African Americans dealing with Asthma - Research Paper Example

African-Americans (Dealing with Asthma) 19 June Introduction Black Americans have come a long way indeed since the days of slavery and the Civil War which was fought over the issue of slavery. It is also preferred that blacks are called their politically-correct term which is African-Americans. Black people are now enjoying all their civil and political rights guaranteed by the same American Constitution equally as the whites. The Civil Rights Movement achieved a great deal in terms of enforcing those political rights which President Kennedy had started but were fully implemented only during administration of President Lyndon B. Johnson in the 1960s. The Great Society programs of Pres. Johnson were a response to the social crises of that period and to institutionalize the reforms started by Pres. Kennedy under his New Frontier program. The New Frontier initiatives were largely a continuation of the New Deal programs of Pres. Franklin Delano Roosevelt but all their ideas were to eliminate officially all practices that caused racial injustices and promote economic prosperity for all by the reduction or elimination of social, economic and political biases. However, despite all of these noble avowed intentions, black people in America today are still not fully enjoying all their promised racial equality. Reforms adopted by a succession of governments still fail to produce the desired results despite the best intentions. The various programs intended for the benefit of blacks which are based on the three Rs (relief, reforms and recovery from the economic recession) have not filtered down to the great majority of the African Americans. One of these failures is the high rate of prevalence of ailments among the black people in America and one of these illnesses is asthma which claims a disproportionate segment of the black populace, both of their young and the adults (Blackdoctor.org 1). Discussion Incidentally, black Americans have the highest incidence of asthma among the various ethnic groups. Why this is so can be attributed to several factors although no single cause has been identified definitively so far. The current prevalence rate among the blacks is higher by 38% compared to white people. About eleven Americans die from asthma each day resulting to approximately 4,200 deaths annually and another 7,000 deaths with asthma as aggravating or contributing factor (Centers for Disease Control and Prevention 1). The figures are certain to be very alarming to public health officials as asthma is preventable although not curable. Part of the reason why black Americans have the highest incidence among the racial groups could be genetics. Although still not proven yet, genetics plays a part whether a black person suffers from asthma or not. If only one parent has asthma, a child has a 1 in 3 chances (33%) of developing into an asthmatic. However, if both parents are asthmatics, probability will rise to 70% (7 out of 10) that their child will have asthma too (AAFA.org 1). There are many other contributing factors which can trigger asthma besides genetics. Among these factors are certain weather conditions (extreme heat or change to sudden cold), living in an inner-city environment (such as dirty tenement buildings which are not very well ventilated), poor access to the right medical information, lack of proper medical care access, not having a regular family doctor, use of overcrowded clinics and emergency rooms in city hospitals and discontinuity in health care for some reason or another (Tanne 1). Asthma is a medical condition resulting from inflammation of the air passageways as a result of certain allergens like animal dander, plant pollen, dust, air pollutants, cold air, mite and secondhand smoke or even cockroaches and vermin (Office on Women's Health 1). The inflammation is a reaction that results in narrowing of the air ways and makes breathing very difficult and could even result in death in severe cases of asthma attacks. Prevalence Rates – approximately 2.4 million of African Americans have this illness. Compared to non-Hispanic white women, black American women have a 30% higher rate of this condition. Prevalence is a measure of the number of people who currently suffer from the effects of asthma. As a general statistic, African Americans are three times likely to die in the asthma-related complications than the overall white population (Office of Minority Health 1). In some congested urban areas like New York City, a black man is eleven times more likely to die from asthma than other men in the same city (Tanne 1). Adult African Americans have five times more emergency room visits which are asthma related than white people. The statistics for self-reported number of people who currently have asthma, the ratios are 8.2 for black men and 5.8 for the white males per 100,000 population (1.4x), 10 for black women compared to only 8 for white females (or 1.3x higher) or for both genders, ratios are 9.2 for blacks versus 6.9 for the whites (a ratio of 1.3 times higher for the blacks). Statistics for self-reported asthma attacks also tilt against the African Americans. For the black men, it is 4.8 against 3.2 only for white males (1.5 times higher). For black women, the ratio is about 5.9 versus 4.7 for the white women (or 1.3 higher) while the overall ratio for both genders is about 5.4 for the blacks and 3.9 for the whites (a ratio 1.4 times higher). Curiously, the ratio of asthma between non-Hispanic blacks and non-Hispanic whites is about the same (13.8 against 13.9 or a 1:1 ratio) for those informed by their doctors they are suffering from asthma aged 18 years and above. On the other hand, the current prevalence rate is also about equal (8.6 for non-Hispanic blacks and 8.1 for non-Hispanic whites or 1:1). The death rate is the most alarming statistic figure, with blacks dying 2.8 per 100,000 against only 0.9 per hundred thousand population of non-Hispanic whites. The rates of death for the two races are 30.6 per million of black people with only 10.4 deaths per million of the whites (Office of Minority Health 1). Many factors contribute to this lopsided statistics. Incidence Rates – the rate of incidence as used in public health epidemiology refers to the number of new cases being reported annually. Prevalence pertains to the cumulative cases of the total number of cases from prior years whereas incidence refers to new cases reported. The incidence rate of asthma for African Americans seems to be a combination of genetics as well as other environment factors that affects their lifestyles based from an economic classes' standpoint. The continuing discrimination against black Americans is a contributory factor to their being predisposed to having asthma because of lower economic incomes stemming from having a high unemployment rate, drug use, living in poor physical conditions and bad diets. Since asthma is a chronic condition, the high incidence rates of this ailment among all black Americans translate into high prevalence rates among children and adults. Asthma is an incurable ailment and being chronic means it persists for a long time (sometimes for an entire lifetime) and recurs frequently if a person who is asthmatic is exposed to certain triggers. The asthmatics can be exposed to dust, gases or fumes in the workplace which irritates the airway passageways and triggers an asthma attack (www.aaaai.org 1). However, actual incidence rates among black Americans could be significantly much higher since a majority of black adults do not report their lung conditions as they might like or should have (Hampton, Gullotta & Crowel 218). Most of them ignore symptoms of asthma such as chest pains, dyspnea and nocturnal awakenings. Many of these asthmatics are often resorting to self-medication and a “wait and see” attitude that tends to exacerbate conditions until these got much worse to the point of becoming emergency cases. Although genetics could be a predisposing factor for asthma, a lot of environmental factors contribute to the high prevalence and incidence rates among African Americans. The other factors are traceable largely to the after-effects of socio-economic disadvantages due to biases, prejudice and discrimination which in turn result into lower access to medical care. Economic Costs – asthma is responsible for lost productivity among workers who had reported missing work on the average for five days per year. In dollar terms, these absences translate into about $3,300 worth of medical expenses and in aggregate figures, into about ten million worker absences for a total cost of $19.7 billion per year. Hospitalizations and other medical expenses account for nearly $14.7 billion while indirect costs reach $5 billion from lost earnings and eventual death (AAFA.org 1). Asthma and Children – although anybody can get asthma, it usually starts in the early childhood years. It is a top-health problem among kids of African American descent and is a primary reason for them missing school days, on the average 4 days per school year. Most of these kids exhibit the common symptoms of asthma such as coughing (especially at night), a marked shortness of breath (a feeling of not getting enough air), faster and noisier breathing, wheezing (a whistling or squeaky sound when breathing) and chest pains (Office on Women's Health 1) characterized by feelings of tightness or pressured breathing. Asthma is the most common chronic condition among children aged 5-17 years old; it is also the leading cause of hospitalization than any other childhood disease. Nearly half of all asthma hospitalizations are for children (45%). From 2003-2005, the death rate from asthma for African American children is nearly 7 times compared to the non-Hispanic white children (U.S. Dep't. of Health and Human Services 1). Black children likewise have a 260% higher rate of emergency room visits compared to white kids and a 250% higher hospitalization rate. What is most alarming is a 500% higher death rate among black kids than white kids. Part of the reason for these startling statistics can be gleaned from the findings of the research study which showed African American kids tend to receive delayed specialist care as a result of belonging to lower socio-economic classes (ScienceDaily 1). By the time the kids are seen by a doctor, they have poorer lung function and may require intensive care already. Common Causes – this section explains some of the common causes in greater detail. This will help the reader understand why asthma is so prevalent today, with an expected 100 million more people expected to be with this disease by the year 2025. Its prevalence rate has increased by 75% in a short time frame (1980-1994) while asthma rates for children below 5 years old has increased by an astounding 160% during the same period. Genetics – parents who are asthmatics are more likely to produce children who will be afflicted with this disease also. Medical researchers have established that genetic factors can be contributory to the susceptibility to asthma and genetic variations are more pronounced in African Americans (Barnes, Grant, Hansel, Gao & Dunston 58). When compared to the white people who also have asthma, black Americans who are asthmatics tend to have more severe asthma, a higher tendency of steroid dependency and more severe clinical symptoms as well. Allergens – approximately 70% of asthmatics also have various allergies and these are triggers of an asthma attack. An allergen is any substance that can cause an allergic reaction. An allergic reaction is the body's immune system response to certain foreign substances that are usually harmless to other people who are not allergic to these substances such as pollens, dust, mites, dander, molds and certain kinds of foods (MedicineNet.com 1). There is a close correlation between allergies and asthma; similar to asthma, allergies are also related to the person's family history too. If neither parent is allergic, the probability for an allergy is about 15% only but if one parent is allergic, this rises dramatically to 30% of getting an allergy and if both parents are allergic, the chances of an allergic reaction rises to more than 60% (ibid.). In the study by Barnes et al. as mentioned earlier, African Americans are found to have very high levels of the immunoglobulin E (shortened to IgE) which usually occurs only in small amounts to fight off minor body parasites but rises to alarming levels in cases of asthma attacks and in allergic reactions (both of them are inflammation in nature). Socio-economic Disadvantages – most black children belong to poor families and the correlation of this factor to increased asthma morbidity and mortality is very strong indeed. Poverty in turn results into delayed or fewer doctor visits whenever required by the situation; poor black parents also do not have proper access to medical care due to financial difficulties such as not having medical insurance resulting in sub-optimal care. African American parents may have low educational attainment because of poverty and this in turn results into the poor comprehension of vital health information such as how to prevent asthma attacks by avoiding the cause that triggers them in the first place. Being economically and socially disadvantaged has far-reaching multiplier effects on the asthma epidemic among black Americans. Being poor usually means living in tenements or some other unsanitary housing which triggers asthma attacks because of dirty environments and poor ventilation. Poverty can also result into improper diets which weaken the body's resistance to even ordinary allergens. The end result is that being poor is often contributory to the epidemic of asthma among blacks. It can be seen in lacking access to proper medical care, delaying seeing a doctor, not having the required medical insurance, lack of health literacy from low educational attainment and lack of financial resources to purchase the prescribed medicines. What this shows is it becomes a vicious cycle in which socio-economic disadvantages resulting from the racial discrimination produces higher asthma morbidity and mortality among black American adults and children. In short, some individual factors like income levels and educational attainment affects adversely a black person's health literacy and behaviors necessary for a healthy lifestyle. The needed approach to solve this problem must be multi-pronged that will address these various environmental factors identified as contributory to an epidemic of asthma among blacks. The other approach that will be supplementary to this effort is to conduct a vigorous educational campaign on how to prevent asthma triggers, as only half of adults reported being taught. Obesity – some studies also suggested the close correlation between obesity and the black person's susceptibility to asthma. Obesity is now considered a worldwide epidemic that is affecting children who eat unbalanced diets coming from the rise in fast-food chains due to changing lifestyles. Obesity is sometimes a cultural thing, with black people associating this obesity in children to signs of being healthy; obesity in some cultures is perceived as wealth (World Health Organization 100). Understanding the patterns of obesity can help to avoid the complications brought about by it such as asthma as it is found to be correlated to changes in the body mass index (BMI). Obesity is a factor in incident asthma as well as the new on-set asthma observed in boys and in previously non-allergic children due to their diets being high in polyunsatured fats found mostly in fast-food diets. Prevention – steps to avoiding asthma should start in early childhood. Although it is incurable, proper medical education on how to prevent asthma attacks by avoiding triggers is a big help especially for people who are financially challenged to make ends meet in life. The best way is prevention as several studies showed children in poor black families are likely to be diagnosed with asthma. Preventing asthma will help to reduce costly hospital emergency room visits as well as buying expensive prescription medicines. Kids in poorer families tend to have adult family members who smoke and therefore expose them to secondhand smoke. This environmental situation results in poor black children having higher blood cotinine level which is a breakdown product of the nicotine found in cigarettes (US DHHS 1). Preventive measures can include having clean surroundings (by cleaning the home), a good awareness of the under-reported dangers of asthma as a major health threat, avoiding a lifestyle that is conducive to developing obesity and hence asthma tendencies, and lastly, the conduct of public awareness programs through better communication tools to increase black people's medical health literacy and improving their socio-economic conditions. Although finding the cure for asthma through a rigorous scientific study of its genetic causes are being undertaken currently by several groups, prevention is still the best medicine. In this instance, early medical intervention can go a long way towards not making the ailment much worse as children grow into adulthood. Delayed presentation of an African American to specialist care helps to account for the high disparities in morbidity and mortality rates. This in turn is caused by a whole combination of socio-economic factors which make the access to proper medical care difficult for most blacks and in some instances, totally impossible. This rising trend of black Americans succumbing to a preventable disease like asthma is one of the hidden epidemics in American society today. It has indeed reached crisis proportions that the National Medical Association (NMA) that is composed solely of black health care providers and professionals has been forced to take action (Tanne 1). Being black is a marker but not by itself significant enough to induce asthma. It is the deadly combination of other environmental factors which are preventable which makes this ailment all the more deserving of public health officials' more focused attention. The numbers of black people getting sick from asthma keeps rising due to a lack of adequate medical care. It can also be attributed partly to poor access to crucial medical information such as the early signs of an asthma attack like a wheezing chronic cough. Many black people afflicted with an asthma do not even know what it is and hence delay seeking medical attention. For example, simple and practical steps can be undertaken by vulnerable people to the sudden changes in weather which is one of the triggers of asthma. Humidity and temperature changes trigger asthma attacks because people with asthma and allergies cannot control their noses in controlling the humidity of the air they breathe in. As a consequence, asthmatics are usually breathing through their mouths instead and take in as a result more pollen, irritants and pollutants than normal people; this in turn aggravates their medical situation. Conclusion While most of the attention of public health officials and medical professionals are focused on the more marquee illnesses like cancer, diabetes and obesity, a rising epidemic of asthma among the most vulnerable segments of society which are black Americans is often understated and is not raising alarms to justify bigger government funding for research. There is still the truth that African Americans are sickened and dying from asthma as a racial/ethnic group in significantly higher numbers compared to other racial minorities. It would be wrong to focus solely on supposed genetic factors on the predisposition of black Americans to asthma as it would obscure the other factors which are found to be greatly contributory to their lack of getting the proper medical care they deserve. Research studies on the genetics of asthma are still a long way off from producing much needed results for racial confirmation of the origins of this dread disease. Studies focusing on the genetic associations in racial minorities like genome-wide linkage analysis for asthma-related phenotypes showed some deficiencies such as small sample sizes (Scirica & Celedon 770s). Results of studies are therefore lacking desired attributes of a good statistical sample like validity and reliability. The National Medical Association (NMA) is planning to embark on educational-type of health literacy campaign that will provide the proper medical information concerning this epidemic affecting black Americans mostly. It will be patterned similarly on direct-consumer product campaigns but the drawback is that it is expensive since it will be conducted mainly through television and radio advertisements; initial targets are people living in the inner-city parts of large urban centers who are the most vulnerable group identified. People who are on self-medication are likewise legitimate targets of such campaigns like those who use “rescue” medicines like albuterol when instead they should be using inhaled corticosteroids. Overall, a new public awareness for asthma as a unique ailment among blacks is most welcome. Works Cited American Academy of Allergy, Asthma and Immunology. “Asthma Statistics.” 2011. Web. 17 June 2011. http://www.aaaai.org/media/statistics/asthma-statistics.asp Asthma and Allergy Foundation of America. “Asthma Facts and Figures.” n.d. Web. 14 June 2011. Barnes, K. C., Grant, A. V., Hansel, N. N., Gao, P. and G. M. Dunston. “African Americans with asthma: genetic insights.” Proceedings of the American Thoracic Society, 4.1 (2007 Jan): 58-68. Print. Black Doctor.org “Asthma & African Americans.” 2011. Web. 15 June 2011. Centers for Disease Control and Prevention. “New Asthma Estimates: Tracking Prevalence, Health Care and Mortality.” 2001. Web. 15 June 2011. Hampton, Robert L., Gullotta, Thomas P. and Raymond L. Crowel. Handbook of African American Health. New York, USA: Guilford Press, 2010. Print. MedicineNet.com. “Definition of Allergy.” 27 Apr 2011. Web. 18 June 2011. Office of Minority Health. “Asthma and African Americans.” 29 Sept 2010. Web. 15 June 2011. Office on Women's Health. “Asthma: Minority Women's Health.” 18 May 2010. Web. 13 June 2011. Science Daily. “Visits to Asthma Specialists Delayed for African American Children, Study Finds.” 16 May 2011. Web. 18 June 2011. Tanne, Janice Hopkins. “Asthma Crisis for Black Americans.” The British Medical Journal, 323 (2001 Aug): 302. Print. U.S. Department of Health and Human Services. “Asthma and African Americans.” 29 Sept 2010. Web. 15 June 2011. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: WHO Consultation, 2000. Print. Read More