Health Disparities Among African Americans

Introduction

Access to high quality and affordable care to citizens is a vital principle that is at the heart of the federal government of the United States. It is for this reason that the government has partnered with state governments to invest heavily to attain universal healthcare.  Despite the collaborative efforts, healthcare disparities among minority ethnic groups are still an issue.  In this context, healthcare disparities refer to differences in the incidence, prevalence, morbidity, and mortality which can be avoided that prevent individuals from attaining optimal healthcare services. African Americans have the highest mortality and morbidity rates of types 2 diabetes Mellitus which have been linked to a poor socio-economic status that has a historical background.Health Disparities Among African Americans

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            African Americans have historically been affected by their previous slavery roles where they were servants executing casual jobs. These roles and mentality relate African Americans to discrimination and exclusion based on religion, gender, race, socio-economic status, mental health, sexual orientation, and geographic orientation. After slavery, African Americans have over the years encountered a lot of social and economic obstacles within systems and structures that have continuously contributed to the high mortalities and morbidities from type 2 Diabetes Mellitus. In this paper, I argue that low socioeconomic status is the major contributing factor to high rates of type 2 Diabetes Mellitus among African Americans.

Supporting Argument 1

            In a study that was conducted by Krishnan et. al. (2010) involving Black women, the researchers highlighted that approximately 20.6 million people in the United States suffered from type 2 diabetes mellitus. However, the burden was higher among African American women whose prevalence was twice that of non-Hispanic whites. It was identified that socioeconomic status influenced the living conditions of most Black women including physical activity, diet, availability of facilities for recreation, educative resources, and stores for groceries. Besides, concerns on individual safety within these neighborhoods usually influence the participation of individuals in outdoor physical activities and this increases the risk of obesity which is a risk factor for type 2 diabetes mellitus.  For these reasons, individuals rarely engage in physical activity to keep fit which increases the overall risk to type 2 diabetes mellitus. It is worth noting that, according to the World Health Organization, there are African Americans who live in neighborhoods of high income and have proven to have diets that are much healthier as compared to their counterparts who live in neighborhoods of low income (Piccolo et al., 2016).

Most African Americans do not have well-paying jobs. Therefore, they often engage in manual and casual jobs thus the low income. Therefore, they live in communities they can afford, most of which are socially deprived such that, they lack facilities for recreation such as tennis courts, parks and gyms. Research has proven that local food environments as evidenced by the local environment of food as revealed by restaurants, food stores, and food prices play a vital role in the diets of individuals in the prevention of obesity excess weight (Krishnan et. al., 2010).  However, neighborhoods of low-income, more so urban neighborhoods whose majority are African Americans have poor access to healthy and nutritious foods and great access to fast foods. It is the same neighborhoods that have been proven to suffer high rates of diabetes complications, poor control of blood sugars, obesity and diabetes mellitus. Based on this finding, researchers hypothesized that the existence of a causal link that the presence of nutritional guidelines such as vegetables, whole grains, and fruits is a key predictor in meeting dietary recommendations to reduce the risk of diabetes and diabetes complications for optimal health (Krishnan et. al., 2010).Health Disparities Among African Americans

Supporting Argument 2

According to Assari et al., (2017) racial makeup of a neighborhood and wealth are determining factors of the location of supermarkets and food stores. Therefore, neighborhoods of low income of ethnic minority groups tend to have fewer supermarkets and food stores as compared to the neighborhoods of white Americans. It is also worth noting that, the neighborhoods of ethnic minority groups have many households that lack access to private means of transport (Piccolo et al., 2015). Therefore, most residents tend to rely on immediate neighborhoods for access to basic resources such as food, water and access to healthcare facilities. This contributes to missed opportunities in primary care such as routine screening and health education.

Robbins et al., (2010) associated the socio-economic status of African American neighborhoods with the incidence of diabetes and appeared to exist at all BMI levels. This highly suggested that a person’s BMI was not the only intermediate on the path between the environment surrounding a neighborhood and the risk of diabetes. Chronic stress has also been identified to mediate this risk which can be brought by neighborhood characteristics such as noise, poverty, and violence (Krishnan et. al., 2010).  From a medical background, chronic stress is a trigger for insulin resistance through either sympathetic nervous system activation or the pathway that involves the H-P-A axis (Hypothalamic-Pituitary gland-Adrenal gland axis).

Supporting Argument 3

            According to Suwannaphant et al., (2017) there is an association between type 2 diabetes mellitus and education level which is determined by socio-economic status. Most African American communities with low education attainment have a high prevalence of diabetes mellitus. The explanation provided by researchers to support this finding is that individuals and communities which are educated have a high likelihood of being health conscious. The knowledge high-income communities’ gain through education improves receptiveness to health education and relevant communication with healthcare personnel. On the other hand, low education levels increase the risk of type 2 diabetes mellitus. It also influences bad nutritional choices, inability to engage in physical activity and engaging in unhealthy behaviors such as tobacco smoking and alcohol consumption, which are all influencers of diabetes. Individuals and communities with high education status have adequate knowledge on prevention which improves their ability to embrace lifestyle changes through healthy behaviors and maximally utilizing healthcare resources (Piccolo et al., 2016). Health Disparities Among African Americans

Conclusion

Type 2 diabetes mellitus and its resultant complications have been categorized among the top killers of Americans, but the burden has been noted to be high for African Americans.  According to the 2014 statistics update by the American Diabetes Association, close to half of all African American adults are in some form of risk to type 2 diabetes mellitus and are twice as likely as white American adults to experience complications. It is evident that the prevalence of DM follows a social gradient whereby, the highest prevalence exists in ethnicities or individuals of a lower socio-economic status and vice versa.

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            It has been noted that, while a minority status is related to a high risk of DM where Blacks are at the highest risk, a low socio-economic status among Blacks impacts the risk of diabetes differently. Low socio-economic status neighborhoods lack facilities for recreation such as tennis courts, parks and gyms which reduces the ability to engage in physical exercise. These neighborhoods also lack food resources for balanced diets and have greater access to fast foods. Due to congestion in low socio-economic neighborhoods, there is a lot of noise and violence which contribute to chronic stress that is a trigger for insulin resistance. Similarly, low socioeconomic status among African Americans influences low education attainment which influences bad nutritional choices, inability to engage in physical activity and engaging in unhealthy behaviors such as tobacco smoking and alcohol consumption, which are all influencers of type 2 diabetes. It should also be noted that the risk, prevalence, and incidence of type 2 diabetes Mellitus can also be high among African Americans with high education levels who are affected by surrounding neighborhood environments. This knowledge is of significance since most African Americans continue to reside in neighborhoods which are disadvantaged while working in decent and professional jobs with adequate income.Health Disparities Among African Americans

Implications

Healthcare providers, policymakers, clinicians, researchers and other stakeholders in the health sector should understand that socio-economic status is a determining risk factor for type 2 diabetes mellitus for general populations and more specifically, in ethnic minority groups.  In this case, socio-economic status does not only refer to income status but includes low education, a minority status, being single and poor neighborhoods. Based on this finding, the efforts to reduce the high rates of type 2 diabetes mellitus among African Americans need to not only focus on personal changes in lifestyle but also focus on improving the societal and neighborhood living conditions of African Americans.

References

Assari, S., Moghani Lankarani, M., Piette, J. D., & Aikens, J. E. (2017). Socioeconomic Status and Glycemic Control in Type 2 Diabetes; Race by Gender Differences. Healthcare (Basel, Switzerland)5(4), 83. doi:10.3390/healthcare5040083

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 epidemiology171(5), 564-70.

Piccolo, R. S., Subramanian, S. V., Pearce, N., Florez, J. C., & McKinlay, J. B. (2016). Relative contributions of socioeconomic, local environmental, psychosocial, lifestyle/behavioral, biophysiological, and ancestral factors to racial/ethnic disparities in type 2 diabetes. Diabetes Care39(7), 1208-1217.Health Disparities Among African Americans

Piccolo, R. S., Duncan, D. T., Pearce, N., & McKinlay, J. B. (2015). The role of neighborhood characteristics in racial/ethnic disparities in type 2 diabetes: results from the Boston Area Community Health (BACH) Survey. Social Science & Medicine130, 79-90.

Robbins, J. M., Vaccarino, V., Zhang, H., & Kasl, S. V. (2010). Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. American Journal of Public Health91(1), 76.

Suwannaphant, K., Laohasiriwong, W., Puttanapong, N., Saengsuwan, J., & Phajan, T. (2017). Association between Socioeconomic Status and Diabetes Mellitus: The National Socioeconomics Survey, 2010 and 2012. Journal of clinical and diagnostic research: JCDR11(7), LC18-LC22.Health Disparities Among African Americans