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Try out PMC Labs and tell us what you think. Learn More. Not applicable. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels.

Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

This compelling assertion remains valid to date. The fact that the African American population is the least healthy ethnic group in the USA is not due to chance. The transport itself from Africa to the New World remains one of the best examples of the ability of one sector of humanity to destroy the health of another.

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Slavery associated deaths were likely much higher [ 23 ]. Once enslaved in what is now the USA, African Americans were forced to live in physical and social conditions in which their health had very little value. For more than years, enslaved African Americans suffered physical, social, and mental brutalization. The end of slavery did not mean that African Americans could suddenly lead healthful lives. To the contrary, they have been subjected to systematic discrimination and oppression for the years since slavery was abolished, and it continues nowadays.

Healthwise, this history may be viewed as resulting in two outcomes. With so much suffering and early death, those who survived this subjection may be the strongest and most resilient members of this group. However, the history of slavery and the current racial discrimination this group continues to suffer clearly underlie the inexcusably poor health status of African Americans as a whole.

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InMargaret Heckler, then Secretary of Health and Human Services HHSdissatisfied with the way health disparities were being reported to Congress, provided the first comprehensive review of health disparities endured by black and minority groups, compared with whites; the report laid the foundations for action to eliminate these disparities through health education, promotion, and access to health care. Thirty years after the Heckler Report was released, African Americans still endure unacceptable health disparities and lack the power over policy and actions that could make the changes to eliminate such disparities.

Our literature search was focused on past reviews and reports and is not a comprehensive review of recent scientific research on African American health, but a Professional black male looking for disease free lady of topics that the published literature identifies as being the top priorities for improving the health status of blacks in the USA. This review is guided by a modified social ecological model [ 67 ] that includes the social determinants of health, health disparities, main health needs, and access to health services.

Recommendations are offered to help frame policies and interventions to ameliorate African American health disparities. Our conceptual model allows us to relate social distal determinants, with individual proximal determinants of health Fig. Social determinants of health include the main variables of health inequalities, namely, race, poverty, and gender.

These influence health needs morbidity, mortality, and health risks. The social response to health needs is represented by health services policies, access, utilization, and workforcewhich in turn influences health needs and risks, by hopefully resolving or improving them. Given the amplitude of our model, we delimited content to top priorities, as supported by the relevant literature. A conceptual model or framework is not intended to represent a universal truth; its purpose and usefulness is to help comprehend and transform reality. Unidirectional, static relationships depicted in a framework do not accurately reflect the historical and social world we live in—including the health of African Americans—since social determinants of health are in turn influenced by the health status of the population; also, health risks influence the social determinants of health and modulate health policies and services.

Health outcomes in turn modify health risks and influence the social response by health services. The relationship between social disparities on health status of disadvantaged population has long been documented, although a direct causal pathway remains elusive [ 89 ].

In this complex causal network, social determinants of health include cultural mores that influence and are influenced by the health status of populations. The following sections present the main components of African American health, as outlined in our conceptual framework: social determinants of health and health disparities, health needs morbidity and mortalityhealth risks, and health services. Special emphasis is made on mental health and criminal and incarceration issues. In this section, we present the main social determinants of health disparities, namely, racism, poverty, education, housing, access to healthy foods, environmental exposures, violence, and criminal justice.

InAfrican Americans ed approximately New York State has the highest of blacks 3. It is well documented that race is a factor in health disparities that is not moderated by age, sex, and level of education [ 14 ]. Virtually, every factor considered in this document is impacted by racism. For African Americans in the USA, racism is a systemic, organized social and cultural phenomenon that, through exclusion, prejudice, and discrimination, is a cause of social and health disparities, manifested as both distal and proximal factors affecting health, for which measurements cannot always be defined [ 14 ].

Socially, racism is correlated with substandard employment, housing, education, income, and access to health services; associated risks include occupational hazards, exposures to toxic substances and allergens in the home, low-quality schooling, lack of availability of healthy foods, easy access to illicit drugs and alcohol, violent neighborhoods, and environmental exposures. This model proposes that daily stressful life events diminish coping mechanisms as well as genetic makeup—through epigenetic effects—damaging immune, hormonal, physiological, and neuronal systems from cradle to grave [ 1718 ].

Reception and utilization of health information are well-known major factors in disease prevention [ 19 ]. Fewer blacks graduate from high school As of Februaryunemployment rates were twice as high for blacks 8. Poverty is a prime predictor for lacking basic human essentials including adequate clean water, nutrition, health care, education, clothing, and shelter [ 23 ].

African Americans are the poorest ethnic group in the USA. Although African Professional black male looking for disease free lady income peaked init has been declining ever since. Poverty is highly correlated with poor health outcomes and increased morbidity and mortality. Heart disease, diabetes, obesity, elevated blood lead levels, and low birth weight are all more prevalent among poor individuals. Many factors in the physical environment ificantly influence the health of all populations including weather, topography, air quality, and vegetation.

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Many other human-made influences also affect health and contribute to health disparities, but seldom receive adequate attention. Asthma is related to poor housing, and African Americans are disproportionately affected from asthma. Segregated housing is correlated with a ificant increase in cardiovascular disease CVDand African Americans live in the most segregated conditions [ 25 ]. Location is also a health determinant, and African Americans live in the poorest neighborhoods with the highest rates of homicide.

Persons who live in poor neighborhoods are also much less likely to gain the benefits of exercise because of safety concerns. Transportation is often a problem in poor communities, presenting obstacles to accessing health care services, especially preventive care, until emergencies arise. Access to healthy foods is also a frequent problem in poor African American communities. Black neighborhoods have ificantly fewer supermarkets than white ones. Several studies also document that the food that is available in poor black neighborhoods is less fresh and of lower quality. In contrast, alcohol outlets are much more numerous in black neighborhoods.

It is not surprising that rates of obesity and diabetes are highest in poor black neighborhoods [ 26 ]. Black people are ificantly more likely to reside near sources of air pollution and a greater distance from air quality monitoring sites. African Americans are more likely to Professional black male looking for disease free lady in a neighborhood in close proximity to a Superfund 2 toxic waste site. Such location has a broad negative health impact. In these neighborhoods, hospitalization for diabetes is increased; there are many adverse pregnancy outcomes—congenital heart defects, nervous system defects, low birth weight, renal dysplasia, etc.

Childhood cancers are also increased in these settings. Violence is also a major determinant of health disparities. It is a major cause of injury, disability, and premature death. Black male adolescents are six times more likely than whites to die of homicide, and firearms are the primary method [ 28 ]. There is a very ificant lifelong inequity in exposure to violence for blacks vs. Young black males are four times more likely to die from a gunshot than their white peers. Firearm homicide was the leading cause of death for African American males ages 15—34, and the third leading cause of death for Latino males in the same age group and would be second if combined with suicides in which firearms were used.

It must also be noted that black children are twice as likely to witness domestic violence and 20 times more likely to witness a murder than white children [ 31 ]. They are also more likely to suffer maltreatment. There are currently more than 2. One in six prisoners has a diagnosable mental illness. This population also suffers from infectious and chronic disease at rates that are four to ten times higher than for the total population, including a rate of HIV infection that is 13 times that of the total population [ 33 ]. Not only do prisoners come from disproportionately poor populations, but a lack of adequate healthcare has been well documented in many US prisons Professional black male looking for disease free lady jails, despite the fact that this population has a constitutional right to health services.

The of women in prisons has been growing steadily from approximately 17, in 10 perwomen totoday 70 perBlack females are imprisoned at a rate nearly three times as high as white females, and seven out of ten imprisoned women have minor children. The impact of incarceration on the family is devastating. One of every 15 black children has an incarcerated parent, compared to one of every white children. Research has shown that children of incarcerated parents are six times more likely to be incarcerated themselves during their lifetimes [ 34 ].

More research must be done to improve our understanding of the long-term impact of this reality. Because the average prison term is less than 2. Many of those released do not have health insurance, and in many states, are not eligible for Medicaid.

There is a scarcity of rehabilitation programs for these individuals and inadequate attention to the resumption of basic rights such as voting. Despite the fact that correctional facilities provide an opportunity to reach groups often not reached by the health and social service systems, it is, instead, a major risk factor for lifetime poor health [ 35 ]. The measures commonly used to determine the health of populations and subgroups all tell the same story. Ten of those objectives were for death rates: neonatal and postneonatal deaths, adolescent deaths, firearm-related deaths and homicides, diabetes-related deaths, and deaths due to HIV infection, coronary heart disease, stroke, and cardiovascular disease among persons with chronic kidney disease.

Below, we present some of the main health indicators of health needs for African Americans [ 36 ]. Blacks had the highest age-adjusted death rate of any ethnic group in The rate for the total population was In the USA, from tolife expectancy at birth increased from Life expectancy at birth for blacks is The gap in life expectancy at birth between blacks and whites decreased from 5.

Overall, African Americans remain the least healthy ethnic population. There seems to have been marked improvement in this picture by African Americans ranked first in only four of the top 10 causes, but the listed causes had changed. Poisoning was added as a new cause and cirrhosis of the liver edged out HIV and diabetes for both of which African Americans were one for the tenth spot. Perhaps black infant mortality provides the most transparent view of black health. It has always been at least 2.

The total rate for all ethnic groups has declined steadily since reporting was initiated, but the disparity between black and white infant mortality rates persists. Interestingly, there was a pause in the decline for all ethnic groups from to Inthe infant mortality rates were 6.

The decline recommenced for the period to However, the total US infant mortality rate was 5. The low birth weight LBW level was 6. And, inthe rate of preterm deliveries was 1. Inlow birth weight and preterm births before 37 weeks gestation were the highest among black women, Inblacks trailed whites in women receiving prenatal care in the first trimester 75 vs. Inonly Black women were also more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use.

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Racial Differences in Hypertension: Implications for High Blood Pressure Management