Point of View

Health disparities can be narrowed

April 12, 2010 

— It's more common in blacks than whites."

During my first year as a medical student at Duke, this was the refrain from one professor after another. Not only were diabetes, hypertension and an assortment of other diseases more common in blacks, but these ailments were more likely to cause crippling and sometimes deadly complications for them. In those instances when a disorder was actually more common in whites, my professors had a sister refrain: "Blacks who get it still do much worse than whites."

As a black man in a sea of mostly white and Asian faces, this chorus was like fingernails on a blackboard. I wanted to challenge their conclusions as outdated, or perhaps even racist, but I did not need to look far to see their truths. My grandmother had just died in her early 70s from stroke-related complications, and my father's side was littered with relatives who died prematurely from pneumonia, cancer and heart disease.

Once I donned my white coat, I saw my family story replicated in the faces of hundreds of black patients. In the midst of this racial reality, I was diagnosed with hypertension at the ripe age of 24, despite my thin frame and recent history as a college athlete. As I sat helpless on the clinic exam table, my professors' words echoed in my mind. Was I doomed for a future of poor health too simply because of my race?

I started medical school back in 1996, and as any honest person can see, much has changed on the racial front. It is commonplace now to see black faces on television (both real and fictional) working as educated professionals, whereas in my childhood, entertainers, athletes and criminals predominated.

This media shift reflects real changes in society. In 1996, there had never been a black CEO of a Fortune 500 company: there are currently five, and four others have held similar roles. In politics, there are two black governors (Massachusetts and New York) where there were none in 1996. And of course, there is President Barack Obama. Even in sports, where blacks have been overrepresented for a half-century, Tiger Woods (sex scandal notwithstanding) and the Williams sisters have blazed new trails.

This is not say that we live in a color-blind world, but only someone stuck in the past or trying to advance a narrow agenda would assert that there has been no meaningful racial progress in many areas of American life.

So where do things stand on the health disparities front? Has there been similar progress?

In 2000, the U.S. Department of Health and Human Services launched Healthy People 2010, a health promotion and disease prevention plan of goals to achieve by 2010. One of its two central aims was to eliminate health disparities.

The 2005 midterm progress report revealed improvement in overall health among blacks in several areas, yet limited progress in eradicating the race-based disparities themselves: blacks, on average, have a life expectancy five years less than whites.

It would be easy to take a negative view on these results. However, focusing on the racial gap alone obscures the progress made: for example, black males added four years of life expectancy in 2005 compared to 1995, more than any other group. This is not say we are where we want to be from a public health standpoint, but there should be some acknowledgment we are headed in the right direction, rather than the more negative tone sounded too often by the media and my first-year professors.

As for me, by conquering some of the cultural beliefs that led me to scorn healthy eating, I have lowered my blood pressure to consistently normal levels without medication. During my decade-plus in medicine, I have seen dozens of other patients - many black - achieve similar results.

With time, I've come to realize the disparity issue has less to do with race and more with socioeconomic status. Education allows one better access to the information needed to make healthy life choices. A good income and health insurance plan provide access to the treatments that improve both the quality and quantity of life.

Historically, blacks have lagged in both areas. The recent passage of health care reform will extend insurance coverage to tens of millions in the years to come. I hope this will go a long way toward remedying longstanding inequalities.

Now that I'm the professor, I stress these points to my impressionable students rather than make blanket racial declarations without placing them in broader context. Health disparities, as with so much in life, are colored in shades of gray rather than simply black or white.

Damon Tweedy, M.D., is a physician at Duke University Medical Center.

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