Research targets diseases that hit blacks frequently Officials want to know why African-Americans become ill, die younger

August 02, 1998|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Officials at all levels of government are taking aim at one of the longest-standing, most ingrained problems in the U.S. health system: the gap between blacks and whites.

From meetings of frustrated local doctors to a five-year, $400 million federal initiative, agencies are studying numbers, trying possible solutions and wrestling with why African- Americans carry such a heavy burden of illness and death.

The evidence is damning. African-American babies are dying at more than twice the rate of white infants. Black adults under age 65 have a 70 percent greater risk of stroke than white counterparts. And in Maryland, African-Americans have a 40 percent higher mortality rate from heart disease than whites.

In some categories, the gap is widening.

In practical terms, it means this for the Baltimore family of Charles Harris: His father died at 64 of a stroke; his mother died at 58 with heart disease; a brother, 36, and a sister, 59, died of cardiovascular disease; another brother died of cancer in his early 60s; one brother had a quadruple bypass, and another had a heart attack.

It's a profile not uncommon among African-American families, and the numbers have mobilized people in government and the private sector.

"All over the country, people are talking,"

said the U.S. Surgeon General, Dr. David Satcher, who has made the issue a priority. "We're beginning to see action at all levels."

Baltimore-area health officers and public health advocates are meeting to analyze numbers, particularly the recent increase in infant mortality among blacks. Last fall, the state health secretary, Dr. Martin P. Wasserman, started a broad initiative on race and health that includes an analysis of how managed care affects poor Marylanders of color, and a potential collaboration with North Carolina on infant mortality.

An effort by President Clinton calls for more research, prevention, and health services, as well as programs to reduce poverty and put children in safe environments. The U.S. Centers for Disease Control and Prevention will have $30 million to award to as many as 30 grass-roots projects to scientifically compare approaches.

Causes researched

But there are many, often conflicting, theories about what's behind the racial gap. Is it food? Pollution? Genes? Or is it as deep as a doctor not wanting to touch?

While socioeconomic factors like poverty and housing have been blamed, some studies in the past year have pointed to biology.

One showed that African-Americans who smoke may absorb more nicotine than whites. Another found that prostate tumors may be more virulent in black men than white men. A third study concluded that the kidney function of African-Americans deteriorates faster than whites' when blood pressure is lowered.

In July, researchers announced that doctors should follow different surgical treatments for black and white glaucoma patients. Dr. Douglas E. Gaasterland, a clinical professor at Georgetown University and one of the authors of the study, said he doesn't believe socioeconomics are the explanation.

Others are just as doubtful that genetics and biology are a cause, noting that over the years, with so much intermingling of the races, racial differences aren't the biggest ones between individuals.

"We're all the same under the skin," said Dr. W. Michael Byrd, an instructor at Harvard School of Public Health who is finishing a two-volume work on race, medicine and health care in the United States. "The things that are probably going to end up being the major influences are external things."

Many researchers suspect a mixture, including income, culture and geography.

"The genetics set the stage for it being there, and the environment sort of tips the scale in the direction of disease," said Dr. Elijah Saunders, head of the division of hypertension at ,, the University of Maryland School of Medicine, and chairman of the International Society on Hypertension in Blacks.

Helped by monitoring group

Consider Charles Harris.

He has a family history of hypertension. But when his physician diagnosed his and put him on medicine, Harris said, the doctor didn't emphasize its seriousness. So, at breakfast, Harris continued to eat foods that made his illness worse, mopping up his eggs with butter-soaked biscuits.

"You could tell me my pressure was up, but that didn't mean anything to me," Harris said. "I didn't know what blood pressure was."

It wasn't until five years later -- when he had his blood pressure checked at a Masons' meeting -- that he understood he needed to revamp his diet and make other lifestyle changes.

"I decided I would try to beat the odds," said Harris, 67, who proudly declares himself in "perfect health." Now, he trains others and volunteers for the group that helped him, the Community Health Awareness and Monitoring Program, or CHAMP.

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