HEALTH ESSAY
If you pay attention to how health is discussed on television or in the newspaper, you
would think that health was primarily about combating illness with the latest technology,
prescription drugs, or insurance. Our health systems are organized and funded with
a concentration on "sick care." According to former Surgeon General David Satcher,
more than 90% of our country's trillion dollar health budget is spent treating
diseases and their complications - many of which are easily preventable. The result
is a nation sicker across all races and classes than our industrialized counterparts and
numerous developing nations.
Even the incomplete data we use to examine the health of African Americans in Oregon
focuses on disease and death, rather than other factors that contribute to health and
wellbeing. In general, access to health care is more limited for African Americans.
While the state of Oregon has relatively low rates of hospitalization for conditions that
could be treated through access to a primary care provider, hospitalization rates are nearly
11% higher for African American Oregonians than their White counterparts. Access to
culturally competent health care is limited simply by the gaping lack of African
Americans trained in Oregon as health care providers. Consider the 55 major community
colleges and four-year universities in Oregon that offer medical training, certificates, and
professional degrees. Of all students majoring in health programs in 1985, African
American students represented less than one percent. Twenty-one years later in 2006,
African American students comprised only 2% of all students seeking a health related
undergraduate or advanced degree in the state of Oregon (National Center for Education
Statistics).
Disparities in health outcomes are staggering in the African American community and
span the lifecycle. African American infants are more likely to be born too soon and too
small. Asthma, a chronic respiratory condition, is experienced at higher rates in the
African American community in Portland than any other racial or ethnic group. It is
estimated that asthma is 26% more prevalent in African American children than in White
children. (Source: Multnomah County Environmental Health Report, 2003). In
adolescence and young adulthood, African Americans experience higher rates of sexually
transmitted disease, and less fruit and vegetable intake, as well as lower participation in
physical activity (source: State of Oregon, and BRFSS). Statewide, African Americans
experience disparities in mental health, homicide and suicide. The top 10 leading causes
of death are malignant cancers (especially lung cancer), heart disease, stroke, diabetes,
unintentional injuries, kidney disease, assault by homicide, influenza/pneumonia, and
infections/parasitic diseases (Joyce A. Grant Worley, Oregon State Dept of Health;
Oregon Vital Statistics Annual Report Vol.2 Table 6-10).
The underlying causes of death for African American adults and infants and the factors
affecting health at all points in between are more complicated than we might think. To
eliminate health disparities, a local or national focus on "sick care" is unlikely to be
the most effective strategy. Being able to see a doctor and have access to the latest
treatments and medicines only accounts for 15% to 20% of the variation in sickness and
death that we see in different populations in this country. Genetic differences account for
20% to 25% of variations in morbidity and mortality. While the most important
strategies for eliminating health disparities and promoting health are related to the social
forces that shape health, these strategies receive the least funding. A mere 3% of health
care funding its targeted on strategies that support healthy lifestyles and avoid the high
costs of health care. (source: David Satcher, MD, PhD, and Eve J. Higginbotham, MD
March 2008, Vol 98, No. 3, American Journal of Public Health 400-403).
Policy makers and community members in Oregon and across the country are rapidly
realizing that health is more than an absence of disease - this is not news in many
countries across the globe. Health is impacted by many of the indicators highlighted in
this report including where people live, work and play; their access to parks and
nature; the quality and content of their education; their ability to make a decent income,
save money, and pass wealth and financial know-how to their children; their ability to
shape public policies; their ability to purchase or rent a healthy home in a safe
neighborhood; and their ability to relax and live stress free. Emerging research is
exposing how health is also impacted by the subtle and persistent experience of
differential treatment (such as institutionalized racism) - which plays out in lower
expectations of achievement, lack of authority, barriers to advancement, and
higher costs of living (also known as the "race tax" and the "poverty tax").
Inequities in each of these indicators contribute overwhelmingly to the disparities in
health experienced by African Americans. Many address inequity in our community by
supporting healthy individual behaviors; however, these behaviors are shaped by social
and physical environments, as well as by what our elected, business, and
community leaders do or fail to do through public policy, media, and funding.
If we attribute the main source of racial health disparities not to failings of
individual African Americans, but to the cumulative result of inhumane past
policies and current inequitable social structures and policies, what does this mean
for the solutions? Though health care is important, solutions to health disparities do not
require an increased emphasis on health care services. Rather, solutions should represent
an intensified emphasis on a wider range of economic, social, environmental, and
political forces that can either promote or compromise the health of populations.
A commitment to racial equity must lie at the heart of efforts to eliminate disparities.
This commitment to equity cannot be realized through race-neutral policies, which often
have differential implications for African Americans and Whites. These policies may
improve conditions in the community while perpetuating disparities. Instead, policies
must target specific inequities and be developed in partnership with multiple members
(not tokenized individuals or recognizable spokespeople) of the communities most
impacted by inequities who are engaged as consultants and equal contributors.
Policy makers, bureaucrats, and community members must learn how institutional racism
and class privilege persist in order to avoid reinforcing it through policies - this requires
training and critical self-reflection.
In communities across the nation, an equity lens is a process that is increasingly used
to support policy makers and leaders in assuring policy that promotes health. As an
equity lens is applied more consistently across multiple sectors, public policy will be
enriched with the consideration of its impact on the most vulnerable. Projects such as
Solar Richmond offer an example of how public investment in the "Green Economy" can
be structured using principles of equity - to assure that people of color can have access to
green jobs as well as solar power. The benefits of this approach are not only for the
individuals employed in living-wage jobs with health benefits, but also for the residents
of low income communities who will have less stress over whether to "heat or eat" and
less illness caused by inadequately heated housing. Using an equity lens with
sustainability, in this case, means that all people can understand and reap the benefits of
going "green." This approach, when applied to other social determinants of health, such
as education, transportation, housing, community safety and other policy arenas will lead
to long term improvements in communities historically burdened by poorer health.
HEALTH DATA POINTS
The population map of the largest urban county in Oregon, Multnomah County, shows
that African Americans are heavily segregated and concentrated in specific parts of the
Portland metropolitan area (Diane McBride, Multnomah County Health Dept, PSU 2006
population estimates), especially areas filled environmental hazards.
In areas where African Americans reside:
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There is an elevated level of asthma in the neighborhoods surrounding the
Northeast I-5 corridor.
These rates are significantly higher than estimates of the state or national asthma
rate.
African Americans experience higher rates of asthma than any other racial/ethnic
group (Portland Neighborhood Survey, Bruce Podobnik 2001).
Racial disparities are also significant when considering who gets access to care. Many
health conditions such as asthma, diabetes, etc. are preventable, but when treatment is
delayed, conditions may escalate to emergency situations or require costly and extensive
care.
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Although the state of Oregon has relatively low rates of hospitalization for
ambulatory sensitive conditions compared to national rates, hospitalization rates
are nearly 11% higher for African American Oregonians than their White
counterparts (Dartmouth Atlas p. 13).
According to a recent report from Multnomah County Health Department (Racial and
Ethnic Disparities in Health Report Card 2008):
 African American mothers are significantly more likely to receive no prenatal
care during the first trimester of pregnancy than White mothers.
 The percent of low birth weight babies is twice as high among African
American mothers compared with White non-Hispanic mothers.
 African Americans had just under two times the infant mortality rate of White
non-Hispanics.
Data from Oregon Department of Health Services, 1999-2004, show that African
Americans are significantly more likely to die from heart disease, stroke, diabetes, and
cancer than Whites (Keeping Oregonians Healthy, Oregon DHS, DISPLAY CHART IN
PUBLICATION FIGURE 3.5, p. 71).
Health areas were no significant disparities were found between African Americans and
other racial/ethnic groups in Multnomah County in 2008:
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Heart disease mortality
Lung or breast cancer mortality
HIV
Among the largest health disparities between African Americans and Whites in
Multnomah County are rates of sexually transmitted diseases. Data for 2001-2005
suggest that for several diseases, African Americans have the highest incidence of all
racial groups:
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The African American population of Multnomah County had over three times the
syphilis incidence rate of White non-Hispanics.
African Americans had over six times the gonorrhea incidence rate of White nonHispanics.
African Americans had over five times the chlamydia incidence rates of White
non-Hispanics.
In 2001-05 African American had the highest rate of homicide mortality among all racial
groups. The African American rate was more than 6 times that of White non-Hispanics in
Multnomah County, however, there has been a significant decline since the early 1990s
when the African American homicide rate was almost 10 times that of White nonHispanics.
DISPLAY CHART IN PUBLICATION: Homicide rate by race, OR, 2005. From Violent
Deaths in Oregon 2005, see p.24 of pdf, Figure 13.