Underserved Populations: African-Americans
African Americans are uniquely the only culture that came to the United States by force rather than choice. More than 4 million people were brought to the US as slaves, a practice which continued form the early 1600’s until after the Civil war. In 1863, President Lincoln signed the Emancipation Proclamation stating that all slaves “are and henceforth shall be free.” After Lincoln’s assassination the Thirteenth Amendment to the US Constitution abolished slavery in the US. In spite of the cruel treatment and the many hardships of the Black culture, Black Americans maintained their rich culture and family structure. Their traditions, customs, religion, spirituality, and health practices have been passed down from generation to generation and still evident today.
Although as nurses we can never know all aspects of every culure it’s vital to educate ourselves about those we serve in order to provide culturally competent care. According to the 2016 Census Bureau it is estimated that more than 40 million blacks live in the United States, making up about 13% of the nation’s population. The term Black or African American is based on the definition used in the 2000 US Census. Black or African American were once interchangeable terms, however because not all Black Americans are from Africa the term Black American has become the more acceptable terminology. Our black American population now includes African Americans; sub-Saharan Africans such as Kenyans, and Nigerians and Caribebean Blacks such as those from Haiti and Jamaica. As the Black American population continues to grow and becomes more diversified within itself, it becomes more of a challenge for the APN to identify and understand the various cultures in order to meet their health care needs.
Learning objectives for the module:
At the end of this module, the student will be able to:
Identify the impact of culture on healthcare in Black Americans
Discuss culturally appropriate care for the Black American
Identify specific health problems of Black Americans
Readings: Andrews & Boyle, J. Chapter 7
Articles: Inequality in Health Care Is Killing African Americans
African American Health: Creating equal opportunities for health
Assignments: Disparity Paper
Topic 1: Defining Health and Illness
Black Americans define health and illness from their African roots, and their health and healing practices contribute to how they care for themselves today. Much of their healthcare beliefs stem from the assumption that all things, living or dead, influence each other. Being healthy means one is in harmony with nature where conversely, illness is a disharmony with nature. Black Americans view health as agreement of mind, body and spirit. This population believes that health is achieved by eating three meals a day, including a hot breakfast, getting proper rest and maintaining a clean environment. Physicians are not regularly consulted and folk medicine still exists in the Black communiities. Traditional healers are more likely to be consulted due to the lack of trust or respect for the health care system, fear, lack of money, lack of resources, and history of bad experiences and humiliation in the healthcare system Often Blacks believe that the disharmony which caused illness is due to possession by demons or evil spirits. The goal of treatment is to remove the evil spirits through voodoo or traditional healers. Even today the most common method of treating illness is through prayer and for many the laying on of hands.
Providing health care to this population may be complicated by ther tradional folk practices their types of health practitioners. These healers may include a member of the family or an old lady who provides hme remedies made of spices. Roots and herbs. The use of a spiritualist is also fairly common and they combine rituals, spiritual beliefs and herbal medicines to provide a cure. Although not as common, Voodoo is still practiced in the rural south and New Orleans but is seen in some northern rural areas as well.
Topic 2: Current Health Problems
According to numerous health studies, Black Americans have the highest rate of mortality from heart disease, cancer, cerebrovascular disease, and HIV/AIDS than any other US racial or ethnic group. The prevalence of hypertension among the Black US population is among the highest in the world. Usully beginning earlier in life than in white Americans, their BP is usually higher and they have an 80% stroke mortality rate and a 50% higher heart disease mortality rate and a 320% greater hypertension renal disease than the general population. Through evidence based practice, diuretics have proven most effective in reducing the morbidity and mortality rates and should be the first line of treatment in this population. However due to high incidence of stage 3 hypertension with angina, post myocardial infarction, diabetic neuropathy and other complications a mutipharmaceutical approachmay be necessary. The use of beta blockers, ACE inhibitors, and calcium antagonists are far more effective in these cases when used with a diuretic.
Unfortunately, studies show that heart disease is extremely prevalent in this population and they are much less likey to receive adequate medication therapy, dialysis, kidney transplants, and coronary artery bypass as are whites. Since manyBlack Americans remain uncomfortable with and suspicious of health care professionals they only see primary care givers when absolutely necessary. They also seem to take medications such as antihypertensives only as necessary and not regularly as prescribed leading to the high incidence of mortality and morbidity.
Despite healthcare advances, the black American population falls way behind. Statistics show that infant mortality rates are 2.5% higher than those of whites and Black American men have a life expectancy of 8 years less than their white counterparts.
Topic 3: Health Care Disparities
Health care disparities in the Black American population affects many areas of health care. More African Americans are diagnosed as psychotic but less likely to receive prescribed antipsychotic medications than Whites. Also more likely to be involuntarily hospitalized, and considered potentially violent, and use of restraints or isolation is more frequently seen in this population. Regardless of the setting, inpatient or outpatient, or the age, these disparities exist at a higher rate than in the White population.
The Minority Health Report of 2007, claims that Black Americans are three times more likely to die from asthma related complications than whites. Black children have a high incidence of underdiagnosis of asthma and inadequate treatment. They are more likely to receive obsolete medical prescriptions rather than the newer recommended single-entitiy prescriptions which has resulted in a death rate seven times that of white children.
One out of every 14 Blacks are Diabetic and are more likely to develop complications than White Americans. They have been found to be less likely to undergo hemoglobulin A1C testing than Whites. Also, they are less likely to have lipids tested, have an ophthalmology visit, have a physician visit, and have immunizations than Whites. All of which contribute to their higher risk of heart disease and strokes.
Black Americans reluctance to seek traditional health care also prevents them from receiving health screenings and preventative services leading to poorer health in general.
With little diversity in healthcare, the disparity in the care of Black Americans continues. Needed healthcare may not be affordable in lower socio-economic groups and if availablemay not be culturally relevant. Another barrier to adequate health care is the long history of discrimination of Blacks, causing some to believe that their lives would not be valued by healthcare providers. Studies have also shown that physicians are less likely to have a positive perception of Black patients due to the perception that Blacks have a higher risk of substance abuse, noncompliance with treatment regimes, and followup care. Physicians are also guilty of stigmatizing Blacks as being uneducated and less intelligent than Whites (Dayer-Berenson 2014). Studies report that the most important issue for the patient was not that the healthcare provider shared the same race but that the healthcare provider had the ability to communicate across language and cultural barriers. As advanced practice nurses we must ensure that a cultural assessment is performed, documented, and communicated clearly among all healthcare team members in order to narrow the gap in healthcare disparities in the U.S. (Dayer-Berenson 2014).
Andrews, M. & Boyle, J. (2016). Transcultural concepts in nursing care. Philadelphia: Walters Kluwer
Dayer-Berenson, L. (2014). Cultural competencies for nurses: Impact on health and illness. Sudbury, MA: Jones and Bartlett Publishers.
Kosoko-Lasaki, S., Cook, C., & O’Brien, R. (2009). Cultural proficiency in addressing health disparities. Sudbury; MA. Jones and Bartlett
Rose, P.R. (2018). Health disparities, diversity,and inclusion. Miami: Jones and Bartlett Learning