, Native, and White Americans regarding Alzheimer’s and dementia care.

Age-Friendly Health Systems
To address disparities and inequities, a multicultural focus is required to understand an individual’s identity – belonging to a specific group or community that experiences phenomena through a unique lens. An age-friendly health system is one in which every older adult’s care:

  • Is guided by an essential set of evidence-based practices (the 4Ms);
  • Causes no harm; and
  • Is consistent with what matters to the older adult and their family.

Caregiving for older adults in Black and African American Communities
Millions of Black and African American people are unpaid caregivers for aging relatives. Because caregiving can disrupt an individual’s employment, many caregivers across ethnicities have needed to adjust their workload or schedule to accommodate their other duties. In some cases, this leads to job loss, retiring early, or quitting,

To learn more

When discussing end-of-life issues with any patient, it’s important to understand preferences based on personal and family views. While there is ample evidence to support the need for hospice and palliative care services for Black and African Americans, they make up only about 8% of hospice patients, while Whites account for more than 80%. In the U.S., the population of African Americans exceeds 12%. This statistic is particularly surprising because African Americans are more likely to have many of the conditions common to hospice care, such as cancer and heart disease.

“Among African Americans, there’s a legacy of distrust with health care. Older folks who are now the age to enter hospice know about the Tuskegee experiments and other such mistreatment. They’ve experienced discrimination and have a lifetime of interacting with White doctors who didn’t listen and take time with them.” 

Dennis Cross, MD, Our Lady of Peace Hospice Physician

To learn more

Other Populations in Minnesota

African American | American Indian | Asian Indian | Bhutanese | Cambodian | Deaf / Hard of Hearing | Ethiopian | European American | Latinx | Hmong | Iraqi | Karen | LGBTQ | Liberian | Poverty | Rural | Russian | Somali | Vietnamese