Health care eludes blacks Decline continues despite many medical advances

August 27, 1991|By Wiley Hall 3rd

There probably are more black doctors now than at any time in the nation's history -- some 16,000, according to the National Medical Association.

Yet the black community appears sicker than ever. Every year, according to federal estimates, some 60,000 black men, women, children and infants die of illnesses that should have/could have been prevented.

"When you look at the problems -- infant mortality, hypertension, cancer, cardio-vascular disease -- our health is the worst that it's been for a long, long time," said Dr. Levi Watkins, the internationally renowned heart surgeon and professor at Johns Hopkins Hospital.

"African Americans are dying of friendly fire," Dr. Watkins continued grimly. "The fire of indifference, the fire of abandonment.

"We lead in everything," Dr. Watkins said. "We lead in heart disease. We lead in diabetes. We lead in prostate cancer, glaucoma, asthma -- everything. And there isn't anything funny about us racially that makes us lead in everything. The main problem is disempowerment. Disempowerment and friendly fire lead to poverty and that leads to a chronic underclass and that leads to this chronic illness in the black community."

Dr. Watkins' grim prognosis earlier this month launched a frank, and at times gloomy discussion on the health problems plaguing the black community in Baltimore and in the United States.

A dozen city physicians participated, representing various medical disciplines. All of the participants were black, and as such, felt particularly pained by the multitude of ills besetting their community.

Those ills are legion.

National studies have found that infant mortality for blacks is twice as high as for whites. Black children are four to five times more likely to catch tuberculosis. Nearly half of all women who die in childbirth are black, and most of those deaths were preventable. Black men are six times more anemic.

Earlier this summer, a study by Johns Hopkins University found that rates of blindness and visual impairment among blacks may twice as high as for whites. Much of that blindness or impairment could have been prevented with proper treatment.

On the average, a black American born in 1988 can expect to live five to six years less than a white person born at the same time. If that baby is a male, homicides alone make him statistically lucky if he survives young adulthood.

Blacks have twice as much heart disease as whites, 33 percent more diabetes. The black death rate from strokes is 80 percent higher. The black death rate from flu and pneumonia is 1.5 times higher -- and these statistics represent just a partial list.

Just two months ago, U.S. Secretary of Health Louis Sullivan noted that "while the health status of the general population has increased, black health status has actually declined.

"This decline," added Secretary Sullivan, "is not in one or two health categories, it is across the board."

And the problems that affect blacks nationwide are particularly acute in Baltimore. The city, for instance, ranks at or near the top in cancer deaths, infant mortality and teen-age pregnancy.

In his address, Mr. Sullivan attributed much of the disparities between the health of blacks and whites to racism and its effects.

But the physicians participating in the round table discussion in Baltimore agreed that racism is only one of the factors.

There also are economic issues and lifestyle issues and education issues and problems with the quality and availability of care that blacks receive.

"There is a 'woe is me' perspective in our community," said Dr. Maxie Collier, a psychiatrist and former commissioner of the city health department.

"Despair and hopelessness is at an all-time high. We have been in a state of despair as a community that is akin to clinical depression."

This despair, said Dr. Collier, leads to suicidal behavior among many blacks, "in a concrete way by people killing themselves or each other, or in a symbolic way by eating things they shouldn't eat, smoking things they shouldn't smoke, or taking all of these poisonous substances.

"So we have a lot of suicidal behavior," continued Dr. Collier, "that allows us to engage in self-destruction, working in and hand with the racism of the system."

"We have a lot of lifestyle problems that feed into our situation," agreed Dr. Miles Harrison Jr., an area surgeon, "along with lack of access to the health care system and our failure to interface with the system so that we are in such bad shape when we finally do.

"All of these issues are inextricably tied together," he continued. "You can't just look at health. You can't just look at disenfranchisement, and you can't just look at homelessness. The problems are tied together in such a way that there has to be a mega-approach."

The physicians were particularly concerned that many people simply were not seeking care even when care was available.

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