TIME: Almanac 1993/TIME Almanac 1993.iso/time/091691/0916130.000

Text File | 1992-08-28 | 12.1 KB | 265 lines

                                                                                HEALTH, Page 50

Why Do Blacks Die Young?


The gap in life expectancy between the races in America remains
wide. The search for the causes runs from poverty and prejudice
to life-style.

By CHRISTINE GORMAN -- Reported by Julie Johnson/ Washington,
Andrew Purvis/New York and Don Winbush/Atlanta


    The birth of a child is a time of joy and promise. In a
land as rich as the U.S., all parents have the right to expect
a life long and healthy for their sons and daughters. But the
odds that this wish will come true are shockingly reduced if the
baby happens to be black.

    A white baby stands a 70% better chance of reaching its
fourth birthday than a black child. And the average life
expectancy of African Americans is 70.3 years, much less than
the 76 years that white Americans can expect.

    The life-spans of both races have lengthened over the
decades, but the gap between white and black has remained
stubbornly wide, and it increased sharply during the Reagan
years, when many social programs that helped minorities were
slashed. The gap has since begun to narrow, but it is just as
large now as it was in 1982. This lack of progress has become
one of the most studied issues of public health and one of the
greatest challenges facing government policymakers. Why are
blacks dying so much younger than whites?

    One cause is the crime and violence that plague many inner
cities. Black boys between the ages of one and four are three
times as likely as white toddlers to be the victims of homicide.
Black teenagers are murdered six times as often as whites.

    But crime is only a small part of the story. Study after
study shows that blacks are just not as healthy as whites or
other racial groups -- at any age. Black toddlers are three
times as likely as white youngsters to die from meningitis,
pneumonia or influenza. Black men are three times as likely to
contract AIDS, and 50% more likely to die from a heart attack,
even if they make it to a hospital. Death from stroke is five
times as common in African Americans of both sexes between the
ages of 35 and 55. Advanced kidney disease is 15 to 20 times as
common.

    Better medical treatment and health education for African
Americans could reduce the black-white mortality gap by an
estimated 60%. "We have a whole segment of our population dying
unnecessarily, and we're worried about whether to eat oat-bran
or wheat-bran muffins," fumes Dr. David Ansell, director of
ambulatory screening at Chicago's Cook County Hospital. "It's
the medical equivalent of Marie Antoinette's saying `Let them
eat cake.' "

    Much of the difference between black and white life-spans
results from poverty and discrimination. But the problem is a
maddening mosaic involving many other factors as well. New
evidence suggests that part of the reason blacks suffer more
from high blood pressure, for example, may lie in genetics. Many
analysts have also cited lack of preventive care and cultural
differences -- such as a fattier diet and a higher rate of
smoking among blacks. None of these factors, however, can be
completely separated from the others.



    Poverty. One-third of African Americans live below the
official poverty line (an income of $12,000 a year for a family
of four), in contrast to 12% of whites. Although the Medicaid
program offers free treatment to the poorest citizens, many
low-income working people are not fully insured. Moreover, the
everyday struggle to survive often takes precedence over health
care. "For many people the question may be `Do I go to work
today, or do I see the doctor?' " says Dr. Earl Scott, medical
director of the Sydenham Clinic, part of a network of free
clinics in Harlem.

    Perils of living in poverty also take their toll. The
sharing of contaminated needles among drug users speeds the
spread of AIDS. Alcoholism, stress and poor diet help fuel
increases in cardiovascular disease, diabetes, cancer and liver
failure. A study in Washington found that 50% of black men
living in public housing suffer from hypertension, in contrast
to 20% of all black men in the city. And 25% of the projects'
women suffer from diabetes, against 7% in Washington as a whole.

    Unfortunately, preaching about health care can seem
laughable in crime-ridden inner cities. "We went door to door
in half a dozen black neighborhoods in St. Louis looking for
young men who had significant hypertension," says Dr. H.
Mitchell Perry of Washington University. "These guys said,
`Look, this is not my biggest problem.' They were wondering
whether they would live to age 35."



    Lack of Preventive Care. Measles, syphilis and other
infectious diseases staged deadly comebacks during the 1980s,
hitting blacks particularly hard. Much of this increase can be
tied to breakdowns in the public health system. In 1982, when
the federal immunization program against measles was cut, health
officials counted 1,700 cases nationally. Last year there were
more than 27,000 cases -- primarily in poor urban areas -- with
89 deaths. In the early days of the AIDS epidemic, health
officials cannibalized their syphilis programs, which had
focused on the inner city, in order to combat the new threat.
As a result, the incidence of syphilis among African Americans
doubled between 1985 and 1989.

    The high rate of infant mortality (18 per 1,000 births for
blacks, vs. 9.2 per 1,000 for whites) results in large part from
the lack of prenatal care, which is perhaps the most
cost-effective type of health care available. Each dollar spent
on prenatal care saves between $3 and $20 in medical expenses
in the infant's first year of life alone. And yet total
government funding for prenatal care -- on both the local and
federal levels -- fell throughout the 1980s.

    Meanwhile, fewer blacks are seeing private physicians than
ever before. In 1977, 3 out of 5 were covered by private health
insurance. By 1987, the ratio had dropped to less than half.
Black doctors tend to treat more black patients than do their
white colleagues. Yet the number of black doctors declined from
26,000 in 1984 to 16,000 last year, largely because federal
scholarship programs for medical students have been cut back.

    With nowhere else to go, many African Americans rely on
the local emergency room for all their medical needs. "The
emergency room may treat a patient's pneumonia, but it won't do
a Pap smear or screen a woman for breast cancer," says Dr. Marc
Rivo, director of the division of medicine at the Department of
Health and Human Services. Without early detection, more than
half of black women with breast cancer admitted to Harlem
Hospital are already incurable, in contrast to 8% of whites at
a nearby facility.



    Discrimination. For unknown reasons -- prejudice may be
the only explanation -- many doctors and hospitals do not treat
blacks' medical problems as seriously as those of whites. In one
study, researchers found that, regardless of income, blacks are
half as likely as whites to receive bypass operations for their
heart problems. Another investigation revealed that among
patients undergoing dialysis for kidney disease, whites are 33%
more likely to get a kidney transplant. A third study showed
that blacks who were hospitalized for pneumonia received
less-intensive treatment than whites.

    No doubt anticipating inferior care, many blacks avoid
doctors and hospitals altogether. Black women report a prevalent
attitude among gynecologists that anything wrong might be the
patient's own fault. "Back a few years ago, I was having
excruciating abdominal pain, and I wound up at a hospital in my
area," says Alicia Georges, who lives in the Bronx and is a
professor of nursing at Lehman College. "The first thing they
began to ask me was how many sexual partners I'd had. I was
married and owned my own house. But immediately, in looking at
me, they said, `Oh, she just has pelvic inflammatory disease.'
"



    Life-Style. Louis Sullivan, Secretary of Health and Human
Services and the highest-ranking black in the Bush
Administration, warns African Americans not to exaggerate the
effects of poverty and bias on their health. Says he: "The top
10 causes of premature death in our nation are significantly
influenced by personal behavior and life-style choices."
Sullivan has exhorted blacks to quit smoking, cut down on
drinking and lose weight. Such personal initiative, he claims,
"could eliminate up to 45% of deaths from cardiovascular
disease, 23% of deaths from cancer and more than 50% of the
disabling complications of diabetes."

    The evidence tends to back him up. A half-century ago,
blacks developed cancer less often than whites. Now, in large
part because of smoking, the mortality rate for malignancies is
25% greater for blacks than it is for whites. Almost half of
black women and one-third of black men are severely overweight,
vs. one-fourth of white men and women. In addition, the salt in
soul food can aggravate high blood pressure. "We have to teach
people that diet is important," says Dr. Harold Freeman, a
surgeon at Harlem Hospital. "As the saying goes, if you can
control your mouth, you can control your life."



    Genetics. In a study of 50 black and 219 white physicians,
who presumably have access to care and can make improvements in
their diet, researchers found a marked difference in the
ability to handle cholesterol. Compared with their white
colleagues, the black physicians exhibited higher blood levels
of a type of lipoprotein believed to aggravate blockage of
coronary arteries. Other research found that elderly black men
are twice as likely to develop tuberculosis as white men living
under the same socioeconomic conditions. Perhaps, scientists
speculated, genetic differences affected the body's ability to
knock out the bacteria.

    More controversial has been the search for a hereditary
factor underlying hypertension. Stress and diet are known to
affect high blood pressure. Racism may also play a role. But
"there is so much excess hypertension in blacks that it's
inconceivable to me that these factors alone are the ones that
balance the equation upward," says Dr. Elijah Saunders, a
cardiologist at the University of Maryland Medical System. Some
researchers have even suggested that African Americans have
inherited a greater sensitivity to salt. But any explanation
along genetic lines will have to account for the fact that
modern-day Africans do not appear to be particularly susceptible
to high blood pressure.

    However important it may be, genetics is not destiny. Nor
is poverty, culture or racism insurmountable. In fact, a number
of developing countries, working with meager budgets over the
past 20 years, have surpassed many parts of the U.S. in health
care. A man living in Bangladesh, one of the poorest nations,
has a better chance of reaching age 65 than a man in Harlem.

    Given the limited amount of government aid for preventive
medicine, a few American communities have started up their own
public-health-education programs. One of the most promising is
in the Mississippi Delta counties of Humphreys and Leflore,
where nearly half the primarily black population lives under the
national poverty line. Three years ago, the Freedom from Hunger
Foundation joined two state agencies to create the Partners for
Improved Nutrition and Health. The program enlists volunteers,
such as Bertha Thurman, to serve as health advisers in their
communities. After completing a 10-week training course, Thurman
has become a crucial bridge to the medical system. "We get
called on to do everything from provide an aspirin to pay the
utility bill," she says. "And we reinforce what the local health
department has already mentioned to people."

    This kind of self-help program is only a beginning.
Secretary Sullivan's emphasis on individual responsibility is
only a beginning. After decades of nothing but beginnings,
governments at all levels need to put more effort into bridging
the gap between black and white health.