February is Black History Month in the United States and Canada. The Centres for Disease Control categorize any Americans who have ancestry in any of the “Black racial groups of Africa” [1]. I will opt in this post to simply use the term Black to be inclusive of the diversities of this racial group, including those identifying as American, Canadian, African, Caribbean, or other more specific demographics [1].

In 2013, 15% of the American population identified as Black or African American (including those who identify as bi-racial or multi-racial) [1].

All ethnic or racial groups face specific health concerns based on the following factors: genetics (health conditions that may be passed down within families), environment (geography, hygiene, access to healthy foods, etc.), access to care,  cultural factors (such as importance of different aspects of health to a community, or traditional diet of a culture, for examples) [2]. Education also plays an important role in the health of both individuals and populations [1]. Many of these factors, such as education and access to care or health insurance, overlap the health factors discussed in January’s post on Poverty in America Awareness Month, and you can learn more by reading that post. It has also been indicated by research that racism—both real and perceived—plays a role in the health of Black populations [3, 4, 5].

While it is noted that, regardless of race, our bodies will respond to medical treatment in the same way [3], whether due to genetic or environmental factors. Blacks have a 60% higher rate of diabetes, and are more likely to have complications related to their diabetes, including requiring amputation of a limb (2.5 times more likely) or kidney disease (more than 5 times more likely). A Black American with asthma is three times more likely to die of asthma than a white american, and though studied to have lower exposure to tobacco, Black men are 50% more likely to develop lung cancer [3]. Black individuals are more likely to develop hypertension [high blood pressure] much earlier in life—up to 45% of Black individuals over 20 have high blood pressure, increasing their risk of heart disease, heart failure with no history of heart disease, and contributing to the doubled risk of stroke—heart disease may be more aggressive as well [3]. As discussed, treatment works the same way for everybody: yet, Black men are 40% more likely to die of cancer than white men—women have a 20% higher death rate from cancer than women who are white [3]. Infants have a higher incidence of Sudden Infant Death Syndrome, and children have higher rates of lung disease like asthma and sleep apnea [3].

One health condition that is specific to the Black community is Sickle Cell Disease [SCD], a genetic condition that causes red blood cells that contain hemoglobin (responsible for transporting oxygen) become mis-shapen to look kind of like hooks or crescents instead of donuts as they normally do. This means that they get stuck inside blood vessels, stopping the flow of oxygen throughout the body and causing attacks of severe pain. SCD can cause organ failure, and while treatment can be effective, the only cure for Sickle Cell Disease is stem cell transplant [6]. Sickle Cell Disease may also cut life expectancy short if not identified early or managed adequately. [7] And yet, while double the number of Americans are affected by Sickle Cell Disease than Cystic Fibrosis [CF], the amount of funding allocated to research for SCD is incomparable to that of CF. [3]

Outside of genetic diseases, our genetics or ancestry, however, may hold clues in what the most appropriate treatment is for a patient—a theory now known as personalized medicine. Disease factors may become sub-typed further beyond an initial diagnosis—for instance, a drug for heart failure that was thought to be ineffective proved remarkably effective for Black patients. This is not because they are Black, but because of characteristics of their disease: these clues may help to treat heart failure patients who are not Black as well [3].

In the United States, 16% of Black individuals do not have health insurance [1], decreasing the chances they will access medical care. While that leaves a majority of individuals insured, they may still be under-insured. Because of both of these factors, they may  be diagnosed later when diseases are more difficult to treat [3], or not be able to consistently afford medications to stay healthy, leading to the increased risk of morbidity (complications) or mortality (death) from a disease. In many situations, predominantly Black communities may have less access to quality medical or lifestyle resources needed to stay healthy: It is noted that “African Americans are more likely to need health services, and less likely to receive them.” [7] Researchers agree that it is a systemic issue, in part stemming from distrust of Black communities towards medical institutions, and that this trust needs to be rebuilt [7, 3] and that more effort needs to be made to improve healthcare for the 15% of Americans that should be just as healthy as other racial groups.

Increased steps need to be taken by both regional and state- or provincial-health systems, as well as federal policy, to improve access to care to all persons, regardless of color. Click here to learn more about Black/African American History Month, and learn more about health in Black populations this February.