As we head into the second year of the pandemic, it’s undeniable that the mental health of a lot of people has been affected; and because mental health and addiction are often co-occurring, the rates of substance use and overdoses have increased as well. Research has also shown that the segment of the population that is being disproportionately affected is the Black community.
Let’s be honest: mental health and/or addiction in the Black community are not welcomed diagnoses. As a Black woman working in behavioral health care, I see first-hand the aversions that many people have towards the words “mental health” and “addiction.” In addition to the stigma that exists with those two conditions in society, people with mental health issues in the Black community can also be seen by some as “crazy,” which is something no one wants attached to them, and also a significant deterrent for a lot of people to reach out for help.
There are other deterrents, though, that exist within the community: namely the systemic racism in health care and all that it entails. Historically, we’ve been subjected to treatment that is highly unethical at best, such as the Tuskegee Experiment in which African American men diagnosed with syphilis were not told nor treated. Then there’s the case of Henrietta Lacks whose cancer cells, taken and utilized without her knowledge or consent, were identified as the first immortalized human cell line. These are just a couple of examples from the past, but inequalities in treatment still exist today. For example, in a 2016 study, 50% of the medical students and residents who participated thought black people couldn’t feel pain in the same way as others because our skin is thicker and our nerve endings are less sensitive than those of other races or ethnicities. The Black maternal death rate is still the highest in the country with researchers suspecting institutional racism to be a contributing factor. And take COVID-19 – a survey found that 35% of Black adults would not take the vaccine with one respondent saying, “… I don’t trust the medical community because of mistakes in the past.” I know that the apprehension to seeking medical care and distrust of the health care system is not something born of paranoia and delusions, and it’s something I’d like to see change.
Right now, a lot of people are struggling with addiction and/or mental health issues that can be treated, but they don’t want to reach out. As we enter the second year of the pandemic, among other stressors, and with signs of deteriorating mental health and substance use becoming ever-apparent, it’s incumbent on us medical professionals to meet this community where they are. Here is how we do that:
Educate. Educate the Black community with subject matter experts who look like them. Us Black nurses, doctors, and other medical providers have a unique understanding of other Black people’s concerns. With our medical expertise and lived experiences as Black people, we can help chip away at the distrust our people have in the medical community.
Access. Provide accountability through accessibility. Once they have the information and are ready to take the steps to receive the type of care they need, we need to make sure that barriers no longer exist. Extremely long wait times, a lack of accessibility, and a lack of practicality is enough to cause people who are actually attempting to get help to stop trying entirely. If we don’t have the tools and resources to get them to an appointment, such as internet access for telehealth and scheduling, then the education we’ve provided becomes null and void.
Break the stigma. At the rate the country is going, it’s very likely that things won’t be changing too much anytime soon. COVID-19 will continue to disproportionately impact the Black community and will continue to lead to substance misuse.
Please ask for help.
I cannot stress the importance of reaching out for help for a medical condition that will progressively get worse. This is where we can use what is typically the cornerstone of our community: the church.
For many, one of the first people our problems are brought to is our Pastor. We ask for guidance and support from the church and everyone does what they can, but we need the church to further that support by pointing those struggling to the medical professionals who can provide appropriate treatment and care.
The doors to treatment centers are still open. Mental health conditions and addiction do not, and will not, cease because of a pandemic. If anything, they’ve both gotten worse. I implore everyone in the Black community to not be afraid to ask for help, there is absolutely nothing wrong in doing so; addiction and mental health conditions are health issues just as real as a broken leg – they both require the help of a professional.
I ask you to please overcome the hesitation to reach out; as a Black woman, I understand, but as a medical provider, I care and want to help.
In the United States, race once defined an individual’s level of freedom, including where they could enter, sit, and eat. Today, with African Americans at a higher risk than White Americans for obesity, high blood pressure, stroke, and heart disease, race also defines the quality of healthcare, making health disparities in African Americans the true silent killer.
Statistics from the American Heart Association and Center for Disease Control and Prevention acknowledges the prevalence of cardiovascular diseases in African Americans. However, the link between race and health are obscured, and there is not much conversation dedicated to eliminating the socioeconomic and cultural barriers that make African Americans a target for death by disease.
So the question is what should we as healthcare professionals implement to address socioeconomic and cultural barriers that contribute to the healthcare disparities in African Americans and other minority populations? Should we continue to research different treatment regimens that can improve the overall health of African Americans and other minority groups? Or should we continue to educate these populations through traditional patient education? The Answer is No! In order for us to get something that we have never had, that means we have to do something that we have never done. The solution to this issue must extend beyond medicine, and instead be addressed by community leaders, community health providers, and minority healthcare professionals so race can be a category and not a barrier to quality healthcare.
There is undoubtedly a necessity to increase the level of cultural sensitivity among physicians, nurses, & other healthcare personnel; recognize unfavorable socioeconomic and cultural barriers as a preexisting condition; improve the community surrounding African Americans & other minority patients; and increase the number of minority healthcare workers. Implementing these actions will begin the process of closing the gap of socioeconomic and cultural barriers that contribute to the healthcare disparities in African Americans and other minority populations.
As health professionals, nurses are well aware of health disparities in communities of color. Some patients will live shorter life spans simply because of their race, ethnicity, education or income.
Raising awareness about health inequities is a constant effort, but this critical issue is highlighted in April, which is National Minority Health Month. This year’s theme: “Prevention is Power: Taking Action for Health Equity” emphasizes the critical role of prevention in reducing health disparities.
The combined cost of health inequities and premature deaths were estimated to be $1.24 trillion between 2003 and 2006, according to the Joint Center for Political and Economic Studies.
From AIDS/HIV to cancer to obesity to tuberculosis, racial and ethnic minorities are more likely to be affected in disproportionate numbers. Health disparities among African Americans and Latinos in 2009 cost private insurers an additional $5.1 billion.
Consider these statistics:
▪Of 197,090 diagnoses of HIV-infection from 2008-2011, Blacks were 47% of the total.
▪African Americans, American Indians and Alaska Natives are twice as likely to be diagnosed with diabetes and Native Hawaiians and Pacific Islanders are more than three times as likely to receive the same diagnosis.
▪Latinos are twice as likely to die from liver cancer.
▪African American women are 40% more likely to die of breast cancer than white women.
▪About five out of 10 Latinos and four out of 10 blacks aged 50 or older never had a colonoscopy or sigmoidoscopy compared to three out of 10 older whites.
▪Black women have more than double the rate of extreme obesity [16.4%] as white and Latino women [7.4% and 7.6%].
Preventive services, such as diabetes screening and pap smears, are game-changing. So is a honest discussion about healthy eating, fresh-food deserts and lack of exercise. People can do better when they know better.
Nurses are the most trusted professionals. Educate patients as well as loved ones to help reduce preventable disease, disability and death.
Robin Farmer is a freelance journalist with a focus on health, education and business. Visit her at www.RobinFarmerWrites.com
Health and Human Services (HHS) recently released enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care—a blueprint to help organizations improve health care quality in serving our nation’s diverse communities.
The enhanced standards, developed by the HHS Office of Minority Health, are a comprehensive update of the 2000 National CLAS Standards and include the expertise of federal and non-federal partners nationwide to ensure an even stronger platform for health equity. The enhanced National CLAS Standards are grounded in a broad definition of culture—one in which health is recognized as being influenced by factors ranging from race and ethnicity to language, spirituality, disability status, sexual orientation, gender identity, and geography.
“We are making great strides in providing quality care and affordable coverage for every American, regardless of race or ethnicity or other cultural factors because of the Affordable Care Act,” said HHS Secretary Kathleen Sebelius. “The Enhanced National CLAS Standards will help us build on this ongoing effort to ensure that effective and equitable care is accessible to all.”
A key initiative in the department’s effort to reduce health disparities, the update marks a major milestone in the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.
Long existing inequities in health and health care have come at a steep cost not only for minority communities, but also for our nation. As cited in a recent report from the HHS Agency for Healthcare Research and Quality, the burden of insufficient and inequitable care related to racial and ethnic health disparities has been estimated to top $1 trillion.
“Disparities have prevented improved outcomes in our health and health care system for far too long,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “The enhanced CLAS Standards provide a platform for all persons to reach their full health potential.”
Specifically, the enhanced standards provide a framework to health and health care organizations for the delivery of culturally respectful and linguistically responsive care and services. By adopting the framework, health and human services professionals will be better able to meet the needs of all individuals at all points of contact.
“Many Americans struggle to achieve good health because the health care and services that are available to them do not adequately address their needs,” said J. Nadine Gracia, MD, MSCE, Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health. “As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity.”
For additional information, please visit www.ThinkCulturalHealth.hhs.gov and www.minorityhealth.hhs.gov.
The American Diabetes Association (ADA) released new data regarding the mortality rate for those living with Type 1 Diabetes during their June annual meeting, highlighting a drop in deaths related to the disease. Analysis of data from the Allegheny County Type 1 Diabetes Registry, in Allegheny County, Pennsylvania, revealed a dip in the number of deaths for the 1,100 individuals diagnosed with the disease between 1965 and 1979.
Disparities were noted between gender and race. Presented findings said that women were still more likely to die from the disease than men–females were 13 times more likely to face mortality from type 1 diabetes than those without. Similarly, African American women were 30% more likely to die when compared to Caucasian women, perhaps connected to racial disparities facing the health care industry as a whole.
According to the ADA, those with type 1 diabetes account for 5-10% of the estimated 23.6 million people dealing with the disease, the vast majority of whom are diagnosed as children. Advances in insulin therapy treatments and early detection can be credited with the lower death rate.