Page 57 - Cultural Competence in Health Education

Disparities in Health Among Racial and Ethnic Groups 35

health because they have a higher mortality for these conditions. The Partnership for
Prevention reports that if the 42 percent of African Americans aged 50 and older who are
current with recommended screening could be increased to 90 percent, an additional
1,100 lives could be saved annually (Partnership for Prevention, 2007).
In 2002, non - Hispanic blacks who died from HIV disease had approximately
eleven times as many age - adjusted years of life lost before age 75 per 100,000 popula-
tion as non - Hispanic whites did (CDC, 2005). Blacks also had more years of potential
life lost than non - Hispanic whites did for suicide (nine times as many), stroke (three
times as many), and diabetes (three times as many).

The exact mechanism underlying these findings is not well understood but a grow-
ing body of literature suggests that they are not due just to difference in socioeconomic
status, which accounts for many of the observed racial disparities in health, but rather
to a complex interaction of race and SES. Racism, expressed as both individual and
institutional discrimination, can adversely affect health status by restricting socioeco-
nomic opportunity and mobility. Living in poor neighborhoods, experiencing discrim-
ination, and accepting the social stigma of inferiority can have negative impacts on
health (Williams, 1999). Blacks who challenged unfair treatment or reported that they
had not experienced racial discrimination actually had systolic blood pressure 9 to
10 mg Hg lower than their African American neighbors, family, friends, and cowork-
ers did in a study by Krieger and Sidney (1996). These results suggest that there may
be a link between discrimination and health and that more research is needed to fully
understand these differences.
Finally, in the area of substance abuse and mental health treatment, African Ameri-
cans have a huge unmet need for services, as reported by numerous health services
researchers (Hu, Snowden, Jerrell, & Nguyen, 1991; Wells, Klap, Koike, & Sherbourne,
2001; Fiscella, Franks, Doescher, & Saver, 2002; Chow, Jaffee, & Snowden, 2003).

HEALTH DISPARITIES AND HEALTH EDUCATION
This chapter has presented facts on health disparities among Americans that may seem
on the surface to be insurmountable. For students in health education programs, it may
feel as though the disparities in health care access and outcomes for the populations
discussed in this chapter are almost impossible to address. It does seem that as we

begin the twenty - first century in the United States, we are at a critical crossroads in the
history of health education practice. For many Americans it is truly the best of times as
technological advances in biology, genetics, and medicine mean that they can live
long and prosperous lives with little or no morbidity and disability until their 80s. At
the same time it is apparent that the racial and ethnic minority groups discussed in this
chapter are living shorter lives, lives compromised by more morbidity and disability
than other Americans face. The root causes of many of the disparities in health care
status and access are inequalities in income and education, racial discrimination, lack
of cultural understanding, and inability to modify health education programs to better
target racial and ethnic minority groups. All health educators need to be aware of the

7/1/08 2:50:12 PM
c02.indd 35 7/1/08 2:50:12 PM
c02.indd 35