Home Health Glenn Ellis Ellis: African Americans and Social Determinants of Health

Ellis: African Americans and Social Determinants of Health

By Glenn Ellis

There is no disagreement that African Americans have worse health outcomes across the board than other groups. Researchers, scientists, sociologists, and doctors all agree.

Data and statistics reflect the dismal reality that if you are African American, you will be more likely to die at birth, die giving birth, grow up sicker, be diagnosed of a life-threatening illness later, and die sooner.

What is less known, and agreed upon, is the fact that the determining factors for all of these outcomes, is not because one is African American, but because of what are known as social determinants of health (SDOH).

It’s true, research had concluded that medical care and is only responsible for 10-20 percent of a person’s health: regardless of what color they are. The remaining 80-90 percent is attributed to SDOH.

Doctors see this every day in their patient population. A recent survey by The Physician Foundation revealed that 90 percent of doctors in this country say that most of their patients have a social condition that poses a serious threat to their health. Only 1 percent of the doctors surveyed felt that none of their patients were affected by SDOH.

So, what exactly are SDOH?

According to the World Health Organization (WHO), these are the “conditions in which people are born, grow, live, work, and age.” In other words, the conditions of health are alarming in communities with poor SDOH such as unstable housing, low income, unsafe neighborhoods, and/or substandard education.

One only has to look at every city (urban and rural) to see how this plays out in most of our lives.

In the United States, it is SDOH, not race that accounts for the dismal health outcomes for African Americans. In fact, the inequities in outcome are clear all the way down to the level of neighborhoods in the same city.

Several years ago, The Robert Wood Johnson Foundation initiated a first of its kind initiative to look at life expectancy by neighborhood in respective cities around the country.

Known as United States Small-Area Life Expectancy Estimate Project (USALEEP), shocking differences in life expectancy of as much as 20 years for residents in the same city, living just a few miles apart; in some cases, just a few blocks were found.

Further examination of the data shows that, almost with exception, neighborhoods with the lowest life expectancy were those with substantial African American or Latino populations.

As the cities in this country become more gentrified, we are seeing the health outcomes for the black and brown people in this country worsen.

Are there other reasons that HVI/AIDs is a chronic condition for whites, while it continues to be an epidemic in the African American communities in this country? Or, black women are two to six times more likely to die from complications of pregnancy than white women? And their babies almost three times the infant mortality rate as whites?

Is it due to the genetic makeup of African Americans? I think not!

Every human being on the planet is 99.99 percent identical. A difference of 0.01 percent is all that separates us. That means that the three billion pairs of genes (human pairs) that make up our individual genetic code are equal to a book with 262,000 pages. The individual differences between us represent only 500 of those pages!

Understanding this is what will allow us to stop using race, a totally social construct, in the concepts of medicine and healthcare. Instead, we must realize how much of our human and financial resources are “misused” applying race to issues of health.

We can see it in how even today some doctors believe that African Americans have a higher tolerance for pain, because of our skin color, and that results in not being provided adequate pain medications. The same was observed even in some children at emergency rooms with appendicitis; African American children were denied pain medication for the same reason.

Most alarming to me are the implications as we move further into genomic medicine.

If we are not careful, we can see research from this endeavor to further engrain the notion that there are racial differences that justify our higher rates of high blood pressure; diabetes; and other diseases and conditions.

Currently, policy, legislation, and funding are directed towards supporting the theory that African Americans are more susceptible to poorer health outcomes, while SDOH are being largely ignored.

Dr. Richard Cooper of Loyola University has done research on high blood pressure that has made an indisputable case for the dismissal of the fallacy of African Americans being “predisposed” to poor health outcomes.

In his research, Dr. Cooper studied high blood pressure in Nigerians, Jamaicans, and in African Americans. His conclusions: only African Americans had the highest rates of high blood pressure. To further make the case, he found that Germans and Russians have rates that were significantly higher than African Americans!

Seems like it’s more about being African American in this country than it is about just being African American.

It begs the question: Is it race or is it racism?

Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor? and Information is the Best Medicine. Ellis is an active media contributor on Health Equity and Medical Ethics. 

 Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.