Black or African American All Persons
1. Diseases of heart Diseases of heart 2. Malignant neoplasms Malignant neoplasms 3. Cerebrovascular diseases Cerebrovascular diseases 4. Unintentional injuries Chronic lower respiratory diseases 5. Diabetes mellitus Unintentional injuries 6. Homicide Alzheimer’s disease 7. Nephritis, nephrotic syndrome, and
nephrosis influenza and pneumonia Diabetes mellitus
8. Chronic lower respiratory diseases Influenza and pneumonia 9. Human immunodeficiency virus (HIV)
disease Nephritis, nephrotic syndrome, and nephrosis
10. Septicemia Septicemia
Source: National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011: Author, pp. 146–147. Retrieved from http://www.cdc.gov/nchs/, June 9, 2011.
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An intentional insult is, of course, a blatant remark or mistreatment. An uninten- tional insult is more difficult to define. A health care provider may not intend to demean a person, yet an action or a tone of voice may be interpreted as insulting. The provider may have some covert, underlying fears or difficulties in relating to Blacks, but the patient quite often senses the difficulty. An unintentional insult may occur because the provider is not fully aware of the patient’s background and is unable to comprehend many of the patient’s beliefs and practices. The patient, for example, may be afraid of the impending medical procedures and the possibility of misdiagnosis or mistreatment. It is not a secret among the peo- ple of the Black community that those who receive care in public clinics and hos- pitals—and even in clinics of private institutions—are the “material” on whom students practice and on whom medical research is done.
Some Blacks fear or resent health clinics. When they have a clinic appoint- ment, they usually lose a day’s work because they have to be at the clinic at an early hour and often spend many hours waiting to be seen by a physician. They often receive inadequate care, are told what their problem is in incomprehen- sible medical jargon, and are not given an identity, being seen rather as a body segment (“the appendix in treatment room A”). Such an experience creates a tremendous feeling of powerlessness and alienation from the system. In some parts of the country, segregation and racism are overt. There continue to be reports of hospitals that refuse admission to Black patients. In one case, a Black woman in labor was not admitted to a hospital because she had not “paid the bill from the last baby.” There was not enough time to get her to another hospital, and she was forced to deliver in an ambulance. In light of this type of treatment, it is no wonder that some Black people prefer to use time-tested home remedies rather than be exposed to the humiliating experiences of hospitalization.
Another reason for the ongoing use of home remedies is poverty. Indi- gent people cannot afford the high costs of American health care. Quite often— even with the help of Medicaid and Medicare—the hidden costs of acquiring health services, such as absence from work, transportation, and/or child care, are a heavy burden. As a result, Blacks may stay away from clinics or outpatient departments or receive their care with passivity while appearing to the provider to be evasive. Some Black patients believe that they are being talked down to by health care providers and that the providers fail to listen to them. They choose, consequently, to “suffer in silence.” Many of the problems that Blacks relate in dealing with the health care system can apply to anyone, but the inherent racism within the health system cannot be denied. Currently, efforts are being made to overcome these barriers.
Since the 1960s, health care services available to Blacks and other people of color have improved. A growing number of community health centers have emphasized health maintenance and promotion. Community residents serve on the boards.
Among the services provided by community health centers is an effort to discover children with high blood levels of lead in order to provide early diag- nosis of and treatment for lead poisoning. Once a child is found to have lead poisoning, the law requires that the source of the lead be found and eradicated.
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Today, only apartments free of lead paint can be rented to families with young children. Apartments that are found to have lead paint must be stripped and repainted with nonlead paint. Another ongoing effort by the community health centers is to inform Blacks who are at risk of producing children with sickle-cell anemia that they are carriers of this genetic disease. This program is fraught with conflict because many people prefer not to be screened for the sickle-cell trait, fearing they may become labeled once the tendency is discovered.
Birth control is another problem that is recognized with mixed emo- tions. To some, especially women who want to space children or who do not want to have numerous children, birth control is a welcome development. People who believe in birth control prefer selecting the time when they will have children, how many children they will have, and when they will stop having children. To many other people, birth control is considered a form of “Black genocide” and a way of limiting the growth of the community. Health workers in the Black community must be aware of both sides of this issue and, if asked to make a decision, remain neutral. Such decisions must be made by the patients themselves.