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African Americans in Minnesota

 

Common health equity issues for African-Americans populations

Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.

Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.

Blacks are the third-largest racial group in Minnesota—at 5.8% of the population.

African Americans in Minnesota

Minnesota is home to more than 317,130 people who identify as African American. At 5.8 percent of the state’s population, African Americans are the third-largest racial group in Minnesota and have been part of the fabric of Minnesota since the 1800s. Descendants of enslaved Black people migrated out of the South between 1916 and 1970. This shifted the population from 90 percent of all African-Americans living in the rural South to 47 percent living in the urban North and West, including Minnesota.

African Americans are people who have origins in any of the Black racial groups of Africa.

In the U.S., the Black immigrant population has increased 71 percent since 2000. Now, roughly one in 10 Blacks living in the U.S. are foreign born, up from 3 percent in 1980. In 2014, 22 percent of Minnesota’s foreign-born residents were from Africa, compared to 5 percent nationally. The top countries of origin for foreign-born African American Minnesotans include:

African American, Black?

African American and Black are used interchangeably. African Americans are people who have origins in any of the Black racial groups of Africa. The term African American used to refer to early African immigrants and descendants of enslaved Black people. As the number of African and Caribbean Blacks immigrating to the U.S. has increased, so have the chances that someone who identifies as Black or African American is a first- or second-generation immigrant.

Language

U.S.-born African Americans speak English. 64,537 Minnesotans speak African languages at home. Of these, 27,046 (42%) describe themselves as speaking English “less than very well.” The most common African languages spoken at home in Minnesota are Cushite, Amharic, Ibo, and Kru.

Health Check:
How do African Americans compare to your overall population across process and health outcome measures?

Health disparities

African Americans in Minnesota face several disparities in health outcomes and care delivery compared to the overall population. Some health issues are biologically tied to race; many are tied to social inequities, including poverty.

  • African Americans experience health disparities in rates of heart disease, diabetes, HIV new infections, Chlamydia, and low-term births.
  • African Americans have higher rates of diabetes mortality, infant mortality, and chronic lower respiratory disease mortality, as compared with Whites.
  • Adult Blacks in Minnesota (33.3%) have a higher rate of obesity, compared to Whites (27.7%).
  • 31 percent of African Americans in Minnesota ages 45-64 have one or more disabilities,
    compared to 12 percent for the overall
    population.
  • Minnesota Clinical Quality Measures 2017

     

    Optimal diabetes care

    Optional vascular care

    Adolescent mental health screening

    Pediatric oversight counseling

    Optional asthma control-A

    Optional asthma control-B

    Colorectal cancer screening

    Black

    White

    ↑ = Above average, ↓= Below average, Blank = Similar to average

  • Black patients had poorer health care outcomes than Whites for five of the seven Minnesota quality measures: optimal diabetes care, optional vascular care, optional asthma control-A, optional asthma control-C, and colorectal cancer screening.
  • Black older adults were less likely to say their home and community-based services meet all their needs and goals than White older adults.

More data on disparities in health and health care for African Americans:

Social determinant disparities

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

  • 34 percent of African Americans in Minnesota are below the federal poverty level, compared to 8.2 percent of Whites.
  • 19 percent of African Americans were unemployed during 2010-2014, the highest rate for any cultural group, compared to 6 percent of Whites.
  • 16 percent of African Americans did not have a high school diploma or GED in 2010 through 2014, compared to 3 percent for Whites. 17 percent had a bachelor’s or higher degree, compared to 37 percent for Whites.
  • 12.8 percent of African Americans in Minnesota lacked health insurance in 2017, compared to 4.6 percent of non-Hispanic Whites. Lack of health insurance may result in less preventive care and health education.
  • The teen birth rate for Blacks in Minnesota is three times greater than for Whites. Teen births are a key indicator for future poverty, low educational achievement, and poor health.
  • African Americans make up 39 percent of homeless adults in Minnesota, but only 5.8 percent of the population.

More data on social determinants for African Americans

Social structure

Many aspects of African-American culture today reflect the culture of the general U.S. population. Generational differences impact social practices. Extended family may be an important source of support. Some African Americans designate friends and loved ones, who are not directly related, as aunts, uncles, nephews and nieces, a practice stemming from individuals being separated from blood relatives during slavery.

In 2015, Black older adults were less likely to say their home and community-based services meet all their needs and goals than White older adults.

Diet

For poorer African Americans, financial constraints often mean consuming a diet based on inexpensive fast food restaurant offerings and processed foods that are high in carbohydrates, sweeteners, and salt. Often called the “American diet,” this way of eating contributes to obesity, heart disease, and other health conditions. More than 30 percent of Black Minnesotans are obese, compared to 27.5 percent of White Minnesotans. Black older adults were more likely to skip a meal sometimes or often due to financial worries.

Medical care

Numerous studies have identified a pattern of implicit bias towards 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.

Mental health

Approximately one in five of all adults in the U.S. experiences mental illness in a given 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 and substandard public education, racism, and other barriers have resulted in historical trauma for African Americans, the effects of which continue today. Carried across generations, this trauma should be considered in mental health treatment. The effects of historical trauma are being studied.

  • Historical Trauma and Cultural Healing. Resources that explore how past experiences shared by communities can result in cumulative emotional and psychological wounds that are carried across generations. University of Minnesota Extension.
  • The Impact of Discrimination. Stress in American, American Psychological Association, 2015.
  • Mental Health and African Americans. Overview of African-American mental health status, psychological stress, suicidal ideation statistics. Department of Health and Human Services, Office of Minority Health.

End of life

Life expectancy for African Americans continues to be lower than life expectancy for Whites. A Black child born in 2014 has a life expectancy of 72.5 years (males) or 78.5 years (females), as compared to 76.7 and 81.4 years for a White child born in the same year. African Americans have higher rates of Alzheimer’s and other dementia than Whites—some estimates are as much as 40 percent higher.

As with discussing end of life issues with any patient, health care providers need to understand preferences based on personal and family views. African Americans were found to consistently prefer the use of life support. Only 8.3 percent of hospice patients are Black—less than half the representation of Black people in the general population.