Jessica E.

Wangia
HSC 210
Fall 2019

Cultural Practices Presentation:

African-Americans
 We will explore...
How residual effects of slavery, federal “Jim Crow “separate but equal” laws, and
discriminatory policies still impact the daily lives of African Americans today.

Why African Americans have a higher predisposition for life threatening

diseases, poverty and a lower life expectancy when compared to other people
groups in America.

Challenges African Americans face in obtaining and utilizing quality, unbiased,

affordable healthcare in the midst of America’s race-based health care
disparities?

How historical trauma negatively impacts the health and wellness of African
Americans today, regardless of their income level or where they live.
 Most African-Americans are the descendants of
Historical sub-Saharan African slaves who were captured and
sold in the Atlantic (or transatlantic) Slave Trade
Background from the 15th - 19th centuries (1).

Due to slavery and the persistence of racial

discrimination in America, African-American or
‘black culture’, developed separately from
mainstream American culture (2).

African-American culture is multicultural, the

health care beliefs and practices are diverse,
complex, crossing ethnic, cultural, and social
boundaries. Many of the cultural traditions have
direct African roots that have been passed down
through the generations. The building blocks of the
American black culture are music, art, dance, faith,
oral tradition, cuisine and community (2).
 Health Behaviors & Beliefs

Health is a state of complete physical, mental and social well-being, and not merely the
absence of disease or infirmity." -World Health Organization

Culture influences our expectations

and perceptions about health, illness,
and disease and cultural values
influence how individuals cope with
illness, disease, & stress (4,7).
The traditional definition of HEALTH
stems from the African belief that life
was a process rather than a state.
The nature of a person was viewed in
terms of energy force rather than
matter. All things, whether living or
dead were believed to influence one
another (6).
Health Behaviors & Beliefs Continued
African-Americans' experience and practice of the herbal, healing folk belief
tradition known as Hoodoo uses home remedies that originating from Africa, like
herbs, spices, foods, teas, ointments, liniments are still used for health promotion
and disease prevention today(7, 18).

In the present day health is maintained with proper diet, by eating 3 nutritious
meals a day-including a hot breakfast. Laxatives are used to keep the system
“running”. Cod liver oil is taken to prevent colds. Another home remedy is to drink
hot water with apple cider vinegar, honey and lemon to help the body fight off
infections (10).

Religion is interwoven into health care beliefs and practices. Prayer and healing
from God are still primary of HEALING acute and chronic illnesses and
conditions(15).
Illness Behaviors & Beliefs Traditionally ILLNESS was
attributed to disharmony caused
by demons and evil spirits. These
spirits were generally believed to
act on their own accord, and the
goal of treatment was to remove
them from the body of the ill
person.

Illness was thought to be caused

by either natural causes when
someone failed to maintain
harmony in the physical or natural
world. Unnatural illness occurred
when the individual was the victim
of a hex, curse or spell, causing the
plan of God to be disrupted(8).
Due to a generational distrust, many Illness Behaviors & Beliefs continued
African-Americans avoid going to the
doctors, even if they have insurance
and can afford to go(10,11). Many still
prefer self-treatment or treatment by
friends, older relatives, or conjure(7).
Many African-Americans will tend to
hope that a symptom or condition will
eventually disappear instead of
spending money to see a doctor as
soon as they start experiencing
symptoms. Often a minor treatable
condition becomes major, more costly
and even deadly if left untreated.
African-American adults with cancer
are much less likely to survive prostate,
breast and lung cancer than white
adults(8).
Sociocultural impact of Racial
Discrimination
Redlining is the discriminatory practice by
which banks, insurance companies, and
others refuse or limit loans, mortgages
and insurance within a specific
geographic areas.

In 1968, the Fair Housing Act, prohibited

housing discrimination by real estate
firms and homeowners. This means that
homeowners may not refuse to lease or
sell property based on race, religion,
gender, color, or national origin(3).
Unfortunately, it is estimated that it may
take seven generations, or over 200 years
for the residual impact of these policies
to be eradicated in America(4).
Sociocultural Experiences continued Home values are tied to property
taxes and property taxes fund the
schools, therefore, the better funded
school districts have higher property
values. Due to redlining,
African-Americans and other minority
groups, do not share the same
opportunities (3). Redlining essentially
caused an unhealthy living
environment and impoverished
educational systems (4).
Redlining has created neighborhoods
that are incubators of chronic stress
due to poor housing, inadequate
access to health care, neighborhoods
that have higher crime rates and are policed like military zones, bad schools, poor
transportation, lack of jobs, lack of access to parks, grocery stores, and in some
communities, no access to fresh safe drinking water (4).
Health Concerns &
Circumstances Research indicates that African-Americans
get sick at younger ages, have more severe
illnesses and are aging, biologically, more
rapidly than whites. Scientists call this the
"weathering effect," or the result of cumulative
chronic stress.

Social and Environmental stressors trigger

the Stress Response System which floods our
bodies with cortisol, a hormone that
negatively affects multiple organs and
systems. Exposure to chronic stress changes
a person’s physiology, behavior and how their
genes are expressed(4).
Health Concerns & Circumstances continued

In America, low income people are physiologically

different than high income people, not because of
their genetics, but because of the persistent racial
discrimination and biases they face produces higher
levels of chronic stress. These same social prejudices
also negatively impact African-Americans that live in
wealthy, affluent neighborhoods (4,5).

The chronic stress that has been created and driven

by America’s discriminatory bias, practices and
policies is lethal. Adult obesity rates for
African-Americans are higher than those for whites in
nearly every state. African-American children have a
500 percent higher death rate from asthma compared
to white children(6).
Health Care Practices and Resources

Legally in the US, all Americans have equal access to health care, but this is not
a reality for many of the poor and disenfranchised ethnic populations(12).
Historical trauma and generational distrust has been passed down, so many
African-Americans do not feel safe going to the doctor(11). Atrocities like the
Tuskegee Syphilis project, sterilization, euthenics, and other horrific medical
experiments have created a deep rooted distrust of the healthcare system in
America (9,18).

African-Americans when compared to White Americans, receive less aggressive

cardiac interventions, less adequate pain management (less adjuvant therapy
for colorectal cancer, less rigorous diabetes management and more
lower-extremity amputations (16). This may be due to unconscious and conscious
biases, doctors may assume that an African-American patient can’t afford
certain treatments; in the case of diabetes, for example, amputation may be
recommended when another, more costly treatment might be available(14).
Health Care Practices and
Resources Continued
Moreover, racial and ethnic minorities are
also more likely to perceive physician bias
and a lack of cultural sensitivity when
seeking treatment, have less trust in the
health care system, and report a lower
level of satisfaction with the health care
they receive (10, 16). African-Americans
experience the worst health status, suffer
the worst health outcomes,
African-Americans experience the worst A U.S. public health worker drawing blood from a man as part of the
health status, suffer the worst health Tuskegee Syphilis Experiment. Encyclopedia Britannica

outcomes, and historically have been forced by social structures (e.g., legalized segregation,
redlining, social exclusion, overt discrimination) to use worse health services and facilities
compared to other racial or ethnic groups(5,10,18). Since times of slavery exploitation of
African-American bodies by white doctors for medical education, experimental research
programs, development of new tools, techniques, medicines was the norm up until the
Tuskegee Experiment was exposed (9,10).
Targets of the
African-Americans were also targeted by the
Eugenics Movement eugenics movement. In 1921,the American
Birth Control League was founded. One of
its board members was Lothrop Stoddard, a
white supremacist who was a member of the
Ku Klux Klan. He introduced the term
“sub-human” as referring to
African-Americans and said, “Non-white races
must be excluded from America … The red and
black races, if left to themselves, revert to a savage
or semi-savage stage in a short time.”(18).

Still today, the majority of these birth

control and abortion clinics are located in
predominantly African-American and
minority communities.
 Targets of the Eugenics Movement continued
In 1934, one of America’s leading eugenists and founder of American Birth
Control League, proposed a law that included this provision: “Feeble-minded
persons, habitual congenital criminals, those afflicted with inheritable disease, and others
found biologically unfit by authorities qualified judge should be sterilized or, in cases of
doubt, should be so isolated as to prevent the perpetuation of their afflictions by breeding.”
Sanger said she wanted “to give certain dysgenic groups in our population their choice
of segregation or sterilization,”(13).

It is no wonder that many pregnant

African American women see an
obstetrician for the first time once
they’re in labor, when they should have
started regular checkups in the first
trimester, this contributes to the
disparate infant mortality and
premature birth rates (17,18).
Joseph’s Emergency Room Experience

● Joseph is a 19 year old male, college

student.

● He his biracial, half white American

and half Kenyan.

● Joe woke up one morning with slight

back, neck and shoulder stiffness. As
the day progressed, the stiffness
turned into pain and he developed a
terrible headache. He took ibuprofen
and went to bed early.
Joseph lacks access to unbiased health care
A few hours later he woke up in
excruciating pain. Light, sound, and
movement all made him feel like he was
dying. He asked his girlfriend, an 18
year old African-American, to drive him
to the emergency room. Once they
arrived at the hospital, he could barely
walk. He was laying on the emergency
floor, crying, as his girlfriend frantically
told the triage nurse his symptoms.
The nurse, did not take his symptoms seriously. She assumed that Joseph
must be a drug user, who came to the ER faking pain in order to get a
prescription for opioids. Several times his nurse told him, that if he would just
stop making such a fuss, that they would give him a script for an opiod and
send him home. He kept crying in pain, pleading with them to find out what
was wrong.
Joseph finally get the help he needs to heal
Several hours passed, other than receiving an initial
dose of morphine when he first arrive nothing had
been done to assess the cause of his pain.

After a shift change, an African-American doctor took

over treating Joseph. Once she looked over his chart,
she realized that he had not been given a single
diagnostic exam and that he was 3 hours overdue for
his second dose of pain medication. The doctor
immediately ordered him a spinal tap, which
confirmed that Joseph had viral spinal meningitis.
Joseph ended up staying in the hospital for 6 days,
before being sent home to recover for another 2
weeks.
 Steps to Cultivate Culturally Competent
Health Care

We must acknowledge the link between race

and poor health before we can meet our
nation's daunting health equity challenge.

The goal of eliminating health disparities

and achieving health equity, will not be
accomplished without changing the odds
by putting government policies in place
that protect minorities and build social
compact and access to Universal Health
Care or Affordable Health Insurance for
everyone (4,18).
Steps to Cultivate Culturally Competent Health Care continued

Health Care and public health professionals must have knowledge and insight
into the concerns and needs of childbearing, parenting, the elderly, caregivers
and caregiving in African-American population as well as understanding the
impact of cardiovascular disease, cancer, diabetes, HIV/AIDS, mental health and
mental illness, and sickle cell disease within the African-American community (19).
In order for transformative and sustained change to take hold, those in power
must take a stand against deep-rooted systematic forces that prelude equal
access to health care. We also need the voices of youth leadership to be heard,
strong community partnerships to be formed, and enhancing diversity in the
health-care workforce at all levels (20).
References
1. African American History Timeline -accessed 18 Nov 2019
https://www.nps.gov/saga/learn/education/upload/African%20American%20History%20Timeline.pdf

2. Toccara, B., Casile,H., Chandler, L. & Dale, N. (31 Mar 2013). Cultural diversity in health and illness. African American Health -accessed 18
Nov 2019
https://sites.google.com/site/afroamericanhealth/traditional-healing-methods

3. Reeves, H (2018) Redlining and the Health of a City TedTalk -accessed 18 Nov 2019
https://www.ted.com/talks/halley_reeves_redlining_and_the_health_of_a_city

4. Change the Odds for Health, TedTalk by Anthony Iton 04Nov2016 -accessed 18 Nov 2019
https://www.youtube.com/watch?v=0H6yte4RXx0#action=share

5. Starbucks Racial Bias training video by Stanley Nelson -accessed 16 Nov 2019
https://www.youtube.com/watch?v=eDPTVEqkGa4

6. Dula, A. (1993). Trials, Tribulations, and Celebration: African-American Perspectives on Health, Illness, Aging and Loss (review). Journal of
Health Care for the Poor and Underserved, 4(1), 65-68. -accessed 18 Nov 2019 https://muse-jhu-edu.ezproxy1.lib.asu.edu/article/267880/pdf

7. 1619 Podcast, Episode 4: How The Bad Blood Started -13Sep2019) -accessed 16 Nov 2019
https://podcasts.apple.com/us/podcast/1619/id1476928106
References
8. Ross, P., Lypson, M., & Kumagai, A. (2012). Using Illness Narratives to Explore African American Perspectives of Racial Discrimination in
Health Care. Journal of Black Studies, 43(5), 520-544. -accessed 17 Nov 2019
https://journals-sagepub-com.ezproxy1.lib.asu.edu/doi/full/10.1177/0021934711436129

9. NewKirk, V (17 Jun 2016). The Terrible Toll of the Tuskegee Study. The Atlantic. -accessed 21 Nov 2019
https://www.theatlantic.com/politics/archive/2016/06/tuskegee-study-medical-distrust-research/487439/

10. Randall, V. (1996). Slavery, Segregation and Racism: Trusting The Health Care System Ain’t Always Easy! An African American Perspective on
Bioethics , 15 St. Louis U. Pub. L. Rev. 191 -235 http://academic.udayton.edu/health/05bioethics/slavery02.htm

11. Hall, G. (16 Nov 2016). Historical Reasons for African American Distrust of Doctors, The Conversation -accessed 17 Nov 2019
http://drgreghall.com/2016/11/16/one-historical-reason-african-americans-distrust-doctors/

12. Shoff, C., & Yang, T. C. (2012). Untangling the associations among distrust, race, and neighborhood social environment: a social disorganization
perspective. Social science & medicine -accessed 17 Nov 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321124/

13. Sanger, M. (Feb 1919). Birth Control and Racial Betterment, Birth Control Review Published Article Library of Congress Microfilm -accessed 19
Nov 2019 https://www.nyu.edu/projects/sanger/webedition/app/documents/show.php?sangerDoc=143449.xml

14. Hammond, W. (2010). Psychosocial Correlates of Medical Mistrust Among African American Men. American Journal of Community Psychology,
45(1-2), 87-106. -accessed 21 Nov 2019
https://web-a-ebscohost-com.ezproxy1.lib.asu.edu/ehost/detail/detail?vid=0&sid=8c1e8687-e72c-458c-b39f-14f71d27db74%40sessionmgr4008&bd
ata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=48356772&db=sih
References
15. Pinn, A., Finley, S., & Alexander, T. (2009). African American religious cultures. Volume 1, A-R (American Religious Cultures). Santa Barbara,
CA: -accessed 17 Nov 2019
ABC-CLIO.https://go-gale-com.ezproxy1.lib.asu.edu/ps/pdfViewer?resultListType=RELATED_DOCUMENT&c2c=true&docId=GALE%7CCX2
191800001&userGroupName=asuniv&inPS=true&contentSegment=&prodId=GVRL&isETOC=true#content

16. Williams, R (06 Mar 2017). From Slavery to Present: Why Blacks Distrust Healthcare BDO BlackDoctor.org -accessed 21 Nov 2019
https://blackdoctor.org/512642/from-slavery-to-present-why-blacks-distrust-healthcare-pt-1/

17. Lavizzo-Mourey, R, William, D. (14 Apr 2016) Being Black Is Bad for Your Health, US News and World Report -accessed 21 Nov 2019
https://www.usnews.com/opinion/blogs/policy-dose/articles/2016-04-14/theres-a-huge-health-equity-gap-between-whites-and-minorities

18. Phone interview on 22Nov2019 with Shaneé Washington-Wangia from University of Washington
(https://education.uw.edu/news/new-faculty-qa-shane%C3%A9-washington-wangia)

19. Underwood,S., Buseh,A., Canales,M., Powe, B., Dockery,B., Kather,T., Kent,N.(2004). Nursing contributions to the elimination of health
disparities among African-Americans: review and critique of a decade of research. Journal of National Black Nurses' Association : JNBNA [01 Jul
2004, 15(1):48-62] https://europepmc.org/abstract/med/15712820 -accessed 20 Nov 2019

20. Phillips, J. M., & Malone, B. (2014). Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity.
Public Health Reports, 129(1_suppl2),45–50. https://journals.sagepub.com/doi/pdf/10.1177/00333549141291S209 -accessed 20 Nov 2019
 Images
● Image on Title Page: https://www.teepublic.com/kids-t-shirt/2887987-american-grown-african-roots
● Image of Marcus Garvey Quote: https://www.pinterest.com/beezafrocentric/marcus-garvey/
● Images of Famous African-Americans
http://www.mnialive.com/images/black-history-month-594.jpg?Action=thumbnail&Width=715&Format=png
● Images of HooDoo medicine: https://conjurehealing.files.wordpress.com/2012/06/mojo_rootwork.jpg
● Images of Medical Professionals treating woman:https://i.pinimg.com/736x/d9/eb/06/d9eb065d506f86bc58c3a80c0337fefe.jpg
● Image of Redlining Map of Philadelphia in 1937: https://philadelphiaencyclopedia.org/archive/redlining/holc-map-philadlephia-1932/
● Image close up of Redlining of Philadelphia in 1936:
https://upload.wikimedia.org/wikipedia/commons/4/41/Home_Owners%27_Loan_Corporation_Philadelphia_redlining_map.jpg
● Image of Health Disparities in DC: https://mccourt.georgetown.edu/news/Health-Disparities-Report
● Image of Stress Response System : https://www.top10homeremedies.com/how-to/reduce-your-high-cortisol-stress-hormone-level.html
● Image of Tuskegee Syphilis Project: https://historycollection.co/20-photos-tuskegee-syphilis-study/
● Image on of African-American Family : https://i.pinimg.com/736x/45/27/88/452788c3ac478c470422cdd9cfd7075d.jpg
● Image of Alveda King Quote : https://blottingoutgoddotcom.files.wordpress.com/2014/02/alveda-king-bus-to-abortion-clinic-quote.jpg
● Images of “Joseph” - Photos taken by B. Marzella, 02 November 2019
● Image The Invisible Man:https://i.pinimg.com/originals/11/01/61/110161fea54e91a8cef50a6f6b9a6105.jpg