Black & White: Death & Dying by Race & Ethnicity

Is health black and white?

Before you answer… Did you know that there are differences in death rates based on race? On average, at birth a white person may expect to live 5 years longer than a black person in the United States. This gap grows to a 10 year difference when comparing life expectancy of white women (81 years) to black men (71 years) [1, 2].

Why is this the case?

Well for starters, the leading causes of death differ down both race/ethnicity and gender lines. For instance, homicide makes the list as one of the top five killers of black men, but does not make the list for white men (nor either group of women). Diabetes makes the list as one of the top five killers of black women, but does not make the list for white women (nor either group of men) [3]. However, when comparing death rates between blacks and whites for the same disease, blacks still tend to have worse health outcomes. In fact, according to 2012 data, the U.S. Department of Health and Human Services Office of Minority Heath states “the death rate for African Americans was generally higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide” [4].

But really, why is this the case?

It comes down to what researchers refer to as ‘social determinants of health’. This term translates into how where you live, work, and play shapes your health. Moreover, these differences may in part be explained by health inequity, “difference or disparity in health outcomes that is systematic, avoidable, and unjust” [5]. For instance, it is common knowledge that many black people in America are living in poverty. This fact is tied to societal oppression dating back to slavery. Poverty manifests in predominately black neighborhoods, leading to limited access to resources such as healthy food, safe environments for physical activity, and quality health care services. As declared by Dr. Martin Luther King Jr., “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” BUT, poverty does not explain it all. Even when a 2015 study compared breast cancer survival rates between low socioeconomic status white women with high socioeconomic status black women, black women still suffered from worse health outcomes [6]. Thus, factors beyond poverty, such as racial discrimination (e.g. subconscious differences in treatment by health care professionals) must be considered.

What can be done?

First and foremost, health education and health inequity awareness must become common knowledge. Children and adults, men and women, black and white must all understand what constitutes health, so that health is not only seen as the physical absence of a pathogen, but more holistic and inclusive of mental, emotional, environmental, and social health. Professionals and patients must work together to actively address gaps in sociocultural competence/humility through being open and honest with each other. Particularly, physicians have a responsibility to treat “humanity as [their] patients” [7]. Thus, systematic discrimination must be deconstructed for the assurance of ‘justice for all’. While health policy should be at the forefront of the conversation to combat these issues of social justice, communities must also consider their power in determining their destiny. Black communities, as they have done in the past, must begin to gather, organize, and mobilize to persevere.

Now, with all of this in mind… you tell me, how long should health continue to be black and white?

Rhoda Moise is a graduate of Pennsylvania State University with a B.S. in Biobehavioral Health and a passion for health promotion. She has been trained to approach health from an interdisciplinary perspective from proteins to people. Through her doctoral studies as a PhD student at The University of Miami, she intends to combat health disparities by conducting research which provides empirical evidence that demands alteration in standing policy.

References

1 http://www.cdc.gov/nchs/nvss/mortality_tables.htm

2 http://www.cdc.gov/nchs/data/dvs/LEWK3_2009.pdf

3 http://www.cdc.gov/nchs/nvss/mortality_tables.htm#lcod

4 http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

5 http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html

6 Keegan, T. H., Kurian, A. W., Gali, K., Tao, L., Lichtensztajn, D. Y., Hershman, D. L., … & Gomez, S. L. (2015). Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. American journal of public health, 105(5), 938-946.

7 http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/declaration-professional-responsibility.page

Black & White: Death & Dying by Race & Ethnicity

Health Isn’t One-Size-Fits-All

By: Delphine Gervais, LCSW

This May will mark five years since my mom was “officially” diagnosed with stage 4 breast cancer and two years since she transitioned.  There were plenty of days that I replayed the rush to the hospital, the exposure of her upper body to the doctors, the shock at what I saw. I remember the doctor questioning my mother, “When did you feel the first lump?”  I remember hearing my mother respond, “four years ago”. (hence my reference to the word “official”).  My mother was a resourceful Haitian woman, who never missed a doctor’s appointment and who never missed out on an opportunity to eat healthy.  Olive oil was a staple in our home.  Processed food was not.  She did everything she knew how to live a fit life.  In her mind, that lump negated every effort,  and it was then that her life completely changed.

For the purpose of conversation, I opt to turn my lense to black women and what their attitudes towards receiving services imply for their ultimate well being.  The stats are not favorable for communities of color.  Heart disease, cancer, hypertension, mental health–people of color lag behind in prevention and are dying at faster rates for lack of both prevention and intervention services.  In the case of breast cancer, although screenings among black women tend to be on level with those of their white counterparts, follow-ups for negative results were much lower.  Death rates among black women are 42% higher than their white counterparts.  It is one thing to schedule and conduct one’s mammogram every year.  Everyone can do that.  It’s another thing to follow up after receiving some not so favorable results.

I didn’t believe my mother loved me and my brother less because she didn’t seek the help she needed.  It couldn’t have been an easy pill to swallow to suffer in silence. Help seeking behaviors among African-American and Afro-Caribbean women have historically been a point of concern among those in the health profession.  The cultural construct surrounding help seeking behavior for physical or mental health concerns boils down to “it’s nobody’s business but mine.” If you couple that with the religious and spiritual impact on decision-making and you likely have a woman who will keep secrets from her loved ones and bear the entire emotional burden of disease.  To say that women of color reject the notion of prevention or intervention services is a fallacy.  It is best to first understand that normalizing health seeking behavior is the first order of business.

Imagine walking into a space where medical jargon is thrown at you left and right.  Machines are beeping.  People hurry about their work day, some stay long enough to inquire as to your well-being, while others just come long enough to poke and prod and leave with nary a word.  A person who speaks the king’s English would have a hard time navigating the health system.  A person who speaks limited or no English would drown in fear and embarrassment.  There is also the matter of inequitable access to services in the communities of color.  Are clinics within walking distance or near a bus stop? Do those who provide services understand the complexities of a person of color coming to their spaces in search for help?  Are they immediately placed at ease?  Are there people present in these spaces who can walk among the emotional minefields of their patient’s mind?

I remembered offering to take my mother to a cancer support group comprised of Haitian women.  The social worker in me thought it would be best for her to be among others who were grappling with similar issues.  She gave me a blank stare and a firm “No”.  I never brought it up again.  At times, we professionals believe we know what’s best for those who need help.   Imposing our norms and expectations lessens the opportunity for the person to establish personal ownership of their circumstances.  They’ve heard about the church member who became ill, went to the hospital and never came back home.  Walking into foreign spaces and experiencing a new normal is difficult for the average human being.  Being a woman of color compounds those feelings of helplessness.  When the strong black woman mystique had been challenged and the figurative “S” was off her chest, my mother didn’t want a support group.  Attendance at weekly church services was support enough.

There cannot be a one size fits all approach to healthcare.  My mother’s doctor knew well enough not to say the big “C” word in sessions.  She was delicate and respectful in her approach, she maintained deference in her tone and she left the hard discussions during one-on-ones with me.  At times she would practice her Creole on my mom.  This would make my mom smile.  The feeble attempts at seeking commonality met with ultimate respect.  For my mom that was enough to keep her committed to returning every month.  Even when the blood work started coming back with less than positive news, she kept her appointments without fail. Being seen by doctors and nurses who knew her name and smiled with their eyes made the trips that much bearable.  Half the battle is won when communities of color are provided with opportunities to maintain their personal dignity while seeking the help they so very much deserve and need.

This is not a mandate to learn a new language or join Doctors Without Borders.  It is however a call to action for professionals in the healing arts to take stock of how they approach their patients of color.  What works for Jane Doe may not work for Marie Pierre and Mary Johnson.  Cultural norms play a big part in how they each approach seeking help.  Knowing Jane’s cultural constructs and not Marie/Mary’s should cause one to pause and assess their effectiveness in providing service.  As the Haitian daughter of a Haitian woman I thought I knew all there was to making sure my mom received the services she needed.  My westernized approach to therapeutic intervention failed miserably.  I should have known that my mother cared less about support groups than ensuring she had a nurse aid to provide meals.  She cared less about the blood work coming back negative and more about when the bus would come to take her to her prayer service.  It didn’t take me long to stop hitting my head against the proverbial wall.  It was less of what I wanted and more about what she needed.  Once I made peace with that, it was smooth sailing.

Delphine is a licensed clinical social worker with experience in education, health, social welfare, community development, and individual/family/group intervention services. Her professional background emphasizes a special focus on community involvement and service; utilizing social networking for the purpose of bridging the gap between those with established needs and those with access to the resources to meet those needs. Read more on her blog.

Source:  American Cancer Society http://www.cancer.org/

 

Health Isn’t One-Size-Fits-All

Suffering In Silence: Mental Health Conversations in Communities of Color

As a person of color, the topic of mental health is avoided like the plague in our community. We all have that family member or friend who, at the mere mention of going to counseling, shouts back “I’m not crazy”; “You should pray about it”; “Tough it out”; “Therapy’s for White people”. These answers are further distractions from the real problem. I’m not saying there’s anything wrong with seeking counseling services from your religious leaders, of which is a great support system for those who believe. However, there are some things that require a different outlook. There’s just something about a fresh perspective that can bring about change. I’ll admit to being a novice in the field, but I can say that I do have some African American clients. However, amid the few, a substantial portion fails to receive continuous care (Snowden & Yamada, 2005). High levels of untrustworthiness and the stigma drenched with the word therapy/counseling may influence this lack of commitment. A part of the problem lies in the lack of public discussion and recognition of these disparities in our community and what can be done about them. Something needs to change ASAP because I, for one, am tired of hearing about the behavior of members of another race being dismissed as a result of mental health difficulties, but my own people who are struggling mentally, just as much in some areas and more in others, being publicly ridiculed, never even given the chance to defend themselves, while struggling to stay afloat in a society that was built on our backs and which is working hard to keep us that way.

The key word here is suffering because that’s exactly what we’re doing. While many people from all different backgrounds find the topic of mental health a difficult one to discuss, African Americans especially have created such a negative association with the term that discussion is actively avoided. According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20% more likely to report having serious psychological distress than non-Hispanic Whites. Unfortunately for us, this stress is often coupled with higher levels of poverty, with those living below the poverty line being 3 times more likely to report psychological distress, when compared to those living twice the poverty level. Yet and still, White people are receiving nearly double the amount of mental health services than African Americans. A more common practice in the African American culture is to seek help from family and friends, not from “out-group members” as therapists may be viewed (Vogul et al., 2007).

To go back to the earlier misconception of being “crazy” as a reason to seek counseling, I for one do not like to use the “c” word with anyone. EVERYBODY has struggles at one point or another in their life. Therapy helps you work through them and helps you find the most effective and productive resolution. Everyone in therapy doesn’t have a diagnosis of Bipolar or Schizophrenia. Therapy can also help you work through grief, trauma due to things such as natural disasters, relationship stress, among countless other things. Yes, you can lean on friends and family for support during these times. In fact, minority groups who value close networks have been found to use family and friends rather than counselors when seeking help (Vogul et al., 2007). African American youth tend to use a family member more often than White American youth when experiencing a problem (Vogul et al., 2007). I hear you when you wonder why someone would want to pay a person to listen to his or her problems, but I promise we have a lot more to offer than our ears. Although each client is unique and each culture has its differences, through research and experience, providers have and will gain the knowledge necessary to assist minorities if you let us.
One thing we don’t see enough of is our own people offering these services. As a member of a non-dominant population, it can be hard to relate to, or expect to be related to, a person of the dominant population, especially when some of their actions have contributed to your suffering. I remember expressing my despondency regarding my relocation to a predominantly White area. Nothing wrong with White friends, I just missed my people. Speaking with a White male, he compared it to his relocation and having to adjust to fishing for a different type of fish than he was used to. I get the analogy, but c’mon now, I’m a person not a fish. Insensitivity has a huge impact on the needs of minorities seeking services and may in fact contribute to why we tend to run the other direction. However, there are issues much bigger than this that are causing us so much pain that it’s worth the exploration to find someone who you can relate to. As much as this profession is growing and expanding, the rate of ethnically diverse providers is struggling to keep up. With this in mind, it’s important for all practitioners to be culturally sensitive to the problems brought to therapy. This is important for clients to know too that they may need to provide a more in depth explanation of their struggles, and it may take some time to find someone they’re comfortable with. Cultural sensitivity can have many interpretations, but here it’s referring to awareness of unique differences that impact treatment. For instance, some symptoms may be misinterpreted in certain cultures as something other than a mental health issue. As an example, the National Alliance on Mental Illness notes that numerous African Americans struggle to identify symptoms, underestimating the impact that it may be having on a person’s life. Take depression, it may be written off and referred to as “the blues” when in reality it is a common mental health disorder experienced among African Americans more often than White Americans.

Anybody out there familiar with the TV series A Different World? I recently began binge watching it again on Netflix, and there was an episode where Whitley attended one therapy session when her feelings for Dwayne and Julian were conflictual. Her one take away was “relax, relate, release”, and I’ve noticed in future episodes that she repeats that same phrase in times of stress. Though comically expressed through Jasmine Guy’s overly dramatic character, it was a great example of one of the many benefits therapy has to offer: the things you learn can be applied to different areas of your life and used over and over again. This is especially true due to the fact that the likelihood of African Americans currently receiving services decreases if there was past service (Broman, 2012). I was pleasantly surprised at even the slightest mention of the subject of therapy in the late 80’s/early 90’s. Psychological distress doesn’t necessarily mean a diagnosable disorder; it simply refers to your mind feeling overloaded with what life has thrown at you.

There has also been a lot of discussion around medication that is offered in conjunction to therapy. True, it can be helpful, but it’s also costly in the long run of continuously having to refill prescriptions. Therapy is about activating tools that you already have within yourself to work through troubling situations. Let me tell you something, the old me was against this ‘hoopla’, as it’s often referred to, at one point too. I’ve experienced things in my life where therapy crossed my mind, and just as swiftly I kicked it out. I won’t sugar coat it, it’s a very vulnerable process; sharing your personal story with a stranger, anticipating judgment and backlash for what you have to say, expecting to be misheard and misunderstood. But for your own good, sometimes you have to take that chance. Speaking from personal experience, it’s a necessity. Just like your doctors and dentists appointments, hair appointments, even the popular need for retail therapy and other personal care appointments, this mental health check-up is just as, if not more, important.

Cost is something that can also contribute to this suffering. Many people think that all these services are offered at an unreasonable price, and that just isn’t true. There are numerous community health clinics that offer these services to individuals with or without insurance and on a sliding scale fee. Sometimes these places also have interns, who are training in the field under the supervision of a licensed professional, and offer these services free of charge. This can also be found on college campus’ that again, offer services on a sliding scale fee and sometimes free of charge. All this requires is a little research, whether it’s through the Internet, word of mouth, or asking other health care providers for referrals.

With all of the discrimination and injustice present in society, because unfortunately it doesn’t seem to be going anywhere, why not strengthen your mind so that we can continue to fight back. When will the media talk about the possibility of a black mans actions being attributed to mental health issues? When we find the motivation in ourselves to take control of our lives and stop being afraid to acknowledge that we need help. Suffering in silence is more detrimental than allowing someone who is qualified to return you to your most empowered state.

Alysha Thomas is a native of Newton, MA and a current resident of Hattiesburg, MS. In the fall she is relocating to California to obtain a Doctorate degree in Marriage and Family Therapy and is looking forward to serving in an urban community to increase the level of ethnic participation in mental health care. Alysha enjoys cooking, being outdoors, and almost everything social.

Sources:

Broman, C. L. 2012. Race differences in the receipt of mental health services among young adults. Psychological Services, 9(1), 38-48.

Snowden, L. R. & Yamada, A. 2005. Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143-166.

Vogul, D. L., Wester, S. R., & Larson, L. M. 2007. Avoiding counseling: Psychological factors that inhibit seeking help. Journal of Counseling & Development, 85, 410-422.

http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

https://www.nami.org/Find-Support/Diverse-Communities/African-Americans

Suffering In Silence: Mental Health Conversations in Communities of Color

HN Kitchen: Zucchini Boats

These zucchini boats are a simple and easy way to incorporate various macronutrients into a wholesome meal.

Zucchini is an outstanding source of manganese, vitamin C, and dietary fiber that will keep your body in the best shape for the long run. It also contains vitamin A, magnesium, folate, potassium, copper, and phosphorus .

The high fiber content of tomatoes helps improve satiety, and they are also a rich source of potassium, Vitamin C, and Vitamin A.

The ground turkey and jasmine rice provide lean protein and carbohydrates to give you fuel throughout the day.


Zucchini Boats

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HN Kitchen: Zucchini Boats

HN Kitchen: Peach Waffle Breakfast Sandwich

Summer is an amazing time. Not only is the weather warm and beautiful, but summertime fruit is just.. yum.  Right now peach season is in full swing and I have the perfect recipe to use them all up. This peach waffle breakfast sandwich will keep you in a good mood for the entire day. Peaches are not only sweet and juicy, they are also low calorie, high fiber, and rich in potassium and Vitamins A & C, if you are into that kind of thing.


Peach Waffle Breakfast Sandwich Continue reading “HN Kitchen: Peach Waffle Breakfast Sandwich”

HN Kitchen: Peach Waffle Breakfast Sandwich

HN Kitchen: Butternut Squash Mac & Cheese

Happy National Macaroni and Cheese Day!

When I was growing up I didn’t want ANY macaroni and cheese that wasn’t my mother’s. It didn’t matter if you speckled yours with pieces of gold, it still got side-eyed. My sister and I would spend what seemed like forever grating blocks of cheese, then eagerly watch her make a cheese sauce, toss it with noodles and other secret ingredients and bake it to perfection. When I first learned to make macaroni and cheese, it was my mother’s recipe, and to this day, if you catch me at a good time, maybe I’ll make it for you.

There are only two problems… 1) It is EXPENSIVE. All the cheeses add up and it doesn’t make sense to make just one serving, and 2) It isn’t the healthiest dish in the world. All the cheeses make it high in saturated fat (bad fat) and cholesterol, so even though it is (so) worth it, it doesn’t hurt to lighten it up. This dish borrows its creaminess from butternut squash so you can cut down the cheese (and money spent!) and still enjoy your favorite comfort food.


Butternut Squash Mac & Cheese

Continue reading “HN Kitchen: Butternut Squash Mac & Cheese”

HN Kitchen: Butternut Squash Mac & Cheese

Breathe, Stretch Shake: Miami’s Guide to Free Yoga

At some point in your life, you have probably vowed to take charge of your health and be a better, more fit you. Most likely, you then realized just how expensive good gym memberships can be. I have good news and bad news. The bad news is that memberships to most yoga studios are pricy, and if you aren’t firmly committed to practicing often you can find yourself wasting a lot of money. The good news is… if you are looking to escape the stresses of everyday life and free your mind, without freeing your wallet of its extra cash, there are plenty of year round free yoga classes offered around the city. Grab a mat and a friend and check out some of these completely free classes.

Miami Beach

Green Monkey Yoga and the Miami Beach Medical Group host free yoga classes at two locations on the beach every Monday & Wednesday at 6pm : Collins Park Bass Museum of Art (2100 Collins Avenue) and North Shore Park Bandshell (7275 Collins Avenue).

There is also a class at South Pointe Park (1 Washington Avenue) every Tuesday and Thursday at 6pm.

Downtown Miami

There are free yoga classes offered at Bayfront Park‘s Tina Hills Pavilion (301 Biscayne Blvd) on Mondays and Wednesdays at 6 pm, as well as Saturdays at 9am. Their website does specify that all participants must be at least 18 years old, but all classes are first come first serve and bring your own mat, water, and towel.

Upper Eastside

Daily Offering Yoga offers free classes Saturdays at Legion Park (NE 66th Street and Biscayne Boulevard) from 10-11am.

Coconut Grove

Dharma Studio offers free yoga at Peacock Park (2820 McFarlane Rd) on Tuesday and Thursday nights at 6pm and at 8am on Saturday mornings.

Currently, the free classes in Miami are limited to certain neighborhoods, so I limited this list to those classes that are easily accessible by car and/or public transportation. Namaste!

Breathe, Stretch Shake: Miami’s Guide to Free Yoga