Lasting solutions to Long term problems
Current events offer a unique opportunity for physicians of Indian origin to make a major impact on the long-standing struggles in the life of Black America. The ground reality is combination of social, political and economic inequalities reflects ultimately in health disparities. What we can do to improve health disparities can also impact social and economic status. Published statements from many medical organizations including AHA, ACS, and even AAPI, long list of Politicians and celebrities are long on condolences, sympathy rhetoric etc., but short on any real meaningful actionable items. Unfortunately, once the dust settles, the status quo is likely to continue. That could change if we jump into action.
Most of us physicians of Indian origin are not likely to fully understand what it means to be Black American or what it is like to raise children as Black Americans. We started arriving in America in the late 1970s and have not lived in America during the long underlying history of racial disparities. However, counting PCPs, hospitalists, nephrologists, cardiologists and other specialists, we account for nearly 60% of the care of Black America. We can certainly engage in the health of Black America in a more robust methodical fashion in prevention, early detection and management of many of the health problems that have plagued Black America.
Having worked side by side with many Black American citizens who have been left behind for the last 12 years I have gained a certain experience and insight which could shape our response in these troubled times. In these past dozen years, I having made more than a thousand appearances and presentations to churches and other social organization, which most non-Black Americans not even aware of. Having been invited into scores of Black American churches across the land, I have the following perspective and action plan for the consideration of our group.
Black American neighborhoods are “healthcare deserts and Food deserts”. Many Black American communities across this great nation have little to no access to healthcare or healthy food options. As members of AAPI collectively we can persuade legislative action, processing industry, restaurant industry, and local businesses to change our approach and behavior for a positive change.
We have to start with trust building efforts: Members of AAPI would be better served by understanding the long history of mistrust in medical establishment. We need to take the initiative to rebuild this lost trust by reaching out into these neighborhoods of Black America where generation after generation they live with hopelessness and a feeling of “nobody cares for us” and “we mean nothing to society.” Understanding the impact of Tuskegee study will help to appreciate some of the deep-rooted mistrust of the medical profession. Trust building efforts in each of the communities we serve in each and every one of our own backyard will go a long way repairing these relationships.
As individuals we can do certain things on our own. But collectively we can be a force. For example, I have taken the initiative to submit a petition to the restaurant association of Ohio has been requesting them to provide salt information on the menu cards. This information is very important to Black America more than any other group. The weight of AAPI could make this happen. Consider some the following facts and figures
Some facts and figures:
- It is a well-publicized fact that Black Americans across the country are dying at a much higher rate from COVID 19.
- Hypertension in Black America is often described as a widespread malignant disease as it affects at a far younger age, more aggressive, more difficult to control and complications occur sooner.
- Kidney failure by the numbers;
- Thirty-seven % of people on dialysis, most of them aged 10 years younger than Caucasians. Young people in their productive years are stuck on dialysis machines for hours at a time every other day.
- Black Americans are four times higher risk of being placed on dialysis
- Black American kidney failure patients are 75% less likely to get a kidney transplant
- Heart failure: Men under 50 years of age are twenty times more likely to present in heart failure.
- Severe high blood pressure, systolic greater than 180 mmHg and hypertensive emergencies with systolic greater than 200 mmHg is five times more common in Black America.
Key actionable items
- Physicians reach out into the neighborhoods, churches, barber shops and minority social clubs in trust building missions
- Legislative: require salt information on the menus, provide resources to educate salt awareness.
- Provide more fruits and nuts at a discounted rate and make easier access to healthy food. Subsidize neighborhood healthy food outlets.
- Processing industry and restaurants to offer healthier options
- Force restaurants to provide salt content information
- Better choices, make sauces without salt to start with
- Industry to provide healthier Lunch meats which is a big source of health problems.
- Stop misinformation and clever marketing of sea salts.
- Medical industry to contribute to prevention education.
Further reading
The Tuskegee Timeline
https://www.cdc.gov/tuskegee/timeline.htm
Racial Differences in Incident Heart Failure Among Young Adults.
Kirsten Bibbins-Domingo 1 , Mark J Pletcher, Feng Lin, Eric Vittinghoff, Julius M Gardin, Alexander Arynchyn, Cora E Lewis, O Dale Williams, Stephen B Hulley
https://pubmed.ncbi.nlm.nih.gov/19297571/
Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of our Society
Keith C. Norris,1 Sandra F. Williams,2 Connie M. Rhee,3 Susanne B. Nicholas,1 Csaba P. Kovesdy,4,5 Kamyar Kalantar-Zadeh,3 and L. Ebony Boulware6
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418094/
Salt Sensitivity and Hypertension in African Americans: Implications for Cardiovascular Disease
Rosalind M. Peters, MSN, RN, John M. Flack, MD, MPH
Disclosures Prog Cardiovasc Nurs. 2000;15(4)