Eliminating African-American Health Disparity via History-based Policy
page 1 | page 2 | page 3 | references

Historical mistrust of American medicine in the Black community

The African-American's history with American medicine may, unfortunately, be labeled as a relationship of bad blood and suspicion. During the chattel slavery era in America, scientific racism and faulty medical theories created an atmosphere in which blacks could be seen and treated only as inferior chattel. Physicians in this era claimed that African-Americans had physiological and anatomical features (small brains; thick skin; high tolerance for heat, sun and pain) that made them well-suited to be both slaves and medical research subjects, thus priming Blacks to develop a lasting sense of cultural mistrust of the medical system.[13]

Unfortunately, such abuses of the black body continued into the Reconstruction and Jim Crow Periods, culminating in the infamous mistreatment of the Tuskegee syphilis study subjects. Maltreatment persisted into the late 20th-century with unethical genetic testing /sickle cell screenings in the 1970s, eugenics-based forced sterilization of Black women in the 1970s,[14] and recent testing of dermatological products on primarily black inmates in Philadelphia's Holmesburg Prison.[15] A number of contemporary factors also contribute to the medical mistrust constructed by improper race definitions and historical abuses. First, Blacks must cope with a current shortage of black physicians and health-care providers. Second, Blacks have historically resided in what are labeled as medically under-served areas, and for a number of socioeconomic and demographic reasons, may still receive inferior care. Third, the changing doctor-patient relationship mediated largely by managed care, coupled with non-mainstream cultural medical practices, may exacerbate mistrust and poor health.

Developing African-American Health Policies

One of the most pressing needs of the African-American patient is for culturally-sensitive care delivery. Despite major American medical and public health advancements afforded by new technologies, research, and critical changes in civil rights legislation, disturbing health disparities continue to plague African-Americans of all ages, and at every level of healthcare delivery. Patients and practitioners must prepare themselves for high-quality, sensitive health care by adopting patient-empowerment skills, learning to be more culturally-sensitive, and by allowing development of health policies and agendas to improve African-American health status.

In the state of Michigan, such changes are taking place, particularly through the efforts of State Senator Raymond Murphy, the Annual African-American Health Conference, and the African-American Health Institute - a collaboration that works to increase access and enhance the quality of medical care given to the Black Michigander. Murphy recognizes two periods in American history that have yielded key reforms reducing race-based health disparities: 1865 to 1872, a period linked to Reconstruction and Freedman's Bureau legislation; and 1965 to 1975, an outgrowth of America's Civil Right's Movement. The senator seeks to personally launch a third period of change within Michigan. Frameworks established by the federal "Healthy People 2010 Initiative," the National Institutes of Health's (NIH) "Strategic Plan on Health Disparities," the HRSA's "100% Access-0% Disparities Initiative," the newly-released Institute of Medicine's report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" (please see Betancourt article pp. 6-11) and African-American health improvement initiatives funded by both the Michigan Office of Minority Health and other state Offices of Minority Health, corroborate Murphy's objectives.

At the state level, the "Challenge of a Lifetime Report," issued by the Michigan Task Force on Improving African-American Male Health, likewise highlights the pressing need for new efforts to secure African-American viability into the 21st century. The report revealed a 30% gap in the life expectancy of Michigan's black males as compared to its white males, a statistic consonant with those presented by the aforementioned national initiatives. Such evidence motivated Murphy, a former member of the health policy committees of both the Michigan House and Senate, to develop a long-term history and evidence-based plan to improve the health status of the Black Michigander. Garnering the support of three prominent universities and research centers in the state (the University of Michigan, Michigan State University, and Wayne State University), Murphy built a support base of institutional representatives, state and local governments, local public health providers, faith communities, and other key healthcare delivery participants to develop what has become one of the largest African-American health activities in the State: The Annual State Senator Raymond Murphy African-American Health Conference.

Since 1999, the three-day Detroit-based conference has educated nearly 7000 Michiganders about African-American health status in Michigan, and has provided statewide government and community collaboratives dedicated to improving health through workshops, mass rallies and comprehensive health screenings. Despite luminous success (the conferences has hosted as keynotes former U.S. Surgeon General David Satcher; former U.S. Secretary of Health and Human Services, Louis Sullivan; and prominent Johns Hopkins-based pediatric neurosurgeon, Benjamin Carson), conference organizers felt a dearth of attention given to evidence-driven interdisciplinary health policies. Such policies should embraced African-American culture and values; enlighten the cultures of both practitioners and patients; and pursue a common good for the Black Michigander through fact finding, study, discussion, analysis and pointed research that increases access to care, enhances healthcare quality, and eliminates health disparities.

To this end, the nonpartisan African-American Health Institute (AAHI, a 510 (c.3) organization), established an outgrowth conference to reduce and eliminate local and national health disparities. The AAHI strives to promote health awareness, resource availability, culturally-sensitive care and African-American health through numerous paths including: education, community resources, policies, legislation, alternative development strategies, research, technical assistance, public debates, conferences and critical partnerships.

An essential branch of the AAHI is its Health Policy Advisory Committee, comprising individuals with expertise in numerous areas of health care and advocacy. During its first year of operation in 2000, the Advisory Committee focused on developing a set of condensed historically and research-based black health policy guidelines, coupled with a descriptive analysis of key health issues that would face the African-American in the 21st century. Consequently, the committee produced an advisory briefing and recommendations sheet entitled, "Why We Can't Wait: An Imperative for the State of Michigan Regarding the Health of African-Americans." The Imperative highlights former U.S. Surgeon General David Satcher's statement that current epidemiological data necessitates reducing modifiable risk factors that reduce life quality and years for all Americans, particularly African-Americans. Specific risk factors include physical inactivity; obesity; alcohol, tobacco and other drug use; poor environmental quality; unintentional pregnancy; sexually transmitted disease and HIV/AIDS occurrence; depression; incidences of injury; and violence.

Due to the original briefing's popularity, the Health Policy Advisory Committee developed a lengthier, more comprehensive document in 2001: the first African-American Health nstitute Policy Brief - a 466-page document examining the health status of African-Americans both nationally and in Michigan. The second brief also provides 22 pages of health policy development recommendations in eight categories, summarized in this article's last section: (1) Close the Gap for the Uninsured and Underinsured; (2) Improve Health and Dental Care Options; (3) Improve Mental Health care; (4) Ensure Fair Data Collection, Research and Reporting; (5) Improve Service Delivery; (6) Enhance Community Outreach; (7) Advocate Environmental Justice; and (8) Promote Healthy Lifestyle Changes. While these recommendations may not be a panacea for all healthcare inequalities, they nevertheless open dialogue and offer suggestions to remedy medical racism and the historical discrepancies in health care.

page 1 | page 2 | page 3 | references