The good news is that the death rate for African-Americans declined 25 percent between 1999 and 2015, according to a newly released CDC Morbidity and Mortality Weekly Report(www.cdc.gov) (MMWR) and an accompanying Vital Signs report(www.cdc.gov). The bad news is that significant health disparities between black and white Americans remain, with black life expectancy still nearly four years less than that of whites.
It's just this sort of mixed bag of health disparity findings that the AAFP's new Center for Diversity and Health Equity will strive to improve. Created to educate, advocate and collaborate on solutions to problems involving such inequities, the center will allow the Academy to "take a leadership role in addressing diversity and social determinants of health as they impact individuals, families, and communities across the lifespan and to strive for health equity."
According to the MMWR and Vital Signs reports, disparities between blacks and whites of all ages are narrowing because mortality rates are declining faster among blacks than among whites. Specifically, the gap in death rates between the two races for all causes of death across all age groups was 33 percent in 1999 but fell to 16 percent in 2015.
- The death rate for African-Americans declined 25 percent between 1999 and 2015, according to a newly released CDC Morbidity and Mortality Weekly Report.
- Still, sizeable health disparities between black and white Americans remain, with black life expectancy still nearly four years less than that of whites.
- A particularly concerning finding from the reports was that blacks in their 20s, 30s and 40s are more likely to live with or die from conditions that typically occur at older ages in whites.
Notably, the racial gap closed completely for all-cause mortality and for deaths from heart disease, among other areas, in those ages 65 and older.
Yet a particularly concerning finding from the reports was that blacks in their 20s, 30s and 40s are more likely to live with or die from conditions that typically occur at older ages in whites, such as heart disease, stroke and diabetes. That's because risk factors for some of these conditions, such as high blood pressure, aren't being detected and treated in younger blacks.
Also disturbing is the fact that homicide death rates among blacks didn't change during the entire period examined.
One positive note from the reports, however, is an improvement in other causes of death, including a sharp decline in HIV-related deaths among blacks ages 18-49 -- about 80 percent from 1999 to 2015. Still, blacks remain seven times to nine times more likely than whites to die from HIV.
"We have seen some remarkable improvements in death rates for the black population in these past 17 years. Important gaps are narrowing due to improvements in the health of the black population overall. However, we still have a long way to go," said Leandris Liburd, Ph.D., M.P.H., M.A., associate director of the CDC's Office of Minority Health and Health Equity, in a news release(www.cdc.gov). "Early health interventions can lead to longer, healthier lives. In particular, diagnosing and treating the leading diseases that cause death at earlier stages is an important step for saving lives."
Based on data from the U.S. Census Bureau, National Vital Statistics System and the CDC's Behavioral Risk Factor Surveillance System, the report reaffirmed conventional wisdom that social and economic conditions such as poverty contribute to health differences between blacks and whites.
For example, the analysis showed that compared with whites, blacks in all age groups had lower educational attainment and home ownership rates and nearly twice the rate of poverty and unemployment. The authors noted that these risk factors may limit blacks' access to preventive services, as well as treatment options. Additional risk factors that affect health outcomes for blacks include obesity and limited physical activity.
According to Kevin Kovach, Dr.P.H., M.Sc., population health manager in the AAFP Health of the Public and Science Division and a certified health education specialist, it's important that markers of health outcomes not be confused with drivers of health outcomes.
"I think we want to be careful about how we talk about race and poverty and other social factors because, technically, they (especially race) are markers of health outcomes but not the drivers of health outcomes," said Kovach. "For example, being black by itself doesn't cause poorer health -- it is the systematic discrimination and racism that cause poorer health. Without systematic discrimination and racism, we wouldn't have the large disparities between white and black Americans. Same with poverty; being poor by itself doesn't cause poorer health, but not having sufficient resources to support good health is a driver."
Among other key findings from the report:
- Blacks ages 18-64 have a greater risk of early death than whites.
- Disparities in the leading causes of death for blacks compared with whites, including homicide and chronic diseases such as heart disease and diabetes, are already pronounced by early and middle adulthood.
- Blacks ages 18-34 and 35-49 are nine times and five times, respectively, as likely to die from homicide as whites in the same age groups.
- Blacks ages 35-64 have double the risk for high blood pressure as whites.
- Blacks ages 18-49 are twice as likely as whites to die from heart disease.
"It's important that we continue to create opportunities for all Americans to pursue a healthy lifestyle," said Timothy Cunningham, Sc.D., lead author and epidemiologist with the CDC's Division of Population Health, in the release. "Public health professionals must work across all sectors to promote health at early ages."
Center for Diversity and Health Equity's Perspective
Danielle Jones, M.P.H., manager of the new Center for Diversity and Health Equity, told AAFP News that a number of factors could have led to the African-American death rate dropping 25 percent from 1999 to 2015.
For example, the start of the 21st century brought with it an increased recognition of the need for a population-based approach to health, she noted.
"Our most at-risk and vulnerable communities were directly targeted with interventions to prevent and minimize the effects of chronic disease and establish positive healthy behaviors," Jones said. "Also, the level of advancement in medical technology in that period has been exponential in the development of treatments for acute and chronic conditions previously considered untreatable."
As to what's being done about the ongoing high rate of homicide in African-American communities, Jones said she thinks the nation is entering a time when community engagement and activism is at an all-time high. "Not only are individuals insisting upon action by their local, state and federal governments, they are also enlisting the support of advocates and allies," she said.
Jones applauded the AAFP on its stance on gun violence and encouraged all family physicians to read the recommendations from the call to action(annals.org) on firearm-related injury and death the Academy developed along with seven other medical organizations, which was published in the American College of Physicians' Annals of Internal Medicine in 2015.
"Individuals and chapters can also look to coalitions in their state for ways in which they can be part of this continuing dialog," Jones added.
Overall, she cautioned that although this report highlighted improvements in African-American health, blacks are still more likely than whites to report being in fair to poor health and have more frequent "mental distress days" at every age.
"It's not enough to extend the length of an individual's life without considering the quality of years lived," Jones said.
As for family physicians' role in improving African-American patients' health, Jones pointed out that the report noted blacks ages 18-34 were less likely than whites to have a personal doctor or health care professional they see regularly.
"I think having that relationship with a family physician is critical to achieving optimal health over the life course," she said. "I think family physicians, with the help of organizations like the AAFP, can develop strategies that identify opportunities for early engagement with young adults that support them at every stage of life."
In speaking with family physicians, Jones said she's learned there's a lot of passion for and need to address issues of disparity and inequity in their practices. "However, most don't know where to start or they don't feel empowered to do so," she said.
The Center for Diversity and Health Equity will fill this need by equipping family physicians with the skills they require and also engaging other stakeholder groups in the AAFP's mission locally and nationally.
"I envision the center's role as one that not only focuses on providing solutions at the individual level, but also at the level of our health care systems and infrastructure," Jones concluded.
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