Ethnicity and race are categories that have been socially constructed and have a significant effect on the livelihoods of persons defined by their own perceptions of self or how they are perceived by others (Weinstein, Geller, & Baciu, 2017). For many years, research has pointed to the appalling racial disparities in health care in the United States. African Americans are among the minority groups in America. Commonly referred to as Blacks or Afro-Americans, these people form an ethnic group of Americans with ancestry from any black racial group of African descent. Despite their long history in the country, African Americans continue to face various social and racial injustices which pose formidable challenges to the provision and access of equitable healthcare for all.
Current Health Status and Health Disparities
The history of oppression and the present-day racial prejudice that African Americans continue to suffer underpin the indefensibly poor health status of the group. In 2013, African Americans posted the highest age-adjusted mortality rate than any other ethnic group in the U.S. (Noonan, Velasco-Mondragon, & Wagner, 2016). Overall, the group remains the least healthy ethnic community in terms of the years of potential life lost. Arguably, the most obvious indicator of the health status of the Black community is its infant mortality rate which has always been about thrice as high as that of the whites. African Americans are also significantly affected by chronic illnesses and morbidity. Over the recent past, the main courses of morbidity that have stood out in the States include cardiovascular disease, cancer, diabetes, and homicide (Noonan, Velasco-Mondragon, & Wagner, 2016). Previously, the black population reported high death rates for cancer, HIV, and cardiovascular disease. However, there has been a decrease in these rates over the years suggesting the narrowing of gaps.
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Moreover, there is a more significant decrease in the incidences of accidental injuries among African American males (Noonan, Velasco-Mondragon, & Wagner, 2016). However, homicides have always been the cause of mortality with the most significant ethnic disparity. It competes with heart disease as the ultimate precipitant of death for blacks. Despite living in more stressful conditions, blacks seemingly have lower rates of suicide and mental health issues. However, it has been shown that African Americans with mental health problems receive inadequate treatment due to their insurance status, low income, and racial bias (Noonan, Velasco-Mondragon, & Wagner, 2016). It has also been shown that clinical uncertainty, prejudice, bias, and stereotyping on the part of health care providers in the U.S. contributes to the ethnic and racial disparities in healthcare. As a consequence, African Americans may be reluctant to receive treatment or refuse it altogether.
Impact of Race and Ethnicity
Socially, racial discrimination against African Americans has been associated with suboptimal education, housing, work, earnings, and access to health care (Weinstein, Geller, & Baciu, 2017). Researchers have identified associated risks to be deplorable living standards, occupational hazards, poor nutrition, low-quality education, violent neighborhoods, and easy access to drugs of abuse. To the individual, racial discrimination has been shown to exert its negative effects by affecting the cognition and emotion of the person resulting in morbidity and psychopathology. Moreover, daily nerve-wracking happenings weaken coping mechanisms and an individual’s genetic makeup. Resultantly, the neuronal, hormonal, and immune systems are damaged extensively through epigenetic effects.
Nutritional Challenges
The nutritional challenges among African Americans are primarily associated with their socioeconomic status. Predominantly black and lower-income neighborhoods have limited access to a healthy food and a range of food stores to choose from unlike most of their Caucasian counterparts or those in higher-income neighborhoods (Kolahdooz et al., 2015) The diet of African Americans is thus typically not balanced as they report low intakes of vegetables, fruits, and dairy products and high intakes of processed foods. Accordingly, the have an inadequate intake of fibers, vitamins, and minerals with excessive amounts of added sugar and trans fat (Kolahdooz et al., 2015). It is such a diet that has been associated with the high incidence of cardiovascular diseases, hypertension, and obesity among African Americans. Cultural necessity and bearing also have a bearing on the dietary preferences of African Americans. This community particularly prefers a type of cuisine known as soul food which has been linked to many health problems. The food typically contains a lot of fatty meals and fried foods. African Americans associate soul food with their history of slavery and social interactions. Accordingly, efforts to get blacks to eat healthier foods are met with great resistance as they are deemed as attempts to eradicate the African culture.
Barriers to Health
Multiple barriers contribute to the ethnic or racial health disparities in the U.S. Some of the socioeconomic barriers linked with racial discrimination include low income, lack of employment and low levels of education (Noonan, Velasco-Mondragon, & Wagner, 2016). Lifestyle behaviors like substance use and abuse, and physical inactivity have also been linked to health disparities. Most blacks in the U.S. also typically grapple social environments that are typified by limited economic and educational opportunities, racial and ethnic discrimination, poor work conditions, and unfriendly neighborhoods. More importantly, the black community has poor access to preventive health-care services such as vaccination and cancer screening. Other barriers that have been identified include fear, medical mistrust, lack of health awareness, fatalism, and the perception that healthcare should be sought as needed. African Americans have also reported bad clinical experiences in the past hence their reluctance to seek care. Furthermore, the linguistic and cultural differences between African Americans and a majority of providers negatively impact the latter’s health seeking behavior.
Health Promotion Activities
Over the recent past, there has been a general improvement in the health promotion activities undertaken by African Americans. More people are taking physical activity seriously and are incorporating them in their daily routines. Mothers are also more focused on ensuring that their children are vaccinated and that they are up to date with their vaccinations. Various community programs in black neighborhoods have also been established to increase health awareness among the African Americans. However, these practices do not adequately address the challenges faced by the black community. Accordingly, barriers to seeking health care may be overcome through health promotion programs such as organizing wellness promotion fairs. Such fairs enable health care professionals to work within communities to identify the specific health promotion needs. Through such programs, essential preventive and educative information may be disseminated to the community.
Health fairs are effective in ensuring the three levels of prevention are incorporated. Primary preventive activities that may be incorporated in health fairs include vaccination and presentations on the various methods of preventing disease such as lifestyle modification. A secondary prevention measure could be through screening the attendees of the fair for the common morbidities that affect them including cardiovascular diseases, hypertension, diabetes, cancer, and HIV. Tertiary prevention activities may be provided to individuals with known histories of chronic diseases. Appropriately, they could be educated on self-care, medication adherence, and lifestyle modification. Health and wellness fairs are effective as they can eliminate unhealthy behaviors, the lack of education, and other barriers to health promotion.
Cultural Considerations
Various cultural aspects should be considered when creating a care plan. It is imperative that practitioners consider the spiritual and religious practices of their clients or patients as these may influence their choice of treatment. Importantly, culinary and dietary preferences should be taken into consideration. This is particularly important when advising patients on dietary modification in conditions that warrant such an intervention. When dealing with children and parents, practitioners should be conscious of the cultural-specific childcare practices to avoid violating the dignity of parents. It is also appropriate to understand the everyday life practices of a people including their perceptions of gender roles and household relationships. This could be particularly important when offering sex education. An appropriate cultural model to support culturally competent health promotion for African Americans would be the Giger and Davidhizar Transcultural Assessment Model. This is because the model focuses on biological variations, environmental control, context, social organization, communication, and space when dealing with people from diverse cultures (Albougami, 2016) .
References
Albougami, A. S. (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing and Health Care , 2 (4). https://doi.org/10.23937/2469-5823/1510053
Kolahdooz, F., Butler, J. L., Christiansen, K., Diette, G. B., Breysse, P. N., Hansel, N. N., … Sharma, S. (2015). Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City. Journal of the American College of Nutrition , 35 (3), 205–216. https://doi.org/10.1080/07315724.2014.959206
Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Reviews , 37 (1). https://doi.org/10.1186/s40985-016-0025-4
Weinstein, J. N., Geller, A., & Baciu, A. (2017). Communities in Action: Pathways to Health Equity . Washington, DC: National Academic Press.
