July 23, 2024

Dr. Mike's Top of Mind

OOPS, There Goes Health Equity

Since George Floyd's passing, the push for greater equity in American society, especially in healthcare, has surged. We're making strides, but the road to health equity is long and winding, and it's not a journey communities of color should have to walk alone.

Let's talk about the social determinants of health - think poverty, food insecurity, violence, and limited healthcare access. These aren't just hurdles; they're massive walls blocking the path to wellness for all Americans. Waiting to address these issues could mean millions more Black Americans suffering or dying unnecessarily. That's not an option.

What can we do now, especially when it comes to healthcare for Black Americans? Tackling unconscious bias in healthcare providers and institutions is critical. The starkly different treatment Black Americans receive after a diagnosis is unacceptable and needs immediate intervention.

Imagine using race as a healthcare quality metric. If 10 surgical infections occur and 6 affect African Americans, that's not just a number - it's a red flag signaling a problem that needs a deep dive and decisive action. The disparities in vaccination rates and the distribution of flu and COVID shots between different communities also scream for urgent attention.

Embarking on the path to healthcare equity is tough, but by tackling both systemic issues and immediate inequalities head-on, we can pave the way to a more equitable and just health system. Let's roll up our sleeves and get to work.

Stay Healthy,

Dr. Mike

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This Week

And Black America

• University Professor Discovers Cause of Adverse Health Effects in some Black Communities
• Racial and Gender Differences in Discrimination and Psychological Distress among Young Adults
• Exploring How Living in Disadvantaged Neighborhoods Affects Stress-Related Gene Expression in Prostate Tumors
• Prostate Cancer Foundation Screening Guidelines for Black Men in the United States
• Medicaid Challenges Leave Many Black Americans Uninsured
• AAWP Health Tip of the Day - The COVID Variant is Different

AAWP Programs on Air

• Black Doctors Speak Podcast
• AAWP Medical Minute

University history professor and author Constance Hilliard, who holds a doctorate in history, has published a groundbreaking book titled “Ancestral Genomics” with Harvard University Press. In this captivating work, she delves into the historical reasons behind the high incidence of health issues like hypertension and kidney failure in certain Black communities.

Hilliard’s book proposes a fascinating theory: When enslaved Africans were brought to America, most were taken from the continent’s interior, where sodium was scarce. Over generations, these populations adapted to be hyper-sensitive to sodium, retaining it extremely well. However, in the context of America’s modern, sodium-rich diet, this genetic adaptation backfires, leading to excessive sodium absorption and resulting in health problems like hypertension and kidney failure.

“Ancestral Genomics” not only sheds light on a critical health issue but also offers a profound historical perspective that could change how we understand and address these conditions in Black communities today.

It's a Good Read!

Racial and gender differences in the effects of discrimination on health are well-established, primarily from studies of older adults, with less focus on younger adults. This study explores how everyday discrimination impacts psychological distress among young Black and White adults aged 18-28 (n=3,894). 

Interestingly, Black men and women report more frequent discrimination than their White peers. However, the distress linked to discrimination is surprisingly lower for Black men and women compared to White men, who seem more sensitive or less resilient to perceived discrimination. In contrast, White women’s experiences align closely with those of White men.

Why This Is Important: These findings highlight that the damaging effects of discrimination on mental health start early in life. They also suggest that the resilience-based coping strategies observed in older Black adults may already be present in younger generations.

From the JAMA Open Network, July 12, 2024 comes a study that suggests that neighborhood disadvantage is associated with higher expression of stress-related genes, which may contribute to an increased risk of aggressive prostate cancer and warrants follow-up in future studies.

Why This Is Important: I don't know about this. While many good scientist are looking for genes and environmental interactions as a cause for increased morbidity and mortality in Black men, I am on the side that suggest that racism and unequal treatment are more responsible for outcomes in black men with prostate cancer than genetics.

In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, this study examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men.

These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.)

According to CNBC.com, African Americans as of 2022 were 1.5x more likely to be uninsured compared to White Americans, and Hispanic Americans or Native Americans could be 2x-3x more likely to be uninsured. While insurance rates improved during the Covid-19 pandemic, we can see that there are still gaps in coverage across the US. 

One possible solution to this has been expanding Medicaid to meet the gap, but it is a state by state action so people are still being left behind. 

A bright spot is community organizations like West Oakland Health that help communities of color understand and access the best health care options available to them. 

More awareness and access to these kinds of resources, as well as more thoughtful action by state and local county governments will help improve healthcare coverage so no one gets left behind.

After every major national meeting Dr. LeNoir has attended, there have been numerous cases of COVID-19. The current dominant strain in the United States, KP.2—nicknamed FLiRT—has become the top COVID-19 variant. While it does not appear to be more deadly, Dr. LeNoir's experience has shown that even vaccinated individuals are becoming much sicker with this variant.

It is crucial that we remain vigilant, continue to take preventive measures, and stay informed about the latest developments in COVID-19. Our health and the health of our communities depend on it.

Wellness Watch on Facebook Live

Black Doctors Speak Podcast

• Addressing Domestic Violence in the African American Community
• The Hidden Dangers of Food Allergies: A Father's Heartbreaking Story
• Why are Black Women Still Dying at a Higher Rate During Pregnancy? What can the Black Community Do?

AAWP Medical Minute

• KBLX - San Francisco Bay Area
• KDEE - Sacramento
• WVON-Chicago
• WGIO-Atlanta

About Health on KPFA 94.1

For more information, go to our website at www.aawellnessproject.org. or listen to our podcast at Blackdoctorsspeak.org on any podcast platform.

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DR. MIKE'S ETHNIC HEALTH REPORT