A Common Destiny Blacks and American Society (1989) / Chapter Skim
Currently Skimming:
Black Americans' Health
Black Americans' Health
Pages 391-450
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From page 392... ...
William H Johnson Convalescents Mom Somewhere (1941-1942)
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From page 393... ...
For example, lack of prenatal care leads to greater likelihood of infant death, neurological damage, or developmental impairment; childhood illnesses and unhealthy conditions can reduce learning potential; adolescent childbearing, substance abuse, and injuries cause enormous personal, social, and health effects; impaired health or chronic disability in adults contributes to low earning capacity and unemployment; and chronic poor health among older adults can lead to premature retirement and loss of ability for self-care and independent living. Health status is therefore an important indicator of a group's social position as well as of its present and future well-being.
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From page 394... ...
found that there was a gradient of mortality rates with steady increases from the highest to the lowest social classes. Mortality rates were higher as socioeconomic status declined for both whites and blacks, whether that status was measured by family income, educational level, or occupation.
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From page 395... ...
life expectancy at birth. It is calculated on the basis of agespecific death rates as of a given date, and it estimates the number of years that will be lived on the average by individuals born in a particular year, assuming a constancy of then-current age-specific mortality rates.)
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From page 396... ...
is lower than that already achieved by white males in 1950, 66.5 years (National Center for Health Statistics, 1988:80-81~. Projections of mortality rates into the future are necessarily uncertain, particularly given the current epidemic of acquired immune deficiency syndrome (AIDS)
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From page 397... ...
.2 The report did not attempt to encompass the full dimensions of disparities in health status; while the mortality data for these six conditions are important, they do not capture the full personal and societal costs of deaths from other causes and of chronic or acute illness. In particular, this methodology has omitted important health problems of black children.
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From page 398... ...
Infant mortality in the United States, 10.6 deaths per 1,000 live births in 1985, remains persistently higher than the rate in many other developed nations; Finland, Japan, and Sweden enjoy the world's lowest rates, less than 7 deaths per 1,000 live births (National Center for Health Statistics, 1987c:94~; see Table 8-1. Black rates of infant mortality have remained at approximately twice the rate for whites over the course of this century despite impressive improvements for all groups in reduced infant mortality.
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From page 399... ...
Black infant mortality rates show considerable variations by region. During 1982-1984, the black infant mortality rate was lowest in the Mountain and Pacific states (15.4 and 16.2 deaths per 1,000 live births, respectively)
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From page 400... ...
The marked gap in the infant mortality rate between whites and blacks mirrors the more than twofold difference in the rates of low birthweight and very low birthweight between the two groups. Blacks are twice as likely as whites to have low-birthweight infants: black rates are 12.4 per 1,000 live births, and white rates are 5.6 (National Center for Health Statistics, 1987c:27~.
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Since the highest infant death rates are associated with preterm birth, research is increasingly being directed to this problem. However, on the basis of existing knowledge, a great many medical conditions that predispose to prematurity could be prevented by appropriate prenatal care.
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From page 402... ...
In 1984, 20 percent of white women and 38 percent of black women received no prenatal care in the first trimester of pregnancy (National Center for Health Statistics, 1987c:77~. The provision of prenatal care can have a demonstrable effect on pregnancy outcomes among high-risk populations.
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From page 403... ...
Farley, 1985:7~; in 1984, the maternal mortality rate for whites was 5.4 and that for blacks was 19.7 (National Center for Health Statistics, 1987c:111~; thus, the black rate remains more than 3 times the white rate. National figures may understate maternal deaths because in many states the information on the death certificate does not indicate whether the woman was pregnant or had recently been pregnant.
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From page 404... ...
· Ensuring that all pregnant women in the United States, especially those at medical or socioeconomic risk, are given access to and receive high-quality prenatal care. · A public information program to call the problem of low birthweight to the public's attention and to reinforce its importance with the nation's leaders and to help reduce low birthweight by conveying a set of ideas to the public about avoidance of important risk factors.
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From page 405... ...
However, black children have not shared equally in the overall health gains, and their death rates are much higher than those for white children. Despite dramatic overall mortality gains, death rates for black children are from 30 percent to 50 percent higher than for whites, and the rate of decline in black children's mortality has slowed in recent years.
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From page 406... ...
These factors include malnutrition, anemia, lead poisoning, lack of immunization, lack of dental care, and child neglect and abuse. All of these factors affect poor, black children disproportionately.
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Current studies show that among poor black children, the young children are most at risk. According to the Nutrition Surveillance Annual Summary for 1983-1985 (Centers for Disease Control, 1985)
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Children 1976 1985 1976 1985 1976 1985 1976 1985 1976 1985 White 68.3 63.6 63.8 66.3 75.3 70.0 50.3 61.8 66.2 58.9 Nonwhites 54.8 48.8 61.6 47.4 68.7 48.7 61.8 47.0 39.9 40.1 aDiphthena, pertussis, tetanus. Source: Data from National Center for Health Statistics.
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From page 409... ...
remains an important problem, with 20,000 reported cases in 1977, and actual cases are estimated to be as much as 20 times the reported number. There is a national health goal for a reported rubella incidence of less than 1,000 cases by 1990 (National Center for Health Statistics, 1987b:30~.
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From page 410... ...
The EPSDT program for Medicaid children has increased its early dental care for poor children very slowly. In the early 1980s, only 20 percent of the target population had been screened, and of those screened only 25 percent were referred for treatment.
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From page 411... ...
Mortality rates for youths aged 15-24 are among the lowest for any period of life, and their health is considerably better than it was for people of that age 40 years ago. In recent years, however, male adolescents and young adults have not shown the sustained health gains seen in other segments of the population.
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From page 412... ...
The youngest mothers are also at increased risk for obstetrical complications or death in comparison with older mothers. Late or inadequate prenatal care, poor nutrition, and poor self-care are factors in low birthweight and infant mortality as well as in maternal death.
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SPECIAL HEALTH RISKS Dings, Tobacco, and Alcohol Use Substance abuse, particularly alcohol and stimulant drugs, increases risk of accidents, suicides, and homicides; family disruption; and poor school and job performance and may lead to acute and chronic medical conditions. Drug abuse among adolescents is highly correlated with adolescent pregnancy, poor grades, dropping out of school, and delinquency (Tessor and lessor, 1982~.
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From page 414... ...
This hypothesis is supported by a 1979 survey that found mortality from drugrelated deaths increased steeply in nine major metropolitan areas, and about one-third of those fatalities occurred among black youth in the 15-24 age group (National Institute on Drug Abuse, 1980~. Currently, cocaine, and its potent derivative "crack," show increased use among all youth.
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. Although the disparity has narrowed, black homicide rates in 1985 for those aged 15-24 were still 6 times greater than white rates (National Center for Health Statistics, 1988~.
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It is the leading cause of blindness 416
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. Black children who are near sighted (myopic)
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To the extent that these differences are reduced, there is the prospect that men will approach more closely the life expectancy of women. Biological differences appear to explain very little of the difference in health status between blacks and whites.
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From page 419... ...
Sociological risk factors relate to American culture and the structure of American society (National Commission on the Causes and Prevention of Violence, 1969)
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access to handguns and training in conflict resolution have been recommended. But perhaps the most important aspect of the situation is that the subject of violence is now accepted as a legitimate public health concern.
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The magnitude of this problem in blacks can be judged by deaths related to substance abuse. The mortality rate per 100,000 people for lung cancer is 95 for black males and 70 for white males.
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It has been estimated that hypertensive disease is responsible for more than 5,000 excess deaths a year in the black population (National Center for Health Statistics, 1987c)
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From 1978 to 1981, the average annual age-adjusted cancer mortality rate per 100,000 population for all sites of cancer was 163.6 for whites and 208.5 for blacks. In 1930, white females had the highest and 423
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From page 424... ...
The continuing deaths for black women from cervical cancer is a marker of the inadequate prevention and treatment they receive. A number of risk factors have been associated with cervical cancer, but there is still a great deal to be learned about its causes (Hulka, 1982; Kessler and Adams, 1976~.
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From page 425... ...
They have had poorer quality of health care from conception and birth, continuing exposure to greater and more severe environmental risk factors, and the stress of prejudice and discrimination (Cooper et al., 1981~. Cohort data for cause-specific mortality and morbidity over the past four decades suggest the presence of accumulated deficits across the early years of the life course.
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From page 426... ...
An examination of sources of income clearly indicates why elderly blacks are in poverty: 22 percent of the black population over age 65 receive support from Supplemental Security Income, reflecting their prior poor earning status. Only 5 percent receive any income from savings; in contrast, 36 percent of the white older adult population has income from savings.
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From page 427... ...
MORTALITY AN D MORBI DITY Although there is disagreement regarding the extent of the change, most observers find that the health status of older blacks has improved considerably over the past few decades, particularly with the advent of Medicaid and Medicare in the mid-1960s. Among indicators of this improvement are an increase in private physician care and a slight increase in nursing home placements for older black adults.
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From page 428... ...
notes that the general decline in death rates from heart disease is undoubtedly due to better medical care and greater efficiency in diagnosing and managing hypertension. There have also been reductions in cerebrovascular disease as a cause of death in all race and sex groupings at each decade over the 30-year period.
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From page 429... ...
5.5 7.6 11.4 13.9 8.0 10.7 24.8 21.5 Time (days) lost from work 4.6 5.1 3.5 4.9 7.1 8.3 3.5 6.5 Source: Data Dom National Center for Health Statistics (1984)
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From page 430... ...
Black Americans are still much less likely to have health coverage than whites. In 1984, an estimated 22 percent of blacks and 14 percent of whites under age 65 were not covered by either public or private health insurance (National Center for Health Statistics, 1987c)
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From page 431... ...
SOURCES OF CARE Blacks are twice as likely as whites to be without a regular source of medical care or to have no regular source other than a hospital outpatient department or emergency room. Some reversals in these patterns have been achieved in the past 20 years, but in 1983, 27 percent of blacks, compared with 13 percent of whites, reported a hospital outpatient department or emergency room as their usual source of care (National Center for Health Statistics, 1986~.
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From page 432... ...
saw physicians an average of 3.6 times per year, compared with an average of 4.7 times per year for whites (see Table 8-9~. By 1985, the gap between whites and blacks had narrowed, with blacks averaging 4.9 visits per year and whites 5.3 visits per year (National Center for Health Statistics, 1987c)
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CIncludes residents in domiciliary care homes. Source: Data from National Center for Health Statistics (1987c)
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Adolescent health problems are often multiple and intercorrelated. Most health settings are not prepared at a single site to offer services for drug or alcohol abuse, sexually transmitted diseases, prenatal care, assessment of learning disorders, and so on.
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From page 435... ...
Among people aged 65 and older, black-white differences in the use of hospital inpatient services declined substantially between 1965 and 1982. Rates for blacks and other minorities, unadjusted for health status, were fairly similar to those of whites (Rusher and Dobson, 1981~.
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From page 436... ...
Black women in medicine were more underrepresented than black men or white women in the profession: in 1980, 11.6 percent of all physicians were women, a mere 0.8 percent of all physicians were black women. Aggregate national data on dentists, registered nurses, optometrists, and pharmacists also show ratios of the number of black professionals in these areas to black population to be well below similar ratios for the nonminority population (U.S.
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From page 437... ...
Comparisons of first-year enrollment for minority women in schools of medicine since 1971 show that minority women have increased their representation in medical schools at a faster rate than all women or minority males. Black women were 20.4 percent of black medical students in 19711972, 38.2 percent in 1977-1978, and 44.9 percent in 1983-1984 (U.S.
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1982 the four predominantly black medical schools (Morehouse, Meharry, Drew, and Howard) had almost 25 percent of the black students in the nation's 127 medical schools.
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From page 439... ...
This care results in little continuity for poor black children and imposes hardships in terms of the conditions of obtaining care.
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From page 440... ...
There are concerns that the adverse effects are pervasive across the life course. Many of the problems responsible for the current gap in health conditions between blacks and whites are problems for which medical knowledge is deficient, for example, knowledge of the causes of hypertension, low birthweight, or cancer of the prostate.
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From page 441... ...
Morbidity and Mortality Weekly Port 55~3~: 1-10. 1988b Differences in death rates due to injury among blacks and whites.
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Paper prepared for the Committee on the Status of Black Americans, National Research Council, Washington, D.C. Davis, K., M
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From page 443... ...
Washington, D.C.: Association of Minority Health Professions Schools. Hanft, R
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From page 444... ...
Institute of Medicine 1985 Preventing Low Birthweight. Committee to Study the Prevention of Low Birthweight, Division of Health Promotion and Disease Prevention.
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From page 445... ...
Kalk, and E Schlesinger 1973 Contrasts in Health Status.
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From page 446... ...
American Heart owl 108:706-710. National Center for Health Statistics 1982a Blood Pressure Levels undo Hypertension in Persons Aged 6-74.
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From page 447... ...
Baugh 1985 Ethnic and RacialPatternsin Enrollment, Health Status, and Health Services Utilization in the Medicaid Population. Washington, D.C., Health Care Financing Administration.
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From page 448... ...
G Manton 1985 Changes in the health status and service needs of the oldest old: current patterns and future trends.
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From page 449... ...
Department of Health and Human Services. 1985a Health Status of Minorities and Low Income Groups.
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From page 450... ...
A Jones 1985 Medical care and mortality: racial differences in preventable deaths.
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