5 takeaways from The Associated Press series on health disparities impacting Black Americans
Kat Stafford | 6/1/2023, 6 p.m.
The Associated Press spent a year examining how racial health disparities have harmed generations of Black Americans. From birth to death, Black Americans fare worse in measures of health compared to their white counterparts. They have higher rates of infant and maternal mortality, higher incidence of asthma during childhood, more difficulty treating mental illness as teens, and higher rates of high blood pressure, Alzheimer’s disease and other illness as adults.
The Richmond Free Press will run these reports throughout June 2023.
Here are key takeaways from each story:
Why are Black babies and mothers more likely to die?
Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention. The 2021 rate was a significant increase from the prior year.
Black babies also are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives. In 2020, there were 364,487 preterm births in the nation, about 1 in 10. Preterm birth rates were highest for Black infants, 14.2%, between 2018 and 2020.
Multiple factors contribute to these disparities, according to the CDC and advocacy organizations, such as underlying health conditions. But more doctors and experts have pointed to structural racism that has created inequitable access to health care, implicit bias and discriminatory care. Poor health care for Black mothers in turn can create issues for their babies, putting them at risk for health problems.
Why do more Black kids have asthma?
Black children are more likely to have asthma and to be exposed to triggers, like mold and air pollution. Their asthma often is more severe and less likely to be controlled. About 4 million kids in the U.S. have asthma. The percentage of Black children with asthma is far higher than white kids; more than 12% of Black kids nationwide suffer from the disease, compared with 5% of white children.
Some of the high rates of asthma among Black children are tied to genetics, but much of the disparity lies in the same racist factors that afflict Black peoples’ health from birth to death.
Black Americans are more at risk of living in homes with asthma triggers, like cockroaches, dust mites, mold and rodents. Research also shows that air pollution can worsen asthma.
Across America, nearly 4 in 10 Black children live in areas with poor environmental and health conditions compared to 1 in 10 white children. Factories spew nitrogen oxide and particulate matter. Idling trucks and freeway traffic kick up noxious fumes and dust.
The disparities are built into a housing system shaped by the longstanding effects of slavery and Jim Crow-era laws. Many communities that have substandard housing today or are located near toxic sites are the same as those that were segregated and redlined decades ago.
How does racism affect Black teens’ mental health?
About 50% of Black youth experience moderate to severe symptoms of depression, and about 18% said they were exposed to racial trauma often in their life.
The drivers of the mental health crisis for Black children begin early and persist through a lifetime. Black children’s first encounters with racism can start before they start school, and Black teenagers report an average of five instances of racial discrimination per day. Young Black students are often perceived as less innocent and older than their age, leading to disproportionately harsher discipline in schools.
Black adolescents are far less likely than their white peers to seek and find mental health care. In part, that’s because Black families often distrust the medical system after generations of mistreatment — from lack of access to care to being subjected to racist practices and experimentation.
Research and health surveillance data point to a growing mental health crisis among Black youth. Between 1991 and 2019, Black adolescents had the highest increase among any other group in prevalence of suicide attempts — a rise of nearly 80%.
What role has high blood pressure played in COVID-19 deaths of Black Americans?
High blood pressure has played a major role in COVID deaths, and especially in the COVID deaths of Black people. Together, they have created a deadly combination: While it is listed as a contributing factor in 15.5% of the deaths of white COVID sufferers, the figure for Black victims is 21.4% — the highest of any racial group.
About 56% of Black adults have high blood pressure, compared to 48% of white people. Three in four African Americans are likely to develop the disorder by age 55.
While only 32% of white adults with high blood pressure have their condition under control with medication, the figure for Black Americans is even lower — 25%.
Like many conditions, genetics do play a part. Experts also blame poor diets, high cholesterol, obesity and smoking — risk factors that often exist at higher rates in Black communities. Black neighborhoods are more likely to experience a lack of access to healthy foods or be inundated with fast food options.
Why do so many Black people develop Alzheimer’s disease?
Black Americans are more likely than white people to develop Alzheimer’s. About 14% of Black Americans over the age of 65 have Alzheimer’s, compared with 10% of white Americans, according to the Centers for Disease Control and Prevention. Experts believe the rates could be even higher.
Health conditions like cardiovascular disease and diabetes experienced in earlier stages of life are known risk factors — both of which are more common among Black and Latino populations. Depression, high blood pressure, obesity and chronic stress are also risk factors. The CDC also acknowledges the impact of “higher rates of poverty, and greater exposure to adversity and discrimination” as risk factors.
Across the board, Black people are also unlikely to receive the health care that white people do — including medication to treat Alzheimer’s and dementia-related disorders. A preliminary study released this year by Mount Sinai researchers found that Black people are less likely to receive dementia-related medications than white people.
Medical racism in history
By Kat Stafford, Aaron Morrison and Annie Ma/The Associated Press
The health inequities documented in this project have their roots in a long history of medical racism. The AP has collected a small sample of that history related to every phase of life.
James Marion Sims, a 19th centuryAlabama surgeon heralded as the father of modern gynecology, pioneered a treatment for vesicovaginal fistulas, a condition that affects bladder control and fertility in women. Between 1845 and 1849, Dr. Sims carried out the once-experimental surgical treatment on a dozen enslaved women without the use of anesthesia. He has been both defended as a product of his era and panned as unethical and inhumane.
Dr. Sims’ belief that Black people could endure more pain than white people is considered a form of racism and still present in the field of medicine. From medical school students of various racial and ethnic backgrounds to primary care providers of small and large practices, this bias has adversely impacted the health outcomes of Black Americans.
CHILDHOOD: BEHAVIORAL TREATMENT
Behavioral challenges in Black children, throughout history and typically in educational settings, have been met with inequitable, inhumane and even extreme treatment. Systemic racism in behavioral counseling and psychotherapy for school-age children has meant lifelong adverse consequences for generations of Black children – from the funneling of Black students with learning disabilities into special education tracks that lack resources and over-reliance on suspension and expulsion to institutionalization and experimental brain operations.
Dr. Orlando J.Andy’s work at the University of Mississippi Medical School in the 1960s is one example. The neurosurgeon testified that he performed 30 to 40 lobotomies and other brain operations on Black children and other people with behavioral problems who had been institutionalized. Although Dr. Andy said his operations were a last resort for patients who lived with uncontrolled destructive hyperactivity, the procedure was performed on institutionalized Black boys as young as 6. Some patients lived the rest of their lives with deteriorated intellectual capacity.
TEEN YEARS: ADULTIFICATION
Black children and teens are often perceived as much older than they are. Because of this bias known as “adultification,” they get viewed as less innocent and less deserving of empathy – resulting in harsher, disparate treatment in health care and other systems. The attitudes date back to slavery, when Black children as young as 2 were made to work and punished for developmentally appropriate child behavior, according to scholars Michael J. Dumas and Joseph Derrick Nelson.
Research shows these attitudes still drive disparities in outcomes for Black children and teens. A Yale study found Black children are 1.8 times more likely to be physically restrained in a hospital emergency room than white kids, a gap that may be driven by hospital staff’s view of Black children. Georgetown researchers have found that adultification of Black girls is linked to them being treated more harshly in school.
ADULTHOOD: STUDYING BLACK BODIES
University of Cincinnati researchers led an experiment from 1960 to 1972 that exposed about 90 poor, mostly Black, terminal cancer patients to extreme levels of radiation without their consent. The Department of Defense funded it as part of Cold War radiation experiments, according to Associated Press stories.
Dr. Eugene Saenger, one of the chief researchers, said the study was meant to find experimental treatments for patients with inoperable cancer to see if he could stop the growth of tumors. But the patients and their families said they were not fully informed of the risks or asked to sign consent forms. They also weren’t told of the Defense Department’s involvement.