Despite living in the most advanced economy in the world with the most advanced health care system in the world, many Americans live with chronic disease and health crises that are similar to those of citizens in developing nations. Even within the United States, health and illness are not distributed randomly; in fact, African Americans are more likely to suffer from chronic diseases, lack access to health care, and die earlier than their white counterparts. Its important to consider these racial disparities in health and life expectancy within the context of the U.S system of health care. Access to this system of health care is significantly shaped by race and social class. AIDS is now the leading cause of death among blacks aged 25 to 44, greater than homicide, heart disease, and accidents combined. The disease, long associated with white gay males, is slowly devastating black communities, claiming more men, women, and children everyday. The leading cause of death for Americans, regardless of race and gender, is heart disease. Heart disease is the only major disease in which the rate of death is higher for whites than for African Americans. This is driven primarily by the extraordinarily high rates of heart disease among white men. With the exception of heart disease among white men, African Americans experience higher rates of each of the most prevalent chronic diseases and higher mortality rates as a result of these diseases.
In June 2005, the FDA approved a drug called BiDil to treat cardiovascular disease specifically in African Americans. 700,000 African Americans have chronic heart disease and they seem somewhat less likely to respond to traditional therapies. The development of BiDil relies on DNA or genetic coding. The pharmacology is based on the fact that an individual’s genetic makeup will make him or her less or more receptive to specific drug therapies. After cardiovascular disease, diabetes ranks as the next most significant chronic disease among Americans. African Americans are 1.6 times more likely to have diabetes than whites of similar age. The rate of diabetes is important because it is related to so many other diseases. Patients with diabetes are 2 to 4 times more likely to develop heart disease and 4 to 6 times more likely to suffer a stroke, and they account for 60% of all non-trauma-related amputations.
HIV/AIDS is an important health issue facing the African American community for a variety of reasons. First, it is the leading cause of death of all African American men and women, and it is the leading cause of death among young African Americans aged 15-44. Second, it is a preventable form of death. Third, it is directly linked to other issues like sexual practice and incarceration. Lastly, the rate of HIV/AIDS in the African American community can be examined not just as an outcome, but also as a symptom of other issues of well being: drug use, poverty, and sexual practices such as multiple sex partners and the “down low”. African American men report at least three reasons for being on the DL, male to male prostitution, habitual mean heaving sex with men, MSM behavior begins in prison and may or may not be continued after release, and the desire to “reject a homosexual identity and maintain a façade of heterosexuality within African American culture, where homosexuality is a highly stigmatized identity”.
More than half a million African Americans are HIV positive. Black males are more likely to contract HIV from IV drug use than their white counterparts and less likely to contract HIV through sexual contact with an infected male. African American women are more likely to contract HIV through sex with an infected male partner than their white counterparts and less likely to contract HIV through all other modes of transmission than their white counterparts. This is also the most common form of transmission of HIV/AIDS for Black women.
The fifth leading cause of death for African American men is homicide. Both HIV/AIDS deaths and homicide often result in children being put into foster care or being raised by their grandmothers, aunts, or other relatives. Premature death is disruptive to family life and frequently results in both poverty and a significant change in family structure. This can also affect the health of the children. One measure of health and well-being is the infant mortality rate, which refers to the probability that a child will die before his or her first birthday. Rates of infant mortality are twice as high for African Americans as for whites. White women have the longest life expectancy and African American men have the shortest.
The relationship between lifestyle causes of poor health and illness and race is confounded by social class. The affluent have the resources to purchase more meat and “rich” foods, it is the poor who find it difficult to afford healthy food such as fresh fruits and vegetables. Social class shapes lifestyle, in particular, access to healthy food and exercise. African Americans are disproportionately likely to be poor, they are less likely to eat healthfully and exercise and more likely to suffer diseases. Americans never die of the diseases the worlds poor die of, such as malaria and cholera; instead, they die of diseases of overconsumption, such as diabetes and heart disease.
Walmart engages in a popular practice of employing its workers fewer than the 40-hour mark that requires health insurance benefits, and as a result, the majority of its employees do not have health insurance. As a result of unemployment and these sorts of corporate strategies, nearly 40 million Americans are without health insurance. Health insurance is linked primarily to employment. The government provides health insurance for the very poor and the retired. The costs continue to rise, making health care a virtually unattainable luxury for all but the insured. At risk individuals are less likely to receive the kind of preventive care that will lead to better health. The cost of the premiums are not fair. Many people cannot afford to pay 300 dollars’ monthly for health insurance. Insurance companies also have a history of charging higher premiums to African Americans.
Private health insurance has the most flexibility; patients find that they can see any physician they choose at any hospital or clinic. The costs vary but they are always reasonable unlike Medicaid. Medicaid has severe limits on hospital and physician’s reimbursements, and as a result, many of the highly ranked hospitals and clinics will not see Medicaid patients. The system of private and public health insurance creates a system of health care that is segregated by social class, and as a result of the conflation of race and social class, the system is racially segregated as well. The vast majority of Medicaid is 70% African Americans. African Americans are twice as likely to report having difficulty accessing specialists when compared to whites.
Access to health insurance directly affects access to health care. African Americans, who are more likely to have chronic diseases are less likely to have access who have the training necessary to treat these diseases. Treatment may be delayed because the patient may not be diagnosed. Diagnosis may be delayed because the patient fails to present his or her symptoms to a health care professional out of fear, lack of health insurance, and access. Diagnosis may also be delayed because of biases on the part of the health care professional. Also, the health care professional may be undertrained or underqualified. African Americans are far less likely to receive regular health care. Delays in treatment may be a direct cause of access to health care or health insurance. Finally, delays in treatment may be a result of prejudice and discrimination.
African Americans have a long and justified history of distrust of the medical community. It was strongly shaped by the Tuskegee syphilis experiment’s and the eugenics movement. The Tuskegee experiments involved poor black men with syphilis got untreated in order to study the long-term affects of the disease. They never told them their disease nor how serious it was. They were basically left to die. The eugenics movement was a social movement for the improvement of the races that relied primarily on the sterilization of potential “unfit” parents. The policies had racial and social class overtones.