Doctors Address Critical Health Concerns in Black Community

    From the lingering effects of COVID-19 to growing mental health needs, well-being is a critical personal and community issue. We assembled a panel of leading health specialists who have shared some of their expertise in previous issues of WayMaker Journal to address these pressing concerns. 

    Our panel:

    Dr. Carmen Woods Hollowell, a women’s health expert, is the managing principal of The Woods Women’s Group and secretary of the Executive Medical Staff of Northwestern Medicine, North Region. 

    Dr. Courtney Hollowell, a nationally regarded expert in men’s health and wellness, is chairman of Urology for Cook County Health in Chicago, and president of the Illinois State Urological Society. 

    Dr. Brandi Jackson is the Chief Behavioral Health Officer at Near North Health Services Corporation in Chicago. She co-founded The Institute for Antiracism in Medicine with her twin sister, Dr. Brittani James. 

    Dr. Brittani James currently practices at a Federally Qualified Health Center on Chicago’s South Side. Her clinical and research interests include Black women’s health, complex chronic disease management, and trauma-informed care. 

    Dr. David Montgomery is a cardiologist, founder and managing partner of PREventClinic Inc. in Atlanta, and a frequent broadcast guest expert on health issues. 

    WJ: What is the single most important health issue affecting the Black community?

    The Hollowells: Three main causes of death stand out: heart disease, cancer and homicide. Heart disease is the leading cause of death among all Americans, but nearly 46% of Black adults suffer from cardiovascular disease and many don’t know it. Blacks have the highest cancer rates and are more likely to die of cancer than any other ethnic group. The disproportionate impact of gun violence on Black Americans is undeniable with homicide being the leading cause of death for Black men under 44 years of age. Along with non-fatal injuries, homicide exacts an emotional, economic and physical toll on our communities.

    James: Structural racism has affected just about every aspect of Black health and well-being, from our access to healthy food, the ability to live in neighborhoods with clean air and free of environmental toxins, to whether we think of ourselves as human beings worthy of rest and good health. There is also the reality that the chronic stress of discrimination affects our cardiovascular and immune systems, for example.

    Jackson: Psychological trauma: Black Americans exist in a country that has been shaped by the brutal enslavement of their ancestors. They have watched Black Americans, like George Floyd, being murdered by the people who are supposed to protect them. All the while, Black people face traumatic experiences in the health care, legal and financial systems.

    Montgomery: The No. 1 killer of Black people is heart disease. While there are several forms, hypertensive heart disease (heart conditions caused by prolonged, uncontrolled blood pressure) is among the top, followed by heart disease caused by blocked heart arteries (coronary heart disease) and stroke. 

    WJ: Is the current health care ecosystem sufficient enough to address African American concerns?

    James: The current health care ecosystem is sorely inadequate to address African American concerns, for many reasons. As one example, we have a health care leadership in which African Americans and other people of color are consistently underrepresented. That means that the majority of high-level decision-making is performed by people without the lived experience of being Black. And yet, they are making decisions that deeply shape the health of Black people. 

    Montgomery: Yes, the current ecosystem is enough, but it is not being leveraged or deployed well in African Americans. In other words, we have the ability to address the concerns of African Americans, but we have yet to make it a priority. 

    The Hollowells: A lack of diversity in the health care workforce has had a negative impact on Black health equity and outcomes. Although medical schools are beginning to teach the importance of culturally competent care, it is crucial that Black patients are able to access health care providers that look like them. Black physicians are more likely to practice in underserved communities which can improve access to medical care. Additionally, Black patients report better patient-physician rapport, and are more likely to receive preventative health services and agree to necessary treatment when they are seen by Black physicians. All of which improves the health and life expectancy of Black Americans.

    Jackson: It is insufficient. According to the Kaiser Family Foundation, Black people have shorter life expectancies compared to white people. We also have the highest rates of infant mortality and maternal mortality among all racial and ethnic groups. Black people also have higher rates of cancer mortality than white people. Any system that produces such disparate health outcomes by race is not just or sufficient.

    WJ: Do we still need to be concerned about COVID and if so, what do we need to do?

    Jackson: At this point, I suggest thinking about COVID the same way you think about the flu. Make sure you and your family keep up with vaccinations and make hand-washing a part of your normal routine. Take all recommended precautions to protect yourself, but don’t live your life in fear. The pandemic put many of our lives on hold for a very long time. We can prevent and treat COVID now. It is safe to go on living.

    James: We absolutely still need to be concerned about COVID. Even several years into COVID, doctors and researchers continue to learn more about the infection that make this particularly clear. For example, long-COVID—when COVID symptoms go on longer than four weeks—can be debilitating. More than 200 symptoms have been identified affecting multiple organ systems. It is best to continue to minimize your risk of COVID infection through masking when indicated and getting the COVID vaccine.

    Montgomery: COVID-19 is likely here to stay for a while. For hundreds of families, it is still very much a concern. As of March 3, 2023 , the death toll in the U.S. from COVID-19 was reported to be 818 people for the day. Remember that COVID is still in the community. Remove yourself from people who are coughing, sneezing or who otherwise appear ill. Masking is an easy option especially in crowded indoor environments, like airplanes. 

    The Hollowells: The coronavirus pandemic has disproportionately impacted Black Americans. They are twice as likely to die from COVID-19 as white Americans and three times more likely to be hospitalized with the complications of the virus, resulting in a drop in Black life expectancy of 2.7 years from pre-pandemic levels. Black Americans are especially vulnerable given the relatively high chronic disease burden in our families. If you have not received an updated vaccine, get it now.

    WJ: What does the term “good health” look like for Black people?

    Montgomery: Developing and executing a strategy for your own personal best health is the key. That involves: 1) Hiring doctors you trust and doing all of the key health screens and reviewing health predictors. 2) Putting your plan for exercise on your calendar. 3) Planning your meals to avoid the trap of frequent use of fast or highly processed food. 4) Prioritizing your sleep schedule (7-8 hours each night). 5) Sticking to a mindfulness regimen (10-20 minutes of prayer or meditation).

    The Hollowells: Familiarize yourself with your blood pressure, body mass index, kidney function, blood lipids and glucose level. Prioritize regular health checkups and cancer screenings. By knowing your numbers, you may learn a lot about the state of your health. Not unlike improving your golf game, the first thing you should do is to know your stats. This will help you pinpoint what part of your game you need to work on.

    Jackson: Good health is more than the absence of disease. It’s the presence of freedom, peace and joy. Good health looks like honoring our bodies by engaging in physical activities we enjoy, honoring our minds by seeking new knowledge and honoring our spirits by connecting with our higher purpose.

    James: Good health for Black people looks like a balance of the mind, body and soul. It feels like peace. It means fulfilling relationships and living in community with others. It means you have identified, learned from and made peace with your past traumas and hardships. It is knowing your life’s purpose and having the energy, resources and motivation to pursue it.

    WJ: If you could change one thing in today’s health care system what would it be?

    The Hollowells: We must continue to cast a spotlight on health care disparities. For example, maternal and infant health is widely regarded as an indicator of a population’s overall health. Black women are four times more likely to die from pregnancy-related causes than white women. Their babies’ lives are at greater risk too. But that risk seems to drop when Black physicians oversee their care. Racial bias can play a big part in health disparities and likely contribute to this alarming trend.

    James: How it is funded. Profit is currently the driving imperative of our system. That drive is fundamentally incompatible with the maintenance of human lives and dignity. As long as profit drives our systems, instead of improved health, we will continue to have poor outcomes.

    Jackson: I wish for universal access to quality health care, regardless of ability to pay. In a country as well-resourced as the United States, all people should have access to the tools and interventions required to ensure good health.

    Montgomery: The cost of medication keeps too many from lifesaving therapy. Thousands of people have to decide whether or not to pay a utility bill because the price of a critical medication leaves no room in their budgets. 

    WJ: What’s one widely believed, but inaccurate, health fact that you would like to correct?

    James: One thing I see a lot is the belief that having a chronic disease, such as diabetes, means your life is “over,” or that you will inevitably end up with severe complications. That is not true. As a Family Medicine doctor, I have seen many people go on to live full, healthy lives that are not limited by their chronic conditions. Stay positive, find support and you can make your life what you want it!

    Montgomery: That if I start a medication, I will have to be on it forever or will become “dependent” on the medication. This is not only patently false, it is also inconsistent with basic biological principles. Medication is a tool to help the body heal or operate more optimally. Ask the health care provider to delineate the circumstances that would indicate a weaning time.

    Jackson: There is an enduring myth that people who are experiencing depression can “just push through it.” Too often depression is seen as a moral failing. Nothing could be further from the truth. It takes great strength for someone depressed to simply get out of bed each morning. Through my work as a psychiatrist, I have been humbled again and again by the resilience and fortitude of people living with depression.

    The Hollowells: Many of us incorrectly believe that our health is simply written into our genes, so what’s the point of eating healthy and exercise? Good lifestyle habits may prevent up to 80% of heart disease. Mounting evidence suggests that smart lifestyle choices like not smoking, maintaining a healthy weight and eating a healthy diet could prevent as much as four out of every 10 cancers.

    WJ: Navigating the health care system in America can be intimidating. What advice do you have for patients and caregivers?

    The Hollowells: Everyone deserves access to high-quality medical care, but in such a complex health care environment, many people can feel as though they are getting lost in the system. No one wants to feel like a number. Find a health care provider you are comfortable with so your doctor can get to know you. Communication and trust are essential so it may not be the first doctor you meet. Like an important job interview, you may need to meet several candidates before settling on the best one for the job.

    Montgomery: Start by hiring a guide—get a primary care doctor with whom you can talk about anything and feel that you are both heard and respected. They will guide you through the maze.

    James: Always know that it is your right to understand what is happening with your body at all times. You have a right to be comfortable with the people providing you care. You have a right to ask questions and keep asking them until you get answers that satisfy you. If you encounter providers that do not respect that, make noise. Change locations if necessary and you have the ability. Because the health care system is deeply racist, sexist and ableist, you have to be an active participant in your health, and not take no for an answer. Trust your gut and don’t be afraid to ruffle feathers if you need to. Having been on the other side of it many times, I always appreciate when folks speak up if they are uncomfortable. Any provider that doesn’t may not be the right fit.

    Jackson: Follow your gut. Whether you are working with a therapist or a cardiologist, it is important to trust your health care provider. If your provider does not earn your trust, move on to the next. Don’t get distracted by reviews, degrees or accolades. Trust your instincts.

    WJ: Mental health issues seem to be on a rapid increase in the Black community. Is this a fact or perception? If a fact, why?

    James: That is true. We are just starting to unpack the tremendous mental health fallout of COVID. There is the direct devastation of lost loved ones, but there is also the economic fallout, which has affected the overall stability of people’s lives. Not being able to meet your basic needs of course affects mental health. Furthermore, there has always been a strong stigma against talking about and seeking mental health care in our community, which makes it challenging for people to see that they are in trouble mental health-wise and get help. The situation is also exacerbated by the fact that there are few mental health professionals of color or trained to understand how racial oppression affects mental health. 

    The Hollowells: We know that Black individuals experience mental health challenges at rates similar to other groups. Serious mental illness, however, rose among all ages of Black people over the past decade, with a rise in major depression, schizophrenia, PTSD and suicidal thoughts, plans and attempts. Blacks can be particularly concerned about stigma, which in turn affects our ability to seek help. If you are experiencing mental health challenges, seek qualified mental health help. Don’t just keep it to yourself and chalk it up as a personal weakness.

    Jackson: It is both. COVID-19 has had a devastating effect on Black communities, physically, spiritually and emotionally. However, mental anguish is not a new phenomenon in the Black community. If anything, the pandemic has merely shined a light on the struggles that Black people have long endured in this country.

    Montgomery: Mental health issues are prominent across the Black community, and have been exacerbated by the recent coronavirus pandemic. They go unrecognized and largely untreated. Stressful life events such as job loss, financial strain and relationship difficulties can all take a toll. The rise of social media and digital technology has created an environment where people are constantly exposed to negative messages and images, which can lead to anxiety and depression. The stigma surrounding mental illness also prevents many people from seeking help or talking about their struggles. As a result, more people are experiencing mental health issues than ever before. 

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