Death rate from heart disease higher among Blacks: Bad behavior?

Eating nutritious food, exercising improves health. African Americans lack access to both.

Though the death rate due to heart disease in the United States has fallen 66% over the past 60 years, a distressing gap exists between the death rates of whites and African Americans.

According to a story in the Boston Globe last month, since 1950, the heart disease death rate dropped 65% for white men compared to just 50% for African-American men. In Mississippi, there has been no change in the heart disease death rate for African-American men in the past 30 years. Many researchers are studying why the heart disease death rate has not decreased as dramatically for African Americans as it has for whites, including Dr. Herman A. Taylor Jr. who is leading the Jackson Heart Study in Mississippi. Dr. Taylor believes that diet, exercise, obesity, and stress all play a role in heart disease among the African-American population in Jackson. Only a small percentage of the participants in his study get regular exercise, and the majority are overweight and eat either a “fast food diet” or “Southern diet.”

There’s a problem with this explanation. It becomes a victim-blaming rationale for health inequity. It amounts to saying “African-Americans die more from heart disease because of their poor health behaviors.”

However, behaviors, including health behaviors, are not innate, hard-wired routines we follow by rote. Nor do they spring up de novo. Rather, human behavior – even that which is, in part, genetically influenced – is shaped, channeled, nurtured or squelched by the physical, social, economic, cultural, and political environment in which we live. High rates of unemployment, dilapidated housing, noisy and cramped living conditions, victimization by the police, and a host of other conditions of life for African Americans in a racist society lead to increased stress. This stress stemming from racial discrimination primes this population for behaviors such as tobacco and alcohol abuse.

The profiteers in the tobacco and alcohol industries, sensing blood in the water, target the African-American community (and other vulnerable populations). The food industry targets these same communities for dumping their least-healthy products – full of fat and empty calories. These unhealthy foods are a cheaper source of calories than healthier sources. However, even getting access to healthier food is made more difficult, as African-American communities have been turned into food deserts, lacking an adequate supply of healthy fruits, vegetables, and protein-rich foods. Again, governmental policies – from zoning regulations to urban planning that privileges neighborhoods composed of people with higher socioeconomic position – are responsible for turning African-American and other minority and working-class communities into food deserts.

Nor is the lack of exercising in the African-American community an issue of individual poor health behavior. African Americans exercise less than other populations, in large part, because African-American communities lack adequate recreational facilities and parks, owing to the active neglect of local, state, and federal governments.

Should individuals, including African Americans, eat healthy, nutritious food; exercise regularly; and not abuse tobacco or alcohol? Certainly. However, focusing on individual-level “risk factors” for poor health outcomes and racial health inequities will not improve population health nor eliminate health inequities. We must ask what puts people at risk of being at risk? Racial discrimination and economic exploitation put African-American and other minority communities at risk. Until the social inequities resulting from this discrimination and exploitation are eliminated, health inequities will continue to exist.

Wednesday, June 2nd, 2010 at 13:45