Health Care in the Black Community

Empowerment, Knowledge, Skills, and Collectivism

Sadye Logan, Edith M. Freeman, Gary Rosenberg, Andrew Weissman

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136379918
• Topic: Medicine
• Subtopic: Health Care Delivery

Empower patients with culture-specific strategies for promoting health, treating disease, and preventing violence!Current reports show that Black Americans have the highest death rate of all racial and ethnic groups. They suffer disproportionately from a number of fatal diseases, including hypertension, diabetes, and certain cancers. Moreover, violence takes far too high a toll, especially among young Black men. Clearly a different approach to health education and promotion is needed to end this tragic waste of valuable human lives. Health Care in the Black Community: Empowerment, Knowledge, Skills, and Collectivism proposes an innovative model for health professionals working in the Black community.Traditional Western medicine focuses on sickness, the isolated individual, and the material world. However, the Afrocentric values of many Black people emphasize wellness, the community, and the spiritual world. By basing health care approaches on the community's positive values of holistic healing and mutual assistance, Health Care in the Black Community suggests practical, effective strategies for promoting physical and emotional wellness. This comprehensive and informative book offers a solid intellectual framework as well as practical advice. Health Care in the Black Community:

• identifies deeply held African-American cultural traditions and attitudes
• offers specific suggestions for combining health care priorities with respect for cultural concerns
• shows how to gain compliance by involving patients in their own care and drawing on community strengths
• discusses the impact of specific problems such as low self-esteem, infertility, HIV/AIDS, and violence on Black families
• develops strategies for preventing family violence by helping family members define and identify emotions
• shares programs and ideas for enhancing the physical and mental health of elderly Black people
• identifies ways to overcome the drawbacks of early parenthood

Health Care in the Black Community offers health care professionals-- policymakers, practitioners, researchers, and educators in the fields of social work, health care, and cultural studies--successful methods, models, and suggestions to help improve health care in Black communities.

PART I:
HEALTH CARE, KNOWLEDGE BUILDING, AND CONSCIOUSNESS RAISING FROM AN EMPOWERMENT PERSPECTIVE: ISSUES AND PROSPECTS

Chapter 1

An Empowerment and Health Prevention Framework for Understanding and Transforming the Health Care Outcomes of African Americans

Sadye L. Logan
Edith M. Freeman

Nearly fifteen years have passed since the Report of the Secretary's Task Force on Black and Minority Health (1986) was issued by the U.S. Department of Health and Human Services. According to this report, people of color suffered nearly 60,000 “excess deaths” annually when compared with whites. The causes of excess deaths included cancer, cardiovascular disease, stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. A national response was demonstrated in the form of the Disadvantaged Minority Health Act, enacted in 1990. The act brought to the national agenda the most persistent and serious health issues of the century. It states:

The Congress finds that racial and ethnic minorities are disproportionately represented among individuals from disadvantaged backgrounds, [and] the health status of individuals from disadvantaged backgrounds, including racial and ethnic minorities, in the United States is significantly lower than the health status of the general populations…. (Disadvantaged Minority Health Improvement Act of 1990 P.L. 101-527)

This law provides a formal statutory authority for the Office of Minority Health to help remedy the toll ill health exacts from people of color—including African Americans, or blacks, as they will be called here. The act was further strengthened by Healthy People 2000, a wide-scale prevention project that established a national strategy to improve the health of all Americans. The intent of this chapter is to present an overview of the most serious and persistent health problems experienced by African Americans and to provide an empowering framework for studying these disease conditions, as well as to point a way to find solutions to these issues and concerns. Exemplars illustrating the empowering framework are presented. As part of the primary understanding of the importance of improving the health of American blacks, the health status of blacks in the United States is examined in the next section.

HEALTH STATUS OF BLACKS

An Overview of Black Health Care

It has been estimated that African Americans will constitute 16.9 percent of the U.S. population by 2050 (O'Hare, 1987). Along with this significant growth in the population are numerous challenges that mitigate against quality health care for African Americans. As indicated earlier, the health status of the U.S. population in general, and of blacks in particular, has dramatically improved in terms of life expectancy; however, statistics show that a disproportionate number of health indicators for blacks do not reflect progress or improvement. Further, this disparity has widened in some areas. Conditions of powerlessness and poverty have continued to impact the lives and health status of American blacks. These conditions have created widespread social, economic, physical, and spiritual disease in black families and communities, thereby resulting in the highest indices of morbidity and mortality in this group, and the lowest access to primary care, with little or no access to primary preventive programs.

Despite the dramatic increases in life expectancy for the U.S. population in general, the twentieth century has not been equally kind to blacks with respect to health care and related concerns. Current reports suggest that blacks still have the highest death rates among all groups. This continuing differential has been attributed, in part, to recent increases in the death rates for African-American males under age forty-five due to AIDS and homicide (National Center for Health Statistics, 1991). The disparity in death lessens with increasing age, and, after age sixty-five, the differences between blacks and whites are almost nonexistent.

Although heart disease, cancer, and cerebral vascular disease continue to be the leading causes of death among blacks, homicide is the second leading cause of death for blacks ages fifteen to forty-four and for black children under fifteen. Injuries are the third leading cause of death for black males and the primary cause of death among black children one to fourteen years of age (National Center for Health Statistics, 1991).

As alluded to earlier, HIV infection is increasingly and disproportionately affecting African Americans and other ethnic groups of color. According to a 1991 report from the Centers for Disease Control, nearly 29 percent of all AIDS cases in the United States have occurred among blacks. A special Newsweek report placed the AIDS deaths in 1996 among African Americans at 42 percent (Case, 1999). Black children under thirteen are also disproportionately represented among older children with AIDS. HIV/AIDS is the fourth leading cause of death for black women fifteen to forty-four years old in two metropolitan areas: New Jersey and New York.

It is also important to note that blacks have very high mortality rates for certain types of cancer with low survival rates. These cancers include oral cavity, esophageal/lung (males), female breast (under age forty), cervix/uterus, prostate, stomach, and pancreas. Other major disease conditions and risk factors for African Americans’ health include diabetes, adolescent pregnancy, obesity, and drug use. Chapter 7 extends the discussion on these disease conditions and risk factors of black people.

Diabetes

Diabetes is an endocrine disorder characterized by an insufficient and/or ineffective secretion of insulin, accompanied by elevation in plasma glucose levels as well as abnormalities in lipoprotein and amino acid metabolism. Current reports suggest that non-insulin-dependent diabetes mellitus is increasing among blacks, with the higher rates occurring among overweight black women. The death rates among blacks from diabetic complications are also higher among black women, with greater degrees of complications from ocular conditions, including cataracts and glaucoma. The most common and clinically significant eye condition is retinopathy. The severity of diabetes is due to its impaired blood sugar control, renal disease, and hypertension (Klein et al., 1988; Tull, Makame, and Roseman, 1994).

Adolescent Pregnancy

Pregnancies occurring in women under twenty years of age are considered to be high-risk pregnancies. Infants born to teenage mothers tend to have a higher incidence of low birth weight (LBW) and remain at a higher risk of dying before their first birthday. Despite the decrease in the number of teen pregnancies overall, teen mothers are more likely to be black than any other ethnicity (Report of the Secretary's Task Force on Black and Minority Health, 1986). National data for 1990 suggest that nearly one-fourth of all black births were to women under the age of twenty (U.S. Department of Commerce, 1993). It follows that age-related risk factors, combined with LBW, generally give rise to high infant mortality. Recent reports, however, suggest that, although still high, infant mortality rates among blacks are decreasing (Case, 1999).

Obesity

Among black women, obesity cuts across all income levels; however, southern rural black women appear more likely to be overweight than black women from other parts of the United States. Available data suggest that people of color are more obese than whites, that the poor are more obese than the affluent, and that women are more obese than men. In addition to being a major risk factor for death, it is a risk factor for numerous physical conditions, such as complex disorders involving genetics, diet, and nondietary environmental factors (Blocker, 1994).

Drug Use

Abuse of alcohol, tobacco, and other drugs has a devastating impact on African Americans, and such abuse places them at a high risk for morbidity and mortality. This devastation may take the form of numerous drug-related health problems, criminal activities, loss of family relationships, high school dropout rates, and absence from the labor force.

According to the National Household Survey on Drug Abuse (NHSDA, 1991), marijuana is the illicit drug most often used among all racial/ethnic groups. Among African Americans, overall use was 11.2 percent, with the highest rates among those eighteen to thirty-four years of age. The lowest rate of marijuana use among blacks was among those thirty-five years and older, with midrange rates among those twelve to seventeen years old. Cocaine and psychoactive prescription drugs represented the next two most frequently used drugs among African Americans (NHSDA, 1991).

THE PROPOSED FRAMEWORK

This proposed empowerment and health promotion framework for African Americans addresses the complex nature of black health care. It describes a set of ideas that provide insight into and understanding about health and wellness and intervention needs in black communities. In this framework, empowerment refers to the process by which individuals and groups gain power, access resources, and take control over their lives (Solomon, 1990). In doing so, they can achieve their highest personal and collective aspirations and goals. Empowerment theories explicitly focus on the structural barriers that prevent people from accessing resources necessary for their health and well-being. These barriers, for example, include the effects of prolonged powerlessness on oppressed and marginalized individuals and groups, as well as the unequal distribution of wealth and power inherent in postindustrial economies. It is important to note that these assumptions about empowerment are not only concerned with the process of empowerment but also with results that produce greater access to resources and power by the disenfranchised.

Health promotion is a positive, expansive concept that came into being during the 1980s. As a health and wellness movement, it offers hope for the 30 to 40 million Americans who lack private or public health insurance coverage. It has been suggested that three areas are intrinsic to health promotion and wellness: (1) self-care, which refers to the choices individuals make to safeguard their own health, (2) mutual aid, which refers to people's joint efforts to handle health problems, and (3) a healthy environment, which refers to policy development and implementation that supports the creation of physical, social, and economic conditions conducive to healthy lifestyles. Health promotion is inclusive of good physical health, physical fitness, mental health, nutrition, family life development, stress management, racial/ethnic relations, conflict resolution and communication styles, alcohol- and drug-free lifestyles, and consumerism (Caplan and Weissberg, 1989; Hawkins and Catalano, 1992).

Health education and promotion can be operationalized through a variety of interventions and service activities. Examples of these are as follows:

1. Awareness activities include public service announcements, at-risk assessment, public forums, and community outreach.

2. Knowledge building for increased personal choice includes workshops and special dissemination of written materials on special topics.

3. Self-care and life skills development provide small, focused self-help groups addressing issues related to everyday problems in living (money management, culturally sensitive parenting, healthy eating, effective communication and decision making).

4. Resource development and management involves people and their talents, goods and services, and the proposal for new and revised service policies, procedures, and practices that support a community-centered orientation.

5. Community building is defined by Weil (1996) and Shaffer and Anundsen (1993) as activities, practices, and policies that support and foster positive connections among individuals, groups, organizations, neighborhoods, and functional geographic communities. The process involves residents taking ownership of, and making decisions about, critical issues impacting their communities and addressing policy practice issues related to their quality of life.

The four health promotion activities are inherent in the fifth activity, community building. Gardner (1994, pp. 13-27) recommends ten ingredients for community building:

1. Wholeness—incorporating diversity

2. A reasonable base of shared values

3. Caring, trust, and teamwork

4. Effective internal communication

5. Participation

6. Affirmation

7. Links beyond the community

8. Development of young people

9. A forward view

10. Institutional arrangements for community maintenance

The empowerment framework also includes a focus on quality, prevention, and culturally competent services and recognizes that all levels of government, voluntary associations, community groups, individuals, and, most important, families must be included in shaping and improving health outcomes.

As a means of integrating the empowerment and health promotion aspects of this framework, a community-centered approach, based on a community-building/development approach, is utilized. Braithwaite and colleagues (1989) sequenced seven steps to frame this approach:

1. Learning the community

2. Learning and understanding community ecology

3. Establishing the community entry process

4. Building credibility

5. Developing a community board

6. Conducting needs assessment

7. Intervention planning

Learning the Community

It is useful to this discussion to begin with a conceptualization of community as a dynamic whole that emerges when

[a] group of people participate in common pra...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Contents
• About the Editors
• Contributors
• Foreword
• Acknowledgments
• Introduction
• PART I: HEALTH CARE, KNOWLEDGE BUILDING, AND CONSCIOUSNESS RAISING FROM AN EMPOWERMENT PERSPECTIVE: ISSUES AND PROSPECTS
• PART II: SKILL DEVELOPMENT AND HEALTH CARE ISSUES IN THE BLACK COMMUNITY: EMPOWERMENT OPPORTUNITIES
• PART III: SELF-HEALING, COLLECTIVISM, AND SOCIAL ACTION IN THE BLACK COMMUNITY: FORMAL AND INFORMAL HELPING
• PART IV: EPILOGUE
• Index