Improving the health of the Elderly Black Population: They are in our Hospital Beds and not in the History Books

Improving the health of the Elderly Black Population: They are in our Hospital Beds and not in the History Books

July 21, 2021  |  Blog Post 

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Harriet Washington’s critically acclaimed book, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans traces medical experimentation on Black Americans going back to the middle of the 18th Century, culminating with the telling of the infamous Tuskegee experiment, in which African Americans suffering from syphilis were denied any available cure to trace the course of the disease. In her bestselling book, Just Medicine: A Cure for Racial Inequality in American Health Care (NYU Press, 2018), Attorney Dayna Bowen Matthew proposes that the cure for racial and ethnic discrimination in American healthcare lies in reforming the Civil Rights Act of 1964. Add to this more books and numerous scholarly articles detailing historical racial accounts and the need for policy changes, all of which paint a very compelling picture for the need to improve the health care provided to Black Americans.

The absence of individual human value eliminates or at least diminishes the need for Patient Engagement. I propose that resolving this absence can lead to better health outcomes for African Americans of all socio-economic status, particularly for the elderly. If we improve the health outcomes of the most vulnerable, we can improve the health outcomes for all populations.

'Looking back,' Hippocrates once said, "It is more important to know the person who has the disease than the disease who has the person." The COVID-19 Pandemic has shed a bright light on the long-standing numerous health inequities experienced by Black Americans across the United States. The Black Population has the highest COVID-19 death rate.

Perception: The prevailing thought is that this disparity is a result of poverty, lack of access to care, social determinants of health, and comorbidities.

Reality: “We still see stark racial disparities even at high income levels,” said Tanjala Purnell, Associate Director of the John Hopkins Center for Health Equity. People say, “Oh, minorities are dying because they are poor." We know that is not true.

For example, Prince George County in Maryland, one of wealthiest black upper-class communities has experienced some of the highest COVID-19 mortality. In Brooklyn, New York, which has a large black population, thirteen hospitals (including three public and one state hospital) and extensive public transportation has among the highest COVID-19 associated deaths. NYC Public Transportation Employees who died were predominantly Black union workers with an average salary of approximately 50,000 dollars with pensions and health coverage.

Some solutions are simple as they are complex: Recommendations for health system culture change The required first step to decrease health care inequities is to increase human value. It is important to recognize and address the role of cultural competency for all populations as currently the English-speaking population is left out of the conversation, particularly the elderly Black Population. The elderly Black population has the worst health outcomes irrespective of disease category.

Patient Voices: An elderly African American woman states: “All I want when I go to a hospital is for someone to be nice to me."

Another elderly African American woman stated, “I picked cotton in the South, and I paid my dues, I don’t deserve to be treated this way.” These powerful quotes are saying: do you know me, my historical background, my pain and my suffering? Do you possess the level of cultural competence to understand who I am and what is important to me? How are you going to express empathy and engage me to improve my health?

When a Holocaust survivor is admitted to a hospital, public or private, the CEO, CMO, CNO, member of the board of directors and the Rabbi will make sure they visit that individual and roll out the red carpet, as they should because of the horrific circumstance they endured and survived. However, when an elderly African American atrocity survivor who fled the South because of the KKK, lynchings and “Jim Crow” is admitted, there is no red carpet roll out, even though this atrocity happened in the United States. This is a major opportunity for health systems to recognize and treat all atrocity survivors with empathy and compassion and to recognize them as an individual instead of just a patient. Equally important is the recognition of the importance of the role of religion in both populations.

Patient Engagement and Cultural Competence must have a bi-directional approach:

- Foreign medical graduates to American patients,

- American born physicians to foreign born patients

- American born physicians to American born patients who are different from themselves.

If we know who the individual is as opposed to one’s perception of the individual, then there will be improved patient engagement and as a result better health outcomes. If one’s perception is the same as the reality, then there is an opportunity to make needed changes but if one’s perception is different than the reality, we run the risk of increasing disparity in care and poor health outcome.

Martin Luther King Jr. Speech to the Medical Committee for Human Rights,1966. “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

“Difficult patients are not just born, they are in part, created by their passage through the medical system. Not only has this system failed to cure, but it may also have done unpleasant things to make matters worse.”

Disorders of Hemoglobin; Steinberg et al 2001-Pg 697) (Hartrick and Pitcher,1995) Fostering Trust and Justice William T. Zemsky, MD JAMA. 2009;302(22):2479-2480. Treatment of Sickle Cell Pain [DN1].

Authors

Dr. Mauvareen Beverley, MD.

Patient Engagement and Cultural Competence Specialist