African American male’s health crisis: A call for action
Plowden, Keith O
A serious health crisis exists in the African American male population. African American men are disproportionately affected by most chronic illnesses and dying at an earlier age when compared to other ethnic groups. Health beliefs, life style practices, and barriers to accessing health services are factors that can contribute to these disparities. Action is needed within the African American male community in order to decrease the statistical disparities. This paper addresses the health crisis in African American male population and offers recommendations for alleviating the problem.
Key Words: African American men; Health Behavior; Health Seeking; Barriers.
A state of urgency exists in the African American male population as evidenced by statistical data with respect to morbidity and mortality. The African American community and the health care market are suffering because of the disparities in morbidity and mortality with respect to African American men. According to the 1990 census, African American men make up 6% of the general population. However, a much higher percentage of African American men are affected by chronic illnesses such as Acquired Immune Deficiency Syndrome (AIDS), coronary heart disease (CHD), cancer, and diabetes. This disparity in incidence is partially due to health beliefs, health practices, barriers to accessing care, and healthseeking behavior in African American men.
Fifteen (15) years into the AIDS epidemic, the disparity among African American men who have been diagnosed with AIDS compared with Caucasian men becomes apparent. Twenty six percent of the reported cases of AIDS are seen in African American men (Centers for Disease Control [CDC], 1998). This is significant since African American men make up only 6% of the total population. While incidences of new AIDS diagnosis are decreasing in Caucasian gay and bisexual men, the numbers continue to increase in African American gay and bisexual men.
CHD disease and related complications are also having a significant impact on African American men. Overall, CHD has decreased in every ethnic group. However, CHD remains 40% higher for African Americans (Department of Health and Human Services [DHHS], 1998). The CDC (1994) reported that hypertension is generally up to 33% higher in all men than women regardless of ethnic background. Thirty five percent of African American men are affected by hypertension compared with 25% for men of other ethnic groups (DHHS, 1998). Complications from CHD are also disproportionate in African American men. For example, stroke is identified as 67% higher in African-American men than all other ethnic groups (CDC, 1994).
African American men make up a significant portion of reported diabetes cases in this country. Fourteen percent (14%) of the total diabetes cases reported for all ethnic groups are seen in African American men (CDC, 1994). Again, this is significant since African American men make up only 6% of the total population. Rates for diabetes complications, such as end-stage renal disease, blindness, and cardiovascular complications are also highest in African Americans. According to DHHS (1998), many complications associated with diabetes are preventable and are usually due to late detection and/ or noncompliance with treatment regimes.
Overall, incidences of cancers are higher in African American men than any other ethnic group (Surveillance, Epidemiology, and End Results [SEER],1998). African American men are twice as likely to develop prostate cancer than Caucasian men (American Cancer Society [ASC], 1998). Additionally, African American men are more likely to develop prostate cancer at an earlier age than Caucasian men, and African American men tend to present with more advanced disease (Optenberg et al., 1995; Powell, Schwartz, & Hussain, 1995). This finding was seen in conditions where cost and access were not an issue such as in the Department of Veteran Affairs Health System.
Incidences of lung cancer are also higher in African American men than any other ethnic group, 122 per 100,000 for African American men compared with 8.7 per 100,000 for Caucasian men (SEERS, 1996). The 5-year survival rate for cancer is 10% lower for African American men when compared with Caucasian men (SEERS,1996; Haas & Sakr,1997). For most cancers, survival is dependent on early detection and treatment.
Besides the personal implications associated with the identified disparities, there are significant financial impacts. According to DHHS (1998), the direct and indirect cost of diabetes care was estimated at $98 billion, $259 billion for cardiovascular diseases, and $10,000-$12,000 per patient per year for AIDS related treatment. ACS (1998) estimates cancer care to be at $107 billion annually with prostate and lung cancer accounting for most of this cost. These figures are significant since an estimated 22% of African Americans do not have health insurance and cannot afford adequate medical care; another 12.5% of them reported inability to see a doctor because of cost (Rice,1994; Census Bureau,1996). As the population continues to grow, this significant burden on the health care system will continue to increase.
HEALTH BEHAVIOR OF AFRICAN AMERICAN MEN
The differences in morbidity and mortality are partially related to general behavior in African American men, which are influenced by perceived outcomes resulting from the behavior. Clearly, masculinity is not just physiologically but also socially determined. Sabo & Gordon (1995) stipulate that social norms are internalized at an early age and begin to influence behavior. Brannon (1976) described masculinity as being independent. Men are expected to be independent and self directed in most activities. Hunter and Davis (1992) interviewed a group of African American men and found that the men defined themselves by their degree of independence. Independence was projected as the dominant expression of manhood. Based on these findings, any behavior that interferes with this expression of manhood, i.e., independence, tends to be avoided. Health seeking may be viewed as a form of dependency and might be avoided.
These statistical disparities between ethnic groups are also due to behavioral lifestyle seen in African American men such as physical activity, risky behavior, and health seeking behavior. CDC ( 1994) reported life-style differences between African-American and Caucasian men. African American men were more likely to report an increase in sedentary lifestyles, being overweight, and less likely to participate in screening programs than Caucasian men. The lack of participation is partially due to a mistrust of health care systems. Additionally, the prevalence of smoking is higher among AfricanAmerican men (27.4%) than Caucasian men (24.5%). Although these behaviors are not barriers to seeking care, they contribute to the health status of African American men and the disparity in statistics. Additionally, these behaviors can be modified with proper interventions.
External dimensions also act as barriers to seeking care. The United Way of Middle Tennessee (1990) studied African American men and women for potential barriers to seeking care. The study identified cost of health services, knowledge of services available, and inability to gain access to services such as lack of transportation as barriers to seeking health care. Fleury (1996) studied 14 African American men and women. Participants were asked to describe potential barriers to seeking care. They identified cost of medication, medical care, and special diets as primary barrier to practicing health promotion (Fleury, 1996). Siegel & Raveis (1997) studied minority access to HIV related services. They found that resources were lower in minority communities, and participants reported information was scarcer in their community when compared to Caucasian communities. The study also identified lack of information as a barrier to seeking care. African American men in the study perceived a lack of information regarding resources and treatment options as a barrier to accessing care services.
INFLUENCE OF FAITH COMMUNITIES
Research has shown that religious belief and faith communities influence many health practices of African Americans. Strawbridge, Cohen, Shema, & Kaplan (1997) studied 5286 individuals from different ethnic and faith communities and found an association between regular attendance at religious services and mortality. The study found that healthier behaviors, such as exercising and nonsmoking, were seen in those with regular religious service attendance, and lower mortality was seen in this group. A study conducted by Wenger and Plowden (1997) on the meaning of faith and health in 12 African-American faith communities found that biblical principles and other faith practices guide many health practices. Both studies showed that the leaders in the church had a significant impact on whether a congregational member sought health care and followed medically prescribed recommendations. Underwood (1991) found that many African American men believed cancer is not caused by external factors, but is an inevitable will of God. This thought process could influence perceived self-control of health and illness prevention, ultimately influencing health behavior.
In summary, African American men are at higher risk for developing chronic illnesses and dying at an early age than other ethnic groups. Disparity in statistics are due to barriers to accessing health care, lifestyle practices, and beliefs of African American men. Research shows that African American men will participate in screening, clinical trials, and treatment programs if barriers are identified and removed (Gelfand, Parzuchowski, & Powell; Robinson, Ashley, & Haynes, 1996; Myers, Wolf, McKee, McGory, Burgh, Nelson, & Nelson, 1996). Interventions that will facilitate healthy behavior and eliminate barriers to seeking care are needed.
A CALL TO ACTION:
Action is needed by health care providers and the African American community in order to deal with this crisis. I recently heard a speech by Dr. Dorothy Irene Height, President Emeritus of the National Council of Negro Women, and in her talk, she used the analogy of a fist to discuss the action needed by the African American community to combat the devastations of AIDS. The fist signifies power and unity. There is more power in a fist, which involves all 5 fingers joined together, than 1 finger standing alone. During the early 1980’s, AIDS was described as a White Gay man’s disease. As a result, the gay community united in an effort to combat this epidemic. Reports show that the number of Caucasian gay men with AIDS is decreasing. Unity of health care providers and the African American community is the first course of action to combat the African American male crisis.
With respect to behavior, the church plays a significant role in the African American Community. Therefore, it is important that any work in the African American population takes into consideration the impact of the religion and faith community on behavior and involve these communities in any interventions. Additionally, many research interventions targeted for African Americans have used the church as an entry into the community (Eng & Hatcher,1991; Underwood,1991; Gelfand, Parzuchowski, Cort, & Powell, 1995; Fleury,1996).
Community involvement is needed. Weinrich, Boyd, Bradford, Mossa, & Weinrich (1998) suggest a consumer-oriented program within the community. Educational programs that are consumer-oriented take place within the target community where it is a safe and familiar environment for the participants. Additionally, a consumer oriented program uses community individuals to assist with intervention design and implementation. Early research has shown that individuals are more likely to participate in healthy behavior and participate in health promotion activity based upon the reaction of social network such as significant others and community individuals (Ajzen & Fishbein, 1980; Ajzen, 1985). Within the community, social networks serve as an external force for reassurance and assistance. This has been proven in other studies employing African Americans (Jemmott & Jemmott, 1991; Montano & Taplin, 1991; Jemmott, Jemmott, & Hacker, 1992; Fleury, 1996; Jennings, 1997).
Finally, more research is needed in order to look at barriers to seeking care, beliefs, and other motivators of health behavior. Literature searches resulted in few studies looking at such behavior in African American men. Research is also needed to generate new questions and problems for exploration and intervention design. The end result will be a decrease in the disparity in areas of morbidity and mortality between African American men and other ethnic groups in accordance with the goals of Healthy People 2000 (DHHS, 1991).
African American men and the community are suffering. Unless action is taken, the crisis will only get worst. There is a serious threat to African American men. Based on statistics, African American men are more likely to develop a chronic illness and die of complications than any other ethnic group. Interventions are needed within the community in order to make a difference in these disparities. Research specifically focused on African American men behavior and belief is used in order to design effective interventions. The time for action is now.
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Keith O. Plowden, PhD, RN, CCRN, Assistant Professor Adult Health Nursing, University of Maryland, Baltimore, Maryland.
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