Minority groups in the United States suffer from more excellent mortality rates, shorter life expectancies, and lower mental health outcomes than non-Hispanic whites. Race/ethnic variations in health have not been studied extensively. This essay aimed to examine health and medical care disparities among African-Americans. The health belief model and social cognitive theory were employed in this study. A systematic review was used to look at previous research. Health differences between races and ethnicities can be explained by using the findings of the studies. Examples of these influences are racism and self-care habits, social standing, and the environment. Neither have African Americans been in financial or political power positions to ensure long-term success nor has their health been a priority for decision-makers. An essential part of providing equal access to health care is mandating frequent training and refresher courses for all health care professionals, particularly those of color. Due to a shortage of funding, much earlier social development and community health programs must be rebuilt to meet the urgent national goal of training more young people of color in health professions.
In 1928 Louis Israel Dublin said that the improvement in Negro health to the point where it is comparable to the white race would eliminate numerous infirmities, improve the race’s economic situation, and develop its innate powers (Noonan et al., 2016). To this day, the validity of this compelling claim cannot be questioned. Because African Americans have the worst health outcomes of any ethnic group in the United States, this is not a coincidental finding. Enslaved people from Africa were imported to the United States and forced to work as domestic servants. A classic case study of how one segment of society can wreak havoc on the well-being of a whole population is the transatlantic slave trade. According to various estimates, in the dreaded “middle passage,” enslaved people died at a rate ranging from 9 to 35%. Many more people died due to slavery (Noonan et al., 2016). When African Americans were enslaved in the United States, their health was of little concern. For more than 250 years, African Americans in slavery suffered physical, psychological, and social torture at the hands of their captors. Even when slavery was abolished, the health of African Americans did not automatically improve. Since slavery was abolished 150 years ago, they have been subjected to systematic persecution and prejudice. Those who have made it through this ordeal may be the group’s toughest and most tenacious survivors. Slavery and the ongoing racial discrimination that African Americans face explaining why they have such bad health.
Minorities’ health is negatively impacted by discrimination. To detect and eliminate health inequalities, the US Congress passed the Minority Health and Health Disparities Research and Education Act (2000) (Noonan et al., 2016). Despite the efforts of the government to improve the health of minorities, minorities continue to have poor health outcomes (Lewis & Van 2018). Further research on the causes of health disparities between people of different races and ethnicities is needed. In the United States, there are many other races, ethnicities, and nationalities. In the United States, Asian Indian, Chinese, Korean, Vietnamese, Filipino, Japanese, Guamanian or Chamorro, Native Hawaiian, Samoan, and Other Pacific Islander are the official racial classifications. (Hawkins et al., 2015). Hispanics and Latinos of all races and non-Hispanic whites and blacks make up this demographic. People of Mexican, Cuban, South, or Central American heritage are Latinos. More study is needed to address racial and ethnic inequities in health. As a result, the focus of this study is on racial disparities in health and health care.
Description of the Problem
As the number of people of color in the United States increases, racial and ethnic health disparities will become an increasingly serious public health issue (Okombo, F. A. (2017). Diabetes, HIV /AIDS, cardiovascular disease, cancer screening, vaccination, newborn mortality, and treatment are six important areas where racial/ethnic minorities face health access and outcomes (Hawkins et al., 2015). Due to a lack of health insurance, the absence of timely medical care is connected to increased morbidity and death rates among minorities (Okombo, F. A. (2017). Regardless of income, African-Americans and Hispanics are more likely than Whites to experience delays in receiving medical care when sick (Hawkins et al., 2015). This is especially true for specialist visits, prescription refills, and other medical tests that their doctors may recommend. Poor health outcomes are more likely to occur among people who do not have health insurance or a regular source of medical care (Carnethon et al., 2017). Health issues and early death are more common for African Americans than for non-Hispanic Whites. As Okombo (2017) pointed out, although Healthy People 2010 was created to eliminate health disparities and improve quality of life so that people might live longer lives, these discrepancies still exist. Noonan et al. (2016) found that many people in the United States are experiencing a decline in disease-related mortality. However, as indicated by their persistent higher rates of illness incidence, morbidity, mortality, vaccination, and newborn mortality, they have not benefited from this development. There is a need to look into why African Americans face healthcare disparities.
Public health experts in the United States are deeply concerned about health care disparities based on race and ethnicity (Hawkins et al., 2015). Compared to the general population of the United States, African Americans have a higher all-cause death rate and a lower life expectancy (Okombo, 2017). For example, whites have a mortality rate of about 15 deaths per 100,000, whereas the rate for African-Americans is over 50 fatalities per 100,000 (Noonan et al., 2016)). There is a greater incidence of diabetes-related problems in African Americans. According to Hawkins et al. (2015), African Americans with diabetes and other chronic illnesses have received little attention from prior researchers focused on health inequities in this population. Racial/ethnic minorities face significant health disparities due to chronic diseases, lack of access to health care coverage, racism, communication difficulties between patients and healthcare providers, historical experiences, and exposure to environmental and occupational hazards (Lewis & Van 2018). Minority health disparities are still poorly understood. This literature review examines the current studies on racial/ethnic health disparities. Discrepancies in health outcomes based on race and ethnicity are explored in-depth in this chapter.
Factors Influencing Minority/African Americans Health Disparities.
Racial discrimination affects the mental and physical health of African Americans every day, according to Brondolo and colleagues (2009). Despite the overall improvement in their lifestyles, African Americans’ poor health may be due to racial prejudice. The biopsychosocial model is often used to understand the link between racism and health. According to the study, the biopsychosocial paradigm links stress from discrimination to physical and mental health problems. Stress-related illnesses like hypertension and other cardiovascular disorders may develop due to this reactivity between racism and psychophysiological responses.
Racism’s impact on blood pressure in young Black and White people was studied by Krieger and Sidney (1996). An online poll looked at the link between blood pressure and self-reported instances of racial discrimination and how people responded to such incidents. A difference in blood pressure was found between Black working people who had experienced racial discrimination and accepted unjust treatment and those who questioned it. The author found that racial and ethnic discrimination, not biological differences, influences blood pressure patterns in the African-American population compared to those Whites.
Self-Care Behavioral Factors
According to Hawkins et al. (2015), diabetic self-care management includes monitoring feet for sores, regulating glucose levels, adhering to a physician’s advised diet, physical activity, and medication routine, and looking for sores on the feet. When it comes to managing Type 2 Diabetes Mellitus, it can be difficult because so much of the care and therapy is focused on behavioral self-management. Compared to non-Hispanic Whites, African Americans are much less likely to follow self-management guidelines, which may explain why African Americans have more excellent complications and mortality rates. According to the author, an individual’s knowledge, beliefs, attitudes, and judgments about the severity of the disease and the results they expect from therapy are all factors that influence drug adherence.
Race and medication adherence among type 2 diabetes patients were examined by Shenolikar et al. (2006). Data from the North Carolina Medicaid program was used for this longitudinal study. Participants were divided into three groups based on their race: Whites, African-Americans, and others. Measuring medication adherence involved obtaining data from pharmacies on how often participants had their prescriptions refilled during the study period. Patients were assumed to take their completed prescriptions; hence prescription refill patterns were utilized as a gauge of adherence. The total number of days an individual spent in the hospital was reduced by 44 since the hospital issued all of the individual’s medication while they were in the hospital, recorded in the pharmacy record. Over the past two years, white people have had much greater prescription refill and pharmaceutical consumption rates than any other race. Whites, as well as African Americans, were shown to have many more comorbidities than other races. According to the results, adherence to medication among white patients was significantly higher than that of African American patients. In persons with type 2 diabetes, the researchers identified a high correlation between race and medication adherence. In addition to a lack of education and the expensive cost of medical care, Shenolikar believes that African Americans are less likely than whites to take their medications as prescribed.
Socioeconomic Status and Environmental Factors
There has been a link between racial and ethnic differences in health outcomes, individuals’ socioeconomic level, and the environments in which they live and work. Health researchers and social scientists are increasingly studying socioeconomic disadvantage and environmental health better to understand America’s racial and ethnic health disparities. Socioeconomic status and Type 2 diabetes are firmly linked, especially between the ages of 40 to 69, according to research by Lowcock and colleagues (2012). The researchers used a community-based diabetes registry to collect data on patients. Additionally, data from the hospital’s diabetic registry was used to compile this report. Information about the gender, age at diagnosis, treatment, and location of the person with diabetes were requested from healthcare facilities. One-parent households, chronic health, pension income, living alone, no car, overcrowding, and living in a leased property were all factors that contributed to the deprivation of SES. Only 13.4 people in the least deprived quintile had type 2 diabetes, compared to 17.2 persons in the poorest quintile.
According to Krishnan et al. (2010), social and economic inequality can explain racial/ethnic disparities in health. As defined by the World Health Organization (WHO), socioeconomic status (SES) encompasses various socioeconomic factors such as a person’s income, occupation, educational attainment, and wealth. WHO claims that social stratification results in an unequal distribution of social factors, such as material living situations and psychosocial circumstances, such as those faced by minorities? It is not uncommon for minorities exhibiting indications of a health problem to face significant financial and social barriers that prohibit them from seeking medical attention as soon as possible. A correct diagnosis can be made at this point.
Studying racial and ethnic disparities in health outcomes, Egerter et al. (2011) looked at schooling as an example of a social determinant of health. Egerter found that in the United States, half of Asians and a third of non-Hispanic Whites have a college degree. However, according to his findings, only 17% of African Americans have a four-year degree. For example, people with a higher level of education are more likely to live longer and have better health outcomes because they engage in health-promoting behaviors, such as eating a nutritious diet, exercising regularly, receiving regular healthcare visits and screenings, and seeking medical attention promptly. It is clear from the study that people with more education can make informed judgments about medical treatment and other health-related options because of their enhanced knowledge and problem-solving abilities. These findings were found in comparison to lower educational attainment individuals who reported increasing fruit and vegetable consumption and abstaining from the use of smoking and drinking alcohol. The dominant race had higher levels of education than African Americans, which was correlated with higher levels of educational success.
Social Cognitive Theory and Health Belief Model
A person’s conduct is defined by the Social Cognitive Theory as a triadic, dynamic, or reciprocal connection between their personal qualities and their behaviors, and the surrounding environment (Luszczynska & Schwarzer, 2015). According to Luszczynska and Schwarzer, people actively seek out and absorb information about their surroundings to attain a favorable outcome. In addition to one’s physical and social surroundings, one’s behaviors and perceptions impact how one acts. According to Bandura’s ” reciprocal determinism ” theory, acts affect the environment, and the environment affects behavior, according to Bandura’s “reciprocal determinism” theory. Health and behavior are connected, with the environment in which a person lives impacting both.
It’s important to remember that everything affects everything else regarding reciprocal determinism. A person’s activities can affect their immediate environment. Some ethnic and racial groups suffer because of social stratification, even if individuals can alter their environment (Luszczynska & Schwarzer, 2015). Access to health care and behavioral and biological risk factors are just two examples of social determinants of health that are not equally distributed. Behavior and the environment have a significant impact on how people form their ideas and expectations and how those beliefs and expectations are formed.
Perceived vulnerability, severity, benefit, and barriers factor into the Health Belief Model’s capacity to accurately forecast people’s health behavior. A psychological model was first developed to explain why some people use preventative treatments like immunization and chest x-ray screening for tuberculosis while others do not (Luszczynska & Schwarzer, 2015). Psychologists theorized that people’s health responses were influenced by their perceptions of danger, including their fear of disease. There has been various research to discover the possible causes of health inequities such as racism, self-care practices, socioeconomic position, and the environment following these theoretical foundations.
The Google Scholar search engine was used to conduct a literature search in 1995. Google Scholar is an online repository for scholarly journals and millions of articles worldwide. Healthcare, health, and inequities were among the search phrases that returned hundreds of articles. When it came to health care inequities, a report was found to be relevant. There was no room for articles that did not address the discrepancy in health outcomes between ethnic groups in the United States. It was necessary to study each article in its entirety before making a final judgment on its usefulness. Additional papers were discovered that examined the works cited in the reports identified as being of interest. The twelve papers that met the inclusion criteria were thoroughly evaluated and included in all publication sections.
It’s no surprise that African-Americans are America’s unhealthiest ethnic group after more than a century of institutionalized racism and social injustice. There has been a lack of long-term commitment to proven tactics and funding even though the United States has the means and policies to erase imbalances. To assure long-term success, neither African Americans nor decision-makers have held financial or political influence positions. People in the black community rarely participate in planning health-related programs and initiatives. Those who do tend to lack an understanding of African American culture and history. It’s rare to find someone with this expertise and dedication to running health and social service organizations for minorities. The modern era has seen increased mortality disparities due to diseases like cardiovascular disease, cancer, diabetes, and neonatal mortality. These are hardly the only health issues affecting African Americans for all their obviousness. The poor health of African Americans is exacerbated by the high rates of poverty and educational achievement. All professions that provide personal, physical, mental, and social health care lack African American representation.
Social Policy Applications and Recommendations
It is important to note a lack of African American representation in all professions that provide intimate physical, mental, and social health care. Therefore, the United States government should ensure that all health care providers, including those of color, are compelled to undergo regular training and refresher courses to provide equitable treatment. Many social developments and community health projects from the past that have been almost killed due to lack of funding must be rebuilt to meet the urgent national goal of training more young people of color in health professions. A greater emphasis should be placed on encouraging young people of color to enter the field of health care. Given that structural reasons are to blame for African Americans’ poor health outcomes and shorter lifespans, it is clear that focusing on health hazards alone is ineffective. Tackling poverty and the built environment and racism and violence will have a greater impact on the health of African-Americans than risk reduction measures. The health disparities faced by African Americans in the United States can only be partially alleviated by providing medical care to those who live unhealthy lifestyles and face social and cultural hurdles but not only through the expansion of Affordable Care.
Brondolo, E., Gallo, L. C., & Myers, H. F. (2009). Race, racism, and health: disparities, mechanisms, and interventions. Journal of behavioral medicine, 32(1), 1-8.
Carnethon, M. R., Pu, J., Howard, G., Albert, M. A., Anderson, C. A., Bertoni, A. G., … & Yancy, C. W. (2017). Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation, 136(21), e393-e423.
Egerter, S., Braveman, P., Sadegh-Nobari, T., Grossman-Kahn, R., & Dekker, M. (2011). Exploring the social determinants of health. Education and health. Robert Wood Johnson Foundation Issue Brief, 5(12), 1-17.
Hawkins, J., Watkins, D. C., Kieffer, E., Spencer, M., Espitia, N., & Anderson, M. (2015). Psychosocial factors that influence health care use and self-management for African American and Latino men with type 2 diabetes: An exploratory study. The Journal of Men’s Studies, 23(2), 161-176.
Krieger, N., & Sidney, S. (1996). Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. American journal of public health, 86(10), 1370-1378.
Krishnan, S., Cozier, Y. C., Rosenberg, L., & Palmer, J. R. (2010). Socioeconomic status and incidence of type 2 diabetes: results from the Black Women’s Health Study. American journal of epidemiology, 171(5), 564-570.
Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the health of African Americans: The potential importance of intersectionalities. Current Directions in Psychological Science, 27(3), 176-182.
Lowcock, E. C., Rosella, L. C., Foisy, J., McGeer, A., & Crowcroft, N. (2012). The social determinants of health and pandemic H1N1 2009 influenza severity. American journal of public health, 102(8), e51-e58.
Luszczynska, A., & Schwarzer, R. (2015). Social cognitive theory. Fac Health Sci Publ, 225-51.
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), 1-20.
Okombo, F. A. (2017). Racial Ethnic Health Disparities: A Phenomenological Exploration of African American with Diabetes Complications (Doctoral dissertation, Walden University).
Shenolikar, R. A., Balkrishnan, R., Camacho, F. T., Whitmire, J. T., & Anderson, R. T. (2006). Race and medication adherence in Medicaid enrollees with type-2 diabetes. Journal of the National Medical Association, 98(7), 1071.