The State of Black Health in America

Over 150 years from the abolishment of slavery, healthcare in America is stilled marred by systemic racial discrimination and inequality. According to the CDC, 20.2 percent of black American adults are living in fair or poor health. This is a visibly higher population compared to white, non-Hispanic (14.1 percent).

The Centra State Healthcare System states that some of the commonest health concerns among African Americans include heart disease, hypertension, diabetes, stroke, and peripheral artery disease (PAD). With a closer look at these conditions, it’s easy to notice that they are related. What’s more, they are potential risk factors for complications like end-stage renal disease and lower-extremity amputations.

PAD is a global pandemic affecting about 8-10 million adults and is 2-3 times more prevalent among black patients than white patients in America. Hypertension,another risk factor for lower limb amputation, has been described as the silent pandemic among black communities, with 56.8 percent of black men aged 20 and above and 57.6 percent of black women suffering from high blood pressure.

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Access to Quality Healthcare

Various factors are responsible for the increased morbidity and mortality of African Americans. However, it is undeniable that ease of access and the quality of care they receive from their providers play a major role. Black people have been, and are still receiving lower-quality health care, and this below-par health care is shortening their lives.

Amputation among black patients is particularly a concerning issue, whose main cause can be traced to lack of access to quality healthcare. Particularly, the reasons for poor limb salvage include advanced clinical stage, presence of comorbid diabetes mellitus and chronic kidney disease, and higher anatomic complexity of disease (which makes it unamenable to revascularization).

Most black patients with diabetes and PAD don’t have access to services like routine blood sugar, blood pressure, and cholesterol checks, vascular screening, and proper wound care. Further, lack of access to proper wound care for black patients with diabetic foot ulcers puts them at a higher risk of amputation. These preventive measures and healthcare services would be a massive boost for lower limb amputation prevention.

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Health Inequalities and Social Determinants

The state of health of African Americans has over the years been determined by social determinants and affected by inequalities such as poverty, systemic racial discrimination, environmental exposures, and lack of access to healthcare. Racism has undeniably played adetrimental role in healthcare in America. Data analyzed using random-effects models and mean weighted effect sizes showed that racism was associated with poor physical health and general well-being.

A 2002 report by the National Academy of Medicine documented that even with similar ages, the severity of conditions, insurance status, and income as white people, racial and ethnic minorities still receive second-class health care. "Second-rate health care" here means the concrete, inferior care that healthcare professionals accord their black patients.

Going by the report, it is clear that black people are less likely to be given proper cardiac care, kidney dialysis,or receive the best treatment for stroke and diabetes. From this, an uncomfortable reality comes up: Black people in America are more likely to die from preventable heart disease or lose their lower limbs due to diabetes, not just because they can’t access proper health care, but simply because of their race.

Black race and low socioeconomic status(SES) are independently prognostic of major amputations in peripheral artery disorder. The risk of amputation among black patients with claudication and low SES (in presence of diabetes mellitus and chronic kidney disease or end-stage renal disease) approaches the risk of Caucasian patients with critical limb ischemia living in high-end neighborhoods. Black race should be considered an independent risk factor for major amputations rather than a substitute for access inequality and low SES in patients with PAD.

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The Role of Black Physicians in Black Health and Wellness

Black or African American doctors make up about 5 percent of the active physicians in the U.S., which is a worrisome figure. While the shortage of Black physicians isn’t directly related to the ailing state of Black health and wellness,chronic health conditions prevalent in Black communities would be better managed with more Black doctors.

Building trust is particularly vital in managing the various health conditions common with Black people. When a patient is attended to by a doctor of the same race or ethnicity, evidence shows there's a significant improvement in time spent together, shared decision-making, medication adherence, patient understanding of the risk of their condition, perceptions of treatment decisions, and cholesterol screening.

In a Stanford University study that paired black patients to either black or non-black doctors, it was found that the patients were more likely to engage with black doctors and even agree to preventive services such as cardiovascular screenings. What’s more, black doctors were more likely to write comprehensive notes about their patients. Patients with the least exposure and trust in the medical system are more likely to benefit most from racial concordance.

Combating the Amputation Scourge in Black Communities

With the soaring amputation rates among black patients with diabetes and PAD, there is a need to stress the importance of preventing disease to close the gap. The Wound Docs brings together healthcare professionals like podiatrists, vascular surgeons, and wound care specialists in the country to curb preventable lower limb amputation invulnerable and minority communities.

The Wound Docs leverages the power of artificial intelligence (AI) and advanced biologics (skin substitutes) to improve clinical out comes in Black patients with chronic non-healing wounds. Using these advanced technologies, they are focused on healing chronic wounds rapidly and decreasing the lower extremity amputation rate in black patients.