Thoughts During Black History Month

February is Black History Month.  This is an appropriate time to reflect on the contributions of African-American physicians to medicine as well as point out some of the glaring differences in the health of black and white Americans. 

Contributions of African-American Physicians   Did you know that the first open heart operation was performed by an African-American?  In 1893 Dr. Daniel Hall Williams removed a knife from the heart of a stab victim. He sutured a wound to the pericardium (the fluid sac surrounding the myocardium), from which the patient recovered and lived for several years afterward. Another black surgeon and researcher, Charles Richard Drew, developed the concept of the blood bank which was responsible for saving many lives during World War II. Dr. Mae C. Jemison is both a physician and astronaut. In 1992, Dr. Jemison was aboard the space shuttle Endeavour making her the first black woman in space.  Pediatric Endocrinologist, Dr. Joycelyn Elders, was the first African-American to serve as U.S. Surgeon General. As Surgeon General, Elders argued the case for universal health coverage, and was a spokesperson for President Clinton's health care reform effort. In addition to these high profile examples, thousands of African-American physicians are providing medical care throughout the U.S., many working in underserved areas of the country.

Health-related inequality between blacks and whites in the U.S.  The efforts to promote civil rights championed by Dr. Martin Luther King and others have made a major positive impact on societal acceptance, economic opportunities and quality of life for many African-Americans.  Unfortunately, a division remains in regard to health of blacks and whites in the United States. Blacks have higher death rates than whites for several causes of death including heart disease, cancer, stroke, lung disease, diabetes, homicide, and HIV/AIDS. In fact, for the two leading causes of death in the U.S.—heart disease and cancer—blacks have death rates approximately 30 percent higher than whites. Other examples of this disparity in health between blacks and whites:

• Black Americans have almost twice the risk of developing diabetes as white Americans.
• The incidence of end-stage renal disease (ESRD) for blacks, primarily related to the adequacy of diabetes management, is 4 times higher than that for whites.
• Black Americans have more asthma than any racial or ethnic group in America.  More than four times as many black children as white children are hospitalized for asthma, and more than five times as many black children die from the disease.
• African American men are diagnosed with prostate cancer much later, and the mortality rate is 2.4 times higher among African Americans than Caucasians.
• High blood pressure tends to be more common, happens at an earlier age, and is more severe for many African Americans.
• African Americans account for a higher proportion of new HIV diagnoses, those living with HIV, and those ever diagnosed with AIDS, compared to other races/ethnicities

Reasons for the differences in disease and death rates between blacks and whites. This is a complex issue with a number of factors being involved including genetics, environmental issues, access to medical care, differences in the response to treatment, and social factors. Some specific examples are that:

• African-Americans appear to have a greater genetic susceptibility to developing certain diseases such as diabetes.
• Despite a lower rate of cigarette smoking blacks are more likely to die from lung disease than whites.
• Black Americans receive fewer operations, tests, medications and other life-saving treatments than whites.
• Black Americans are half as likely to get flu and pneumonia vaccinations as white Americans.
• A higher percentage of African-Americans live in communities non-compliant with federal air pollution standards or that are located near toxic waste sites.
• Clinical trials show blacks and whites respond differently to treatments for high blood pressure.

How can we close this health gap?   There actually has been some progress related to the health of African-Americans in the U.S., particularly related to death rates from homicide and cancer.  The National Center for Health Statistics has reported a 40 percent decrease in homicides from 1995 to 2013 among blacks as compared to a 28 percent drop for whites. Also, the death rate from cancer fell by 29 percent for blacks over that period, compared with 20 percent for whites. To continue to narrow the health gap between blacks and whites, society must continue to address racial segregation, narrow the income gap, and improve medical care, especially preventive services, for vulnerable populations. Additionally, medical science must learn more about how the effects of various diseases and the response to treatment differ among races.  Through these measures we can continue to make progress in realizing the dream of racial equality envisioned by Dr. King.
 
 Sources for article:
Why 7 Deadly Diseases Strike Blacks Most from WebMD
Racial health inequalities in the USA: the role of social class from Public Health. 2008 Dec; 122(12): 1440–1442.
Gap Between Death Rates for Blacks and Whites Remains as Large as in 1950 from Circulation. 2000;101:e9026

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