Healthcare spending is at an all-time high in the U.S., yet young African-American men see little benefit, according to new research published in the current issue of the Journal of the American Medical Association (JAMA).
The researchers point out that black men have a life expectancy nearly five years less than white men. While heart disease and cancer contribute to this decreased life expectancy, homicide also plays a large role. From ages 1 to 14, homicide is either the second or third leading cause of death for African-American men, and from ages 15 to 34, it is the leading cause of death. A particularly frightening statistic cited by the researchers: Black men are safer in prison. Data show that black men are half as likely to die if they are in prison than if they aren’t incarcerated, whereas white men die at higher rates if they are incarcerated.
There have been calls from the public health sector to address the health of young African-American men, but the medical community has been relatively silent, according to lead author Stephen Martin, MD, EdM, of the department of family medicine at Boston Medical Center (BMC) and the Boston University School of Medicine.
“[W]e in the medical field are not meeting young African-American men where they are to address their medical needs — cardiovascular disease, diabetes management, HIV, mental health and much more,” Martin and colleagues wrote. They explain:
Traditional models of medical practice generally stand apart—in place, time, and perspective—from the experiences and needs of young African American men. Instead of the traditional routes of enrolling in primary care, lower-income African American men more readily connect with health care through military service, prison, or emergency departments. Health care systems are not well designed to acknowledge, attend to, and successfully address the health issues that are most salient: violence, trauma, shootings, and the psychological anguish that accompanies them.
Shortages of primary care practitioners in certain areas certainly add to this problem. Even when clinicians are available, they may recognize risks but have little to offer to ameliorate them.
Many African American men are invisible from health care settings until their health conditions are severe, resulting in preventable disability and death, the authors say. For example, African American men are 30% more likely to die from heart disease and 60% more likely to die from stroke than are white men. Additionally, African American men are 3-4 times more likely to experience serious complications stemming from diabetes, including limb amputations and end-stage renal disease.
The authors call for improved funding and other support for social and public health programs to address the disparities in healthcare, particularly as they impact young African-American men. Effectively addressing social determinants of health — conditions in which people are born, grow, live, work and age — has the greatest impact on health disparities and requires interventions beyond just medical care, the researchers said.
“There are many shadows that young African-American men in this country walk with every day of their lives; shadows that impede their ability to access a myriad of needed services,” said co-author Kenn Harris, president-elect of the National Healthy Start Association. Racism, economic inequality, harmful masculinity scripts, and disproportionate incarceration rates are just a few examples of the social conditions that affect the health of young African American men, as well as their interactions with the health care system.
The authors also point out that U.S. public health programs and activities receive only three cents of each healthcare dollar to support efforts to improve the health and well-being of our most vulnerable populations. That’s a costly decision: According to a recent analysis from Johns Hopkins University, health inequities among African-American men accounted for $341.8 billion in excess medical costs between 2006 and 2009.
For medical care itself to improve, they call for proactive engagement and partnerships, effective lifestyle support such as the YMCA’s Diabetes Prevention Programs, creating trusted spaces for men to feel comfortable and safe, and the use of newer technologies such as texting and virtual care team members to communicate with patients.
Martin and his colleagues also stressed the importance of programs such as the National Healthy Start Association, which bases its fatherhood programs on first addressing survival needs to ensure family involvement. Over the years, Healthy Start has developed programs that involve fathers, helping them to have bigger roles in their children’s lives and promote the importance of responsible fatherhood, thereby adding value and strengthening family resilience.
“There is still much to be done to meet men on their own terms and provide them with the survival, behavioral, and medical care they need,” said Brian Jack, MD, chair of the department of family medicine at Boston Medical Center and Boston University School of Medicine. “Traditional medical care generally isn’t built to do this well. But we are learning better approaches and ways to join efforts with others to truly and effectively meet the needs of young African-American men.”