I light of a March 9th JAMA article on African American male health, I thought I’d briefly summarize it and share some personal commentary.
The article was published in the March 9th issue of Journal of the American Medical Association (JAMA) by Martin, Jack, titled “The Health of Young African American Men.” Please refer to the attached article for details.
Briefly, young African American (AA) men face a 4.7 year decreased life expectancy compared to their young white American male counterpart (THE LOWEST life expectancy of any major demographic in the US) caused by:
1. Heart disease
4. Disproportionate incarceration rates (6x more likely to be imprisoned than white male counterpart); 1/3 AA men born today will be incarcerated
What is the underlying etiology of many growing disparities in AA male health? I personally believe they are found in the barriers to healthcare for young African American men. The authors point out several large scale issues of note (I’ve added links for context):
2. Shortage of primary care practitioners in urban areas
3. Lack of resources to address psychological anguish, or influence behaviors (lack of social support)
The authors conclude the article by addressing barriers to care for young African American men. The suggestions, though obvious to some, may be quite instructional for others:
1. Advocate for public health and social support (currently US public health fund 3 cents of each dollar in healthcare spending)
2. Be proactive in establishing a “medical relationship” at encounters such as:
a. During patient’s partner’s pregnancy
b. After patient becomes a father
c. Experience of physical, mental trauma
d. Presenting to the emergency department
e. Physical exams for employment
f. Drug court
g. Sports physicals, military physicals, occupational screening
h. Reentry from corrections
3. Meet men on their own terms
4. Create an open door and trusted space
5. Build where medical care works, rebuild where it does not
6. Engage in thoughtful use of newer technologies (web, mobile, devices, etc)
In 2013, Gov Pat McCrory denied Medicaid expansion to the poorest NC citizens. What does the future hold for our state’s poor?
Unemployment; enduring health ignorance and its consequence, illness; disdain and growing hopelessness in the hearts of those who we may call our brother or sister, neighbor, friend. For when you don’t have your health, what else in life matters?
1. I am concerned about the mounting ignorance of our lay public. Based upon Gov. McCrory's decision to deny Medicaid expansion in NC, many people with whom I've spoken have been unintentionally misguided into believing that they no longer can seek out a PCP due to doctor's offices no longer accepting Medicaid patients. Many people have lost employment, for various reasons.
2. Secondly, I am concerned about the lofty, duplicitous parlance of politicians. Why hasn’t the State’s existing Medicaid program been fixed by now? The underlying origins of the aforementioned unmet needs stem from Gov. McCrory's refusal to expand federal provisions to NC's at-risk populations, which would make it possible for our poorest and sickest to afford their primary, secondary, etc preventative care.
3. Finally, I am concerned about the general lack of backbone on the part of our elected officials and in part, physicians. Acts speak louder than words, yet in the NC State Assembly there is a deafening silence and not enough physician advocacy is happening. Advocacy is now a matter of necessity. Medical student (SNMA, AMSA) and physician advocacy groups (NMA, Durham Academy of Medicine, AMA) are essentially our lifeline. The HK on J People’s Assembly Coalition has made this clear. Politics aside, all elected positions are sworn positions whose seat, in accordance with the US Constitution, must “insure domestic tranquility” and “promote the general welfare.”
1. Leslie, L. McCrory says no special session on Medicaid expansion. Read more at http://www.wral.com/mccrory-says-no-special-session-on-medicaid-expansion/13045944/#7udkr7ft8a3KUHVE.99WRAL
2. Leslie, L. McCrory, feds differ on Medicaid rule. http://www.wral.com/mccrory-feds-differ-on-medicaid-rule/13023399/
3. Wilson, Reid. NC Gov McCrory: ‘Door open’ to Medicaid expansion. http://www.washingtonpost.com/blogs/govbeat/wp/2014/07/14/n-c-gov-mccrory-door-open-to-medicaid-expansion/
4. Barrett M. NC may reverse course on Medicaid expansion. http://www.citizen-times.com/story/news/local/2014/11/15/nc-may-reverse-course-medicaid-expansion/19115499/
Askia K. Dunnon, MS
UNC at Chapel Hill, School of Medicine
(c) (252) 412-7214