Health Promotion and the African American Community
The nursing profession has always been an advocate for providing community assessment, education, and health screenings to the public to promote healthier communities. Never has health promotion been more important than now. Healthy People 2020 are leading the charge by providing goals and objectives to improve the health for all Americans. One of their goals is to “achieve health equity, eliminate disparities, and improve the health of all groups.”1 This is a very important goal for the African American population in particular. Two-thirds of all deaths in the United States are caused by five major chronic diseases: cancer, cardiovascular disease, chronic lower respiratory disease, diabetes, and stroke.2 And African Americans have the highest mortality rates for three of them.
Research has found that African Americans have higher rates of mortality and morbidity from cardiovascular disease (CVD) than their Caucasian counterparts. In 2008, the National Heart, Lung, and Blood Institute (NHLBI) found CVD accounted for 25% of all deaths in the United States, and CVD was the number one cause of mortality for African Americans.3 Within the African American group, women have a higher mortality rate for CVD than males as well as Caucasian females. African American women have a 35% higher mortality rate for CVD compared to Caucasian women, whereas African American males have only a 7% higher mortality rate compared to Caucasian men.4
Diabetes also affects the African American population at a higher rate. African Americans are twice as likely to be diagnosed with diabetes as their Caucasian counterparts. The effects of diabetes make this population twice as likely to have end-stage renal disease and lower extremity amputations.5
Stroke is another chronic disease that leads to a higher rate of death for African Americans. They are 60% more likely to have a stroke than Caucasians, and African American men are 60% more likely to die from a stroke than Caucasian men.6 Additionally, African American stroke survivors are more likely to become disabled and have difficulty with activities of daily living.7
Chronic illnesses are a vicious cycle where one illness often leads to another. There are several behaviors and lifestyle choices that can influence the development of these chronic conditions, such as uncontrolled high blood pressure, poor diet (which can lead to high cholesterol and obesity), and smoking. Education and mentoring about health promotion and screening unhealthy behaviors are important measures in preventing CVD, diabetes, and stroke. While there are many educational programs available to African Americans about chronic illnesses and unhealthy behaviors, they are less likely to seek out preventive care.8
Cheatham, Barksdale, and Rodgers have identified numerous barriers that prevent African Americans from seeking health care and wellness promotion: socioeconomic status, masculinity, prejudice, not knowing or understanding the need for a physician, peer influences, and religious beliefs.9 Additionally, slavery and the Tuskegee Syphilis Experiment have made the African American population wary of seeking medical treatment.10 Finding an effective way to address these barriers is crucial in order to decrease the morbidities and mortality rates from chronic illnesses in the African American population.
Are Health Fairs the Answer?
Lack of education, unhealthy behaviors, and barriers to seeking health promotion play a large part in these high mortality rates among African Americans. One way to provide health promotion information to a variety of communities is through a wellness promotion fair. Health fairs allow you to work within a specific community to identify unique needs for health promotion as well as provide basic education and preventive information. Screenings and presentations are great ways to deliver basic health information to a large population—and they can inspire a community to make better health choices. Wanting to improve health is simply not enough. A person needs the education and support to make smarter decisions, and health fairs can provide important information that can ultimately save lives. A well prepared health fair can support more effective health promotion activities, education, and assessments.
There are several important issues to address when planning a wellness promotion fair. Qualified individuals need to be enlisted to provide accurate screenings and reliable information. It is important that individuals organizing these events properly train the screeners and educators regarding the services they are providing to build trust between the workers and the population. It is particularly important to establish a trusting relationship between the health care provider and African Americans. A 2006 study in the Archives of Internal Medicine found that African Americans are less likely to report a trusting relationship with their health care provider.8
It is also important to remind those attending the health fair that the information and screenings provided do not replace the need to seek further follow-up from a physician. Simple screenings on blood pressure or cholesterol and basic information on health changes are great ways to identify health concerns. However, they should never replace a primary care physician. It should be a goal of the health fair to direct the African American population to health care providers practicing in their area because continuity care with patients can improve trust among African Americans.8
Another one of Healthy People 2020’s goals is to “attain a higher quality of life that is free from preventable disease, disability, injury, and premature death.”1 The goal is not to teach but rather to mentor those who do not have the tools to make better choices about their health.
Kathleen Thimsen, RN, CWON, MSN, FNS, instructor at the Southern Illinois University Edwardsville School of Nursing and clinic director of its Community Nursing Services, states it best: “Vulnerable populations are rich with people who want the same as everyone else, yet have tremendous obstacles. Mentoring goes farther to create change than ‘teaching at people.’”11
- Healthy People 2020. Overarching goals. www.healthypeople.gov/2020/about/default.aspx. Accessed October 2012.
- Fierro MP. Costs of Chronic Diseases: What are States Facing? The Council of State Governments Trends Alert. Spring 2006. www.healthystates.csg.org/NR/rdonlyres/E42141D1-4D47-4119-BFF4-A2E7FE81C….
- National Heart Lung and Blood Institute. Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Disease.Chart Book. www.nhlbi.nih.gov/resources/docs/2012_ChartBook_508.pdf. Accessed October 2012.
- Williams RA. Cardiovascular disease in African American women: A healthcare disparities issue. J Natl Med Assoc.2009;101(6):536-40.
- The Office of Minority Health. Diabetes and African Americans. http://minorityhealth.hhs.gov/templates/content.aspx?ID=3017. Accessed October 2012.
- The Office of Minority Health. Stroke and African Americans. http://minorityhealth.hhs.gov/templates/content.aspx?ID=3022. Accessed October 2012.
- Centers for Disease Control and Prevention. Differences in Disability Among Black and White Stroke Survivors – United States, 2000-2001. MMWR. 2005;54(1):3- www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a2.htm.
- Halbert CH, Armstrong K, Gandy Jr. OH, and Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896-901.
- Cheatham CT, Barksdale DJ, Rodgers SG. Barriers to health care and health-seeking behaviors faced by black men. J Am Acad Nurse Pract. 2008;20(11):555-62.
- Osher T, Garay L, Jennings B, Jimerson D, Markus S, Martinez K. Closing the gap: Cultural perspective on family driven care. Technical Assistance Partnership for Child and Family Mental Health. September 2011. www.tapartnership.org/docs/ClosingTheGap_FamilyDrivenCare.pdf. Accessed October 2012.
- Thimsen K. Creating healthy nutrition and access in the inner city with community Gardening. Southern Illinois University School of Nursing with the Community Nursing Center. http://www.aptrweb.org/resource/resmgr/sp_nursing/southernillinoisevansville_t.pdf. Accessed October 2012.