Race, Health & Medicine The View from the Black Diaspora

1. Race, Health & MedicineThe View from the Black Diaspora Sheila L. Thorne President & CEO Multicultural Healthcare Marketing Group

2. The Global Village 82 out of 100 Persons of Color 61of the 82 Asians 9 out of 100 Speak English www.TheDiversitySpeaker.com If the World Were 100 Updated 201000 People updated 2010

3. A Microcosm of the Global Village

4. “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

5. “Slave Health Deficit” An American Health Dilemma Race, Health & Medicine in the United States Slavery to 2000 W. Michael Byrd, MD, MPH Linda A. Clayton, MD, MPH Harvard School of Medicine Harvard School of Public Health

6. Blacks/AfricanAmericans45,003,665 = 14% of U.S. Population

7. Gary 84% Chicago: 39% Detroit: 85% New York: 32% Philadelphia: 45% Baltimore: 65% Oakland: 44% Washington, DC: 72% Memphis: 64% Atlanta: 67% Los Angeles: 14% Miami: 27% Dallas: 48% Houston: 28% New Orleans: 61.9% Black/African-American Population Cleveland: 53% St. Louis: 51% Miami Gardens: 77% 7

8. Health Profile of Blacks/African Americans • Tend to be poorer in health • Lower level of symptom and disease awareness • Use fewer health services • Suffer disproportionately from premature death, disease and disabilities • Do not receive preventative health tests and the likelihood of undergoing those screenings declines with age • Higher mortality rates • Co-morbid conditions; multiple meds • First entry in healthcare system – advanced disease • CHRONIC STRESS!

9. Cardiovascular Disease Cancer Diabetes HIV/AIDS Infant Mortality Asthma Mental Health Disorders LeadingHealth Disparities National Institute of Medicine – Institute of MedicineUnequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

10. WhyHealthDisparities? No health insurance Poverty Low Literacy Poor Housing Unemployment Social policy Bad Neighborhoods Hopelessness Stress Smoking Limited Access to Care Adverse Environmental conditions Poor Education Poor Family Support Poor Working Conditions Racism Lack of access to good Nutrition Adapted from A. R. James

11. 1985 Heckler-Malone Report • The Report stated: " Despite the unprecedented explosion in scientific knowledge and the phenomenal capacity of medicine to diagnose, treat and cure disease, Blacks, Hispanics, Native Americans and those of Asian/Pacific Islander heritage have not benefited fully or equitably from the fruits of science or from those systems responsible for translating and using health sciences technology."

12. “Our findings indicate that the race and sex of patients independently influence physicians’ recommendations for the management of chest pain. They suggest that decision making by physicians may be an important factor in explaining differences in the treatment of cardiovascular disease with respect to race and sex.” The Beginning Of The Cultural Competency Movement SOURCE: Schulman KA, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization.  N Engl J Med. 1999; 340:618-26 12

13. Racial and Ethnic Health Disparities: Documented Data! “Our findings suggest that race and sex independently influence how physicians manage chest pain.” Kevin Schulman, MD, The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catherization, NEJM 1999

14. 2002 Institute Of Medicine Report“Unequal Treatment” Health disparities remain even after adjusting for health insurance coverage, income, education and health care system characteristics that influence access to and quality of health care. Racial and ethnic minorities receive less than quality care in America. REFERENCE: Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002.

15. American Medical Association Physicians dedicated to the health of America Cultural Competence Initiative “Unconscious bias”

16. American Medical Association Apologizes for Racism July 30, 2008 “On behalf of the American Medical Association, I unequivocally apologize for our past behavior,” said AMA President Dr. John C. Nelson, “including barring Black physicians from our ranks for decades.” “We pledge to do everything in our power to right the wrongs that were done by our organization for decades to African-American physicians and their families and their patients.”

17. Cultural SensitivityCulturalCompetencyNational Movement Cultural Sensitivity– a recognitionand awareness that there are differences between cultures Cultural Competency – a set of behaviors, attitudes and policies that enables effective work in cross-cultural situations; the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors and needs presented by individuals and communities.

18. Professionally Active MDs - Clinicians Source: American Medical Association Physician Characteristics

19. PROFESSIONAL MEDICAL SOCIETIES: published guidelines/policies related to the care of culturally diverse populations and the elimination of health disparities • Society of Teachers of Family Medicine • American Academy of Family Physicians • American Osteopathic Association • American Academy of Pediatrics • American College of Physicians • Society of General Internal Medicine • American College of Cardiology • American Heart Association • American Psychiatric Association • American College of Obstetrics & Gynecology • American College of Emergency Physicians • American Academy of Orthopaedic Surgeons

20. Psycho social impact of racism…on healthcare! “Discrimination is the hellhound that gnaws at Negroes in every waking moment of their lives declaring that the lie of their inferiority is accepted as the truth in the society dominating them.”

21. U.S. History of Bias and Discrimination • Imposed by legislation • Supported by business • Enshrined in government policy • Enforced by flawed U.S. judicial system • Legitimized by bigots

22. 20.0% 15% 13% 15.0% 11% 10.0% 5% 5.0% 1% 0.0% African Americans Believe They Would Receive Better Health Care If They Were of a Different Race Total White AfricanAmerican Hispanic AsianAmerican 22 Source:The Commonwealth Fund 2001 Health Care Quality Survey

23. African Americans More Likely to Feel Treated with Disrespect * Felt disrespected because of ability to pay, to speak English, or their race/ethnicity Percent of adults who felt they were treated with disrespect* AfricanAmerican AsianAmerican Hispanic Total White Source: The Commonwealth Fund 2001 Health Care Quality Survey

24. Chart 16 African Americans HaveLess Confidence in Their Doctors Percent of adults reporting great deal of confidence in doctor Source: The Commonwealth Fund Health Care Quality Survey.

25. Trust & African Americans Widespread, deep-rooted mistrust/distrust of clinical research, healthcare providers, Western medicine, U.S. healthcare system

26. The Tuskegee Syphilis Experiment1932 – 1972 • In 1932, Public Health Service began Tuskegee Study of Untreated Syphilis in the Negro Male – to record the natural history of syphilis in hopes of justifying treatment programs for Blacks • Initially involved 600 Black men – 399 with syphilis, 201 without; conducted without patients' informed consent   • Men did not receive the proper treatment; penicillin became treatment drug of choice for syphilis in 1947--not offered to these men! • Originally projected to last 6 months, the study lasted 40 years SOURCE: Centers for Disease Control and Prevention: US Public Health Service syphilis study at Tuskegee. (http://www.cdc.gov/tuskegee/timeline.htm)

27. HenriettaLacks–HeLa Cells 1. In 1951, Henrietta Lacks, African American mother of five, native of rural southern Virginia, went to Johns Hopkins Hospital and she was quickly diagnosed with cervical cancer. Eight months later, she died at age 31. 2. Researchers took a fragment of Lacks' tumor and sliced it into little cubes. The cells, dubbed "HeLa“, multiplied as no other cells outside the human body had done before. 3. Their growth spawned a breakthrough in cell research. The cells were put into mass production and traveled around the globe--even into space.

28. J. Marion Sims, MD, PhDFather of Gynecology In the 1840s, J. Marion Sims, MD, a native of South Carolina, touted to be the Father of Gynecology, owned slaves in Alabama, and in fact, actually purchased slave women and conducted experiments on them for several years in his backyard hospital. Sims honed his surgical skills by performing scores of painful operations on the genitals of black female slaves. His early attempts so often failed that he operated on one young black woman 34 times without anesthesia. Dr. Sims became the world’s leading authority on female reproductive health and by the late nineteenth century, he was internationally praised and rewarded for his surgical discoveries.

29. Communities of ColorParticipation in Clinical Research • Blacks/African Americans comprise 14% of U.S. population but just 5% of clinical trial participants • African-Americans on average are twice as likely and Hispanic Americans are 1.7 times more likely to develop type II diabetes yet underrepresented in clinical trials of new medications. • Hispanics/Latinos comprise 16% of U.S. population but less than 1% in clinical trials • Cancer is leading cause of death for Asian Americans yet less than 3% of trial participants. Sources: http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm; clinicaltrials.gov; www.cdc.gov/nchs/data/factsheets/factsheet_disparities.pdf ‎

30. Factors Contributing to Variability in Drug Response BIOLOGICAL FACTORS Age Gender Genetics Disease CULTURAL FACTORS Attitude Beliefs Family influence VARIABILITY IN: Drug metabolism Drug receptors Drug response proteins Disease progression proteins ENVIRONMENTAL FACTORS Climate Smoking Parasites Alcohol Pollutants Drugs Adapted from Poolsup et al. (2000)

31. Perceived and Real Barriers • Widespread, deep-rooted mistrust / distrust of scientists, White researchers, medical establishment • Based upon historic abuses (Tuskegee Syphilis Experiment), personal negative experiences, documented institutional racism in healthcare delivery • Pressure from family members with negative attitudes about clinical research • Time, travel and economic barriers • Personal obstacles: work / family-related (e.g. childcare, eldercare) • Communication / language / literacy issues • No insurance or Under-insured • Lack of access to healthcare and healthcare information

32. Loretta Mary Aiken Jackie ‘Moms’ Mabley

33. “If you always do what you always did, you will always get what you always got.” Jackie ‘Moms’ Mabley

35. Crayola – Skin Tones!

36. Quality, Affordable, Accessible, Culturally Respectful , Evidenced-Based, Healthcare is not a privilege. It’s a civil right!