Chapter 11 HEALTH and ILLNESS in the Black Population
God speed the day when human blood shall cease to flow! In every clime be understood, the claims of human brotherhood, And each return for evil, good, not blow for blow; That day will come all feuds to end, and change into a faithful friend each foe.
—Frederick Douglas’ 4th of July Speech (1852)
■ Objectives
1. Discuss the background of members of the Black population. 2. Discuss the demographic and new immigrant profiles of members of the
Black population. 3. Describe the traditional definitions of HEALTH and ILLNESS of members of
the Black population. 4. Describe the traditional methods of HEALTH maintenance and protection of
selected communities of the Black population. 5. Describe the traditional methods of HEALING of selected communities of
the Black population. 6. Describe current health care problems of members of the Black population. 7. Describe demographic disparity as it is seen in health manpower distribution
of the Black population as represented in the health care delivery system.
The opening images for this chapter depict objects symbolic of items used to maintain, protect, and/or restore HEALTH for people in the Black American
Figure 11–1 Figure 11–2 Figure 11–3 Figure 11–4
266 ■ Chapter 11
communities. Figure 11–1 is a typical Haitian meal—it consists of rice, beans, plantains, and chicken—a well-balanced, nutritious meal for health maintenance. Figure 11–2 is a beaded neckpiece that may be worn for protection. Beads carry with them centuries of history and are symbols of wealth and social rank. Their many uses include protection from evil spirits, symbols of stages of growth through life, and symbols of health, fertility, and beauty. Figure 11–3 is that of a dried garden snake and the powder derived from grinding it. The powder is dissolved in water and the solution is used to treat skin maladies, such as rashes and insect bites. Figure 11–4 is the grave monument for Dr. Martin Luther King, Jr., and his wife Coretta Scott King. They are located on the grounds of the King Center in Atlanta, Georgia. The King Center is the official, living memorial dedicated to the advancement of the legacy of Dr. Martin Luther King, Jr., leader of America’s greatest nonviolent movement for justice, equality, and peace. More than 1 million visitors from all over the world are drawn annually to the King Center to pay homage to Dr. King. The Memorial attempts to meet with uncompromising insistence, the problems, and needs that face Black people today.
■ Background “Black or African American” in the 2010 census refers to a person having origins in any of the Black racial groups of Africa. The Black racial category includes people who marked the “Black, African American, or Negro” check- box on the census form. It also includes respondents who marked Sub-Saharan African entries, for example Kenyan and Nigerian; and Afro-Caribbean entries, for example Haitian and Jamaican. The 2010 census showed that the United States population on April 1, 2010, was 308.7 million people. Out of the total population, 38.9 million, or 13%, identified as Black alone. In addition, 3.1 mil- lion people, or 1%, reported Black in combination with one or more other races. The Black alone-or-in-combination population grew by 15%, which was more growth than the total population and the Black alone population. Both groups (Black alone-or-in-combination) grew at a slower rate than most other major races and ethnic groups in the country. The majority of Blacks or Afri- can Americans alone in the United States in 2010 lived in the South, 56.5%; 16.8% lived in the Northeast; 17.9% in the Midwest; and 8.8% in the West. The states with the highest population of Blacks or African Americans in 2010 were New York, 7.9%; Florida, 7.7%; Texas, 7.6%; Georgia, 3.1%; and California, 7.7% (Rastogi, Johnson, Hoeffel, & Drewery, 2011, pp. 4–9). In 2010, 84.2% of Blacks were high school graduates and for persons over 25, 19.8% were col- lege graduates (U.S. Census Bureau, 2012, p. 151).
“Black” is used in this chapter’s text to refer to the Black or African American population, but “Black or African American” is used in tables and figures. This follows the pattern used in Census 2010. Most members of the present Black American community have their roots in Africa, and the majority descend from people who were brought here as slaves from the west coast of Africa (Bullough & Bullough, 1972, pp. 39–41). The largest importation of
HEALTH and ILLNESS in the Black Population ■ 267
slaves occurred during the 17th century, which means that Black people have been living in the United States for many generations. Today, a number of Blacks have immigrated to the United States voluntarily—from African coun- tries, the West Indian islands, the Dominican Republic, Haiti, and Jamaica.
Blacks are represented in every socioeconomic group; however, the 1 year estimate released by the United States Census Bureau American Community Survey for 2010 revealed there were over 10 million Blacks or African Americans below the poverty level 27.1% of the Black or African American pop- ulation (2011). Furthermore, over half of Black Americans live in urban areas surrounded by the symptoms of poverty—crowded and inadequate housing, poor schools, and high crime rates.
For example, Kotlowitz (1991) described the Henry Horner Homes in Chicago as “16 high-rise buildings which stretch over eight blocks and at last census count housed 6,000 people, 4,000 of whom are children.” The degree of social and economic change between 1990 and 2000 has been minimal. He presented 2 facts about public housing: “Public housing served as a bulwark to segregation and as a kind of anchor for impoverished neighborhoods” and “It was built on the cheap—the walls are a naked cinder block with heating pipes snaking through the apartment; instead of closets, there are 8-inch indentations in the walls without doors; and the heating system so storms out of control in the winter that it is 85 degrees.” Situations similar to this prevail presently.
In 2010, there were a total of 1,042,635 Legal Permanent Residents (LPRs) in the United States, 46% of whom were new arrivals. People from Africa comprised 9.7% of this population of LPRs and people from the Caribbean, 13.4%. The nations that the LPRs were from included Ethiopia, 1.4%; Nigeria, 1.3%; Haiti, 2.2%; and Jamaica, 1.9%. California, New York, Florida, and Texas had the largest populations of LPRs (Monger, & Yankay, 2011, p. 4).
In 2010, there were 619,913 people who naturalized—became citizens of the United States. Of this number, 10.3% were born in Africa and 10.1% were from the Caribbean. Of the African population, 1.5% were from Nigeria and 1.4% from Ethiopia; from the Caribbean, 2.0% were from Haiti and 1.9% from Jamaica. Close to half of the nation’s naturalized citizens lived in the met- ropolitan areas of New York, Los Angeles, or Miami. The median number of years that the people were LPRs was 5 (Lee, 2011, p. 2).
According to some sources, the first Black people to enter this country ar- rived a year earlier than the Pilgrims, in 1619. Other sources claim that Blacks arrived with Columbus in the 15th century (Bullough & Bullough, 1972, pp. 39–41). In any event, the first Blacks who came to the North American con- tinent did not come as slaves, but, between 1619 and 1860, more than 4 million people were transported here as slaves. One need read only a sampling of the many accounts of slavery to appreciate the tremendous hardships that the cap- tured and enslaved people experienced during that time. Not only was the daily life of the slave very difficult, but the experience of being captured, shackled, and transported in steerage was devastating. Many of those captured in Africa died before they arrived here. The strongest and healthiest people were snatched from their homes by slave dealers and transported en masse in the holds of ships
268 ■ Chapter 11
to the North American continent. In general, Black captives were not taken care of or recognized as human beings and treated accordingly. Once here, they were sold and placed on plantations and in homes all over the country—it was only later that the practice was confined to the South. Families were separated; chil- dren were wrenched from their parents and sold to other buyers. Some slave owners bred their slaves much as farmers breed cattle today, purchasing men to serve as studs, and judging women based on whether they would produce the desired stock with a particular man (Haley, 1976). However, in the midst of all this inhuman and inhumane treatment, the Black family grew and survived. Gutman (1976), in his careful documentation of plantation and family records, traces the history of the Black family from 1750 to 1925 and points out the existence of families and family or kinship ties before and after the Civil War, dispelling many of the myths about the Black family and its structure. Despite overwhelming hardships and enforced separations, the people managed in most circumstances to maintain both family and community awareness.
The people who came to America from West Africa brought a rich vari- ety of traditional beliefs and practices and came from religious traditions that respected the spiritual power of ancestors. They worshiped a diverse pantheon of gods, who oversaw all aspects of daily life, such as the changes of the seasons, the fertility of nature, physical and spiritual personal health, and communal success. Initiation rites and naming rituals, folktales, and healing practices, dance, song, and drumming were a part of the religious heritage. Many aspects of today’s Christian religious practices are believed to have originated in these practices. In addition, it has been estimated that between 10% and 30% of the slaves brought to America between 1711 and 1808 were Muslim. The people brought their prayer practices, fasting and dietary practices, and their knowledge of the Qur’an (Eck, 1994).
Ostensibly, the Civil War ended slavery but in many ways it did not eman- cipate Blacks. Daily life after the war was fraught with tremendous difficulty, and Black people—according to custom—were stripped of their civil rights. In the South, Black people were overtly segregated, most living in conditions of extreme hardship and poverty (Blackmon, 2008). Those who migrated to the North over the years were subject to all the problems of fragmented urban life: poverty, racism, and covert segregation (Bullough & Bullough, 1972, p. 43; Kain, 1969, pp. 1–30).
The historic problems of the Black community need to be appreciated by the health care provider who attempts to juxtapose modern practices and traditional health and illness beliefs. In addition, health care providers must be aware of the ongoing and historical events in the struggle for civil rights that affect people’s lives. Box 11–1 highlights several events in the early history of this struggle. In 2007, the Supreme Court ruled in Parents v. Seattle Schools and Meredith v. Jefferson Schools that public schools can’t consider race when mak- ing student school assignments. This may be viewed as an effort to strike down Brown v. Board of Education, the landmark ruling of 1956. Also, in 2007, James Ford Seale, a Mississippi Klansman was sentenced to 3 life terms in prison for the Moore/Dee murder of 1964.
Chapter 11 HEALTH and ILLNESS
in the Black Population
God speed the day when human blood shall cease to flow! In every clime be understood, the claims of human brotherhood, And each return for evil, good, not blow for blow; That day will come all feuds to end, and change into a faithful friend each foe.
—Frederick Douglas’ 4th of July Speech (1852)
■ Objectives
1. Discuss the background of members of the Black population. 2. Discuss the demographic and new immigrant profiles of members of the
Black population. 3. Describe the traditional definitions of HEALTH and ILLNESS of members of
the Black population. 4. Describe the traditional methods of HEALTH maintenance and protection of
selected communities of the Black population. 5. Describe the traditional methods of HEALING of selected communities of
the Black population. 6. Describe current health care problems of members of the Black population. 7. Describe demographic disparity as it is seen in health manpower distribution
of the Black population as represented in the health care delivery system.
The opening images for this chapter depict objects symbolic of items used to maintain, protect, and/or restore HEALTH for people in the Black American
Figure 11–1 Figure 11–2 Figure 11–3 Figure 11–4
266 ■ Chapter 11
communities. Figure 11–1 is a typical Haitian meal—it consists of rice, beans, plantains, and chicken—a well-balanced, nutritious meal for health maintenance. Figure 11–2 is a beaded neckpiece that may be worn for protection. Beads carry with them centuries of history and are symbols of wealth and social rank. Their many uses include protection from evil spirits, symbols of stages of growth through life, and symbols of health, fertility, and beauty. Figure 11–3 is that of a dried garden snake and the powder derived from grinding it. The powder is dissolved in water and the solution is used to treat skin maladies, such as rashes and insect bites. Figure 11–4 is the grave monument for Dr. Martin Luther King, Jr., and his wife Coretta Scott King. They are located on the grounds of the King Center in Atlanta, Georgia. The King Center is the official, living memorial dedicated to the advancement of the legacy of Dr. Martin Luther King, Jr., leader of America’s greatest nonviolent movement for justice, equality, and peace. More than 1 million visitors from all over the world are drawn annually to the King Center to pay homage to Dr. King. The Memorial attempts to meet with uncompromising insistence, the problems, and needs that face Black people today.
■ Background “Black or African American” in the 2010 census refers to a person having origins in any of the Black racial groups of Africa. The Black racial category includes people who marked the “Black, African American, or Negro” check- box on the census form. It also includes respondents who marked Sub-Saharan African entries, for example Kenyan and Nigerian; and Afro-Caribbean entries, for example Haitian and Jamaican. The 2010 census showed that the United States population on April 1, 2010, was 308.7 million people. Out of the total population, 38.9 million, or 13%, identified as Black alone. In addition, 3.1 mil- lion people, or 1%, reported Black in combination with one or more other races. The Black alone-or-in-combination population grew by 15%, which was more growth than the total population and the Black alone population. Both groups (Black alone-or-in-combination) grew at a slower rate than most other major races and ethnic groups in the country. The majority of Blacks or Afri- can Americans alone in the United States in 2010 lived in the South, 56.5%; 16.8% lived in the Northeast; 17.9% in the Midwest; and 8.8% in the West. The states with the highest population of Blacks or African Americans in 2010 were New York, 7.9%; Florida, 7.7%; Texas, 7.6%; Georgia, 3.1%; and California, 7.7% (Rastogi, Johnson, Hoeffel, & Drewery, 2011, pp. 4–9). In 2010, 84.2% of Blacks were high school graduates and for persons over 25, 19.8% were col- lege graduates (U.S. Census Bureau, 2012, p. 151).
“Black” is used in this chapter’s text to refer to the Black or African American population, but “Black or African American” is used in tables and figures. This follows the pattern used in Census 2010. Most members of the present Black American community have their roots in Africa, and the majority descend from people who were brought here as slaves from the west coast of Africa (Bullough & Bullough, 1972, pp. 39–41). The largest importation of
HEALTH and ILLNESS in the Black Population ■ 267
slaves occurred during the 17th century, which means that Black people have been living in the United States for many generations. Today, a number of Blacks have immigrated to the United States voluntarily—from African coun- tries, the West Indian islands, the Dominican Republic, Haiti, and Jamaica.
Blacks are represented in every socioeconomic group; however, the 1 year estimate released by the United States Census Bureau American Community Survey for 2010 revealed there were over 10 million Blacks or African Americans below the poverty level 27.1% of the Black or African American pop- ulation (2011). Furthermore, over half of Black Americans live in urban areas surrounded by the symptoms of poverty—crowded and inadequate housing, poor schools, and high crime rates.
For example, Kotlowitz (1991) described the Henry Horner Homes in Chicago as “16 high-rise buildings which stretch over eight blocks and at last census count housed 6,000 people, 4,000 of whom are children.” The degree of social and economic change between 1990 and 2000 has been minimal. He presented 2 facts about public housing: “Public housing served as a bulwark to segregation and as a kind of anchor for impoverished neighborhoods” and “It was built on the cheap—the walls are a naked cinder block with heating pipes snaking through the apartment; instead of closets, there are 8-inch indentations in the walls without doors; and the heating system so storms out of control in the winter that it is 85 degrees.” Situations similar to this prevail presently.
In 2010, there were a total of 1,042,635 Legal Permanent Residents (LPRs) in the United States, 46% of whom were new arrivals. People from Africa comprised 9.7% of this population of LPRs and people from the Caribbean, 13.4%. The nations that the LPRs were from included Ethiopia, 1.4%; Nigeria, 1.3%; Haiti, 2.2%; and Jamaica, 1.9%. California, New York, Florida, and Texas had the largest populations of LPRs (Monger, & Yankay, 2011, p. 4).
In 2010, there were 619,913 people who naturalized—became citizens of the United States. Of this number, 10.3% were born in Africa and 10.1% were from the Caribbean. Of the African population, 1.5% were from Nigeria and 1.4% from Ethiopia; from the Caribbean, 2.0% were from Haiti and 1.9% from Jamaica. Close to half of the nation’s naturalized citizens lived in the met- ropolitan areas of New York, Los Angeles, or Miami. The median number of years that the people were LPRs was 5 (Lee, 2011, p. 2).
According to some sources, the first Black people to enter this country ar- rived a year earlier than the Pilgrims, in 1619. Other sources claim that Blacks arrived with Columbus in the 15th century (Bullough & Bullough, 1972, pp. 39–41). In any event, the first Blacks who came to the North American con- tinent did not come as slaves, but, between 1619 and 1860, more than 4 million people were transported here as slaves. One need read only a sampling of the many accounts of slavery to appreciate the tremendous hardships that the cap- tured and enslaved people experienced during that time. Not only was the daily life of the slave very difficult, but the experience of being captured, shackled, and transported in steerage was devastating. Many of those captured in Africa died before they arrived here. The strongest and healthiest people were snatched from their homes by slave dealers and transported en masse in the holds of ships
268 ■ Chapter 11
to the North American continent. In general, Black captives were not taken care of or recognized as human beings and treated accordingly. Once here, they were sold and placed on plantations and in homes all over the country—it was only later that the practice was confined to the South. Families were separated; chil- dren were wrenched from their parents and sold to other buyers. Some slave owners bred their slaves much as farmers breed cattle today, purchasing men to serve as studs, and judging women based on whether they would produce the desired stock with a particular man (Haley, 1976). However, in the midst of all this inhuman and inhumane treatment, the Black family grew and survived. Gutman (1976), in his careful documentation of plantation and family records, traces the history of the Black family from 1750 to 1925 and points out the existence of families and family or kinship ties before and after the Civil War, dispelling many of the myths about the Black family and its structure. Despite overwhelming hardships and enforced separations, the people managed in most circumstances to maintain both family and community awareness.
The people who came to America from West Africa brought a rich vari- ety of traditional beliefs and practices and came from religious traditions that respected the spiritual power of ancestors. They worshiped a diverse pantheon of gods, who oversaw all aspects of daily life, such as the changes of the seasons, the fertility of nature, physical and spiritual personal health, and communal success. Initiation rites and naming rituals, folktales, and healing practices, dance, song, and drumming were a part of the religious heritage. Many aspects of today’s Christian religious practices are believed to have originated in these practices. In addition, it has been estimated that between 10% and 30% of the slaves brought to America between 1711 and 1808 were Muslim. The people brought their prayer practices, fasting and dietary practices, and their knowledge of the Qur’an (Eck, 1994).
Ostensibly, the Civil War ended slavery but in many ways it did not eman- cipate Blacks. Daily life after the war was fraught with tremendous difficulty, and Black people—according to custom—were stripped of their civil rights. In the South, Black people were overtly segregated, most living in conditions of extreme hardship and poverty (Blackmon, 2008). Those who migrated to the North over the years were subject to all the problems of fragmented urban life: poverty, racism, and covert segregation (Bullough & Bullough, 1972, p. 43; Kain, 1969, pp. 1–30).
The historic problems of the Black community need to be appreciated by the health care provider who attempts to juxtapose modern practices and traditional health and illness beliefs. In addition, health care providers must be aware of the ongoing and historical events in the struggle for civil rights that affect people’s lives. Box 11–1 highlights several events in the early history of this struggle. In 2007, the Supreme Court ruled in Parents v. Seattle Schools and Meredith v. Jefferson Schools that public schools can’t consider race when mak- ing student school assignments. This may be viewed as an effort to strike down Brown v. Board of Education, the landmark ruling of 1956. Also, in 2007, James Ford Seale, a Mississippi Klansman was sentenced to 3 life terms in prison for the Moore/Dee murder of 1964.