50 years after “Dream,” loose ends are left untied
Advocates are trying to reduce the gap in health disparities between African-Americans and white Americans
August 25, 2013
This is one new front in the civil rights movement:
Walking groups are forming and health education classes are planned in Mount Auburn. At a Cincinnati festival, Bennie Lundy had his first prostate cancer test at age 55.
And in Colerain Township, when Jocelyn Storr turned 40, she looked at her scale and her father’s deteriorating health from a stroke and heart attack and decided to make a change.
As an African-American, she had resigned herself to a life of hypertension and weight struggles. Then she realized that she controlled her own health. So she started walking regularly, closely monitoring her portion sizes and sugar intake as well as that of her children and grandchildren. She has lost 30 pounds and gained energy to put into her event planning business.
“I didn’t want to end up like my dad, and I know how hard it is to change, so I wanted to give my kids and grandkids a head start,” said Storr, 43.
These actions embody the type of change that health advocates want more people of color to experience. The effort to reduce critical health disparities between African-Americans and white Americans is expanding locally and nationally and – on this, the 50th anniversary of the March on Washington for Jobs and Freedom – is increasingly seen as some of the unfinished business in the fight for racial equality.
The 1963 event stands as the pivotal moment of the civil rights movement, the day 50 years ago Wednesday that Martin Luther King delivered his “I Have a dream” speech on racial harmony. Other speakers that day called for jobs and a living wage for low-income people, particularly African-Americans.
As the anniversary renews attention on economic inequality, health disparity moves to the fore as well. African-Americans on average don’t live as long as whites. They have less access to private health care and healthy foods and are significantly more likely to suffer from an array of diseases and conditions, ranging from cancer and diabetes to high blood pressure and obesity.
“Health disparities certainly are a civil rights issue, and while each person has the responsibility to care for themselves by eating right and exercising, it is clear that African-Americans do not have equal access to health care,” said Bobby Hilton, senior pastor of Word of deliverance, Forest Park, and president of the Greater Cincinnati Chapter of the National Action Network, a civil rights group founded in 1991 by Al Sharp-ton and sponsor of the daylong march held Saturday in Washington.
The local National Action Network, along with the Baptist Ministers Conference and the Black Nurses Association of Greater Cincinnati, are among organizations supporting the local movement to narrow health disparities, led by the nonprofit Center for Closing the Health Gap.
“Everything else has been addressed – education, housing, jobs, voting rights – even though they’re not all fgured out,” said Dwight Tillery, Health Gap’s founder and president and a former Cincinnati mayor and councilman.
Health and economics are closely linked and, to some civil rights activists, inseparable.
“Social justice is what drives us,” said Noble Maseru, Cincinnati health commissioner. “If you start with food, shelter, and clothing, you have greater distribution of health.”
The disparity between blacks and whites is greater in Cincinnati than it is nationally. Several government and health industry reports quantify the disparities.
In 2002, the Institute of Medicine, part of the National Academy of Sciences, in its report “unequal Treatment,” said, “some evidence suggests that bias, prejudice, and stereotype on the part of health care providers may contribute to differences in care.”
In 2011, the u.S. Centers for disease Control and Prevention released its “Health disparities and Inequalities Report” that, in part, used data to show how people living in “lower socioeconomic circumstances are at increased risk” for serious disease and premature death, have reduced access to health care, and receive an inadequate quality of care.
Advocates say the Affordable Care Act, by making health insurance available to millions of currently uninsured Americans, provides part of the solution.
Nationally, the New Jersey-based Robert Wood Johnson Foundation is one of the strongest voices working to close health disparities. Another involved group is the American Public Health Association, whose president, Adewale Troutman, spoke June 1 at Woodward High School as a guest of the Center for Closing the Health Gap.
“A basic part of the problem is there is still a ‘them’ and an ‘us,’” said Troutman, a physician. “I say when an African-American baby dies in the frst year of life, it affects us all. We are connected.”
In his Woodward speech, attended by about 275 people, Troutman said, “In order for all members of the community to know that there is an injustice in the health of African-Americans, we must teach them about health disparities.”
Greater Cincinnati’s Center for Closing the Health Gap is one of the leading organizations nationally in creating awareness, Troutman said.
Individual lives change to change communities
The center’s latest program is the Mount Auburn Block by Block model, a resident-led education program that has gone door-to-door in the hilltop neighborhood of 6,700 residents with information on diet and exercise. Besides the new walking groups, cooking classes and other education sessions are planned.
Howard Martin, 40, an unemployed diabetic who lives with his elderly parents, earned a stipend by walking the neighborhood to deliver pamphlets. The money was enough to buy medicine to treat his diabetes.
“I got involved to save myself,” Martin said. “I don’t get the splitting headaches any more. I’m jogging now. I feel better.”
On Aug. 10, the Health Gap and local National Action Network chapter sponsored a screening of the documentary “Soul Food Junkies” at Hirsch Recreation Center as part of the Avondale Health Fair. The film examines soul food, such as fried chicken and barbecued pork, as part of black cultural identity and measures its often negative effects on African-American health.
Joyce Edwards, 68, of North Avondale spoke during a post-screening discussion, saying how she changed to a vegetarian diet 10 years ago when she started having to take medicine to treat high blood pressure.
“I was always a little chunky thing,” said Edwards, who now makes and drinks carrot juice, “but I lost 20, 25 pounds by changing my diet and starting to walk at least three times a week.”
She now looks more optimistically at a longer and better-quality life and no longer has to take blood pressure medicine.
The Center for Closing the Health Gap had an information table at the Midwest Black Family Reunion last weekend at Sawyer Point, where event planner Storr and many others received free information on diet, exercise, and other prevention programs and medical assistance.
Nearby, Lundy of Walnut Hills had blood drawn for a prostate cancer screening. Herschel Chalk, 67, a two-time prostate cancer survivor and advocate for screening, waved down Lundy and persuaded him to have the free screening provided by the Barrett Cancer Center at the university of Cincinnati Medical Center.
“I hope I’m good,” said Lundy, on disability after getting hurt on his manufacturing job. “I am scared of the results. This is the first time I have had this test. I’ve been walking more and trying to not eat things like fried chicken.”
“Economics,” said Chalk, of Roselawn. “People say they don’t get checked because they don’t have insurance. We try to take away any excuse. It’s free and we will go anywhere, a church or an organization. By any means necessary will I get men tested.”
Chalk is one of the major organizers of a black men’s health conference planned for Nov. 9 at Drake Center.
Hospitals, churches are key players in movement
Hospitals and predominantly black churches play vital roles in increasing awareness and decreasing disparities.
Overall, 112 black churches regionally have expanded their health ministries in recent years with the help of the Center for Closing the Health Gap. Of them, 22 churches in Hamilton County created community gardens that reach 60,000 people, 25 percent of whom live below the federal poverty levels.
Produce markets at churches, schools, and the Gabriel’s Place food ministry in Avondale are temporary solutions, advocates say, while grants from the Greater Cincinnati Foundation and American Heart Association are being used in efforts to bring grocery stores to urban neighborhoods that lack them.
Three Avondale-based corner stores have improved display and in-store location of fresh produce and whole-grain foods. Still, buying habits are largely unchanged. The Lexington Market, at the corner of Lexington Avenue in Reading Road, stocks a produce cooler every Monday but is forced to either throw away or discount much of it by week’s end.
The 33 member hospitals or health organizations in the 14-county region that are members of the Greater Cincinnati Health Council also are working to do more to close the gap, said Colleen O’Toole, council president.
She said emergency departments, where many low-income people go for primary care, are now connecting patients to primary care physicians, nurse practitioners, and specific clinics for underserved people inside their hospitals.
Increasing attention is being paid to transportation or other social issues, and referrals are being made to social agencies that can address environmental or other causes of poor health.
Interpreter services are increasing for the growing number of Spanish-speaking residents. data collectors and doctors are trying to get more race- and income-specific information from patients that can help hospitals better understand underlying causes.
Four hospital systems – the Christ Hospital, Mercy Health, TriHealth, and uC Medical Center – provide the Center for Closing the Health Gap with most of its budget, a total of $700,000. Another $200,000 from the city of Cincinnati is pending, though some in City Hall are critical of Tillery and the center for receiving money when some direct health services for the poor have seen their funding cut or reduced in previous city budgets.
Health disparities are costly to society in many ways
Progress is being made, advocates say, and the stakes are high.
“In black history, people often felt there was nothing they could do about their health,” Tillery said. “They accepted diabetes as a little sugar or high blood pressure as just part of life or the way things are. But we have seen people realize that they do control their own health. This movement, like any movement, will have to rise up from the people who demand better health care.”
Said O’Toole, “It’s not just an individual tragedy. They affect the quality of life and our competitiveness in the global economy. It’s that big when you’re talking about inclusion and diversity.”
Steve Schwalbe, senior vice president of strategy and communications at TriHealth, is a Health Gap board member. “I think about low birth weight and how we have such great hospitals and doctors in this region,” he said. “Then I think of the disconnect. It’s the space in between them that isn’t working. It severely undermines the overall strength of the community.”
Health disparities exact a high price. Nationally in 2009, they cost the u.S. economy $82.2 billion – $60 billion in health care spending and $22.2 billion in lost productivity – according to “The State of urban Health,” a study released in december by the National urban League Policy Institute in Washington, D.C.
And as he had crystallized the modern civil rights movement 50 years ago, King provided watchwords for the movement working to close health gaps.
“Of all forms of inequality,” King said at the 1966 convention of the Medical Committee for Human Rights, a group of health care professions that supported the civil rights movement, “injustice in health care is the most shocking and the most inhumane.”