Introduction “I am no longer accepting the things I cannot change. I am changing the things I can no longer accept.” —Dr. Angela Davis Black Health Matters was written with a single purpose—to empower you, the reader, to take control of your own health and healthcare. This means positioning yourself to make informed decisions about your well-being and that of your loved ones. Of course, you need to work with your healthcare professional, but to accomplish this, you must be armed with knowledge and understanding. Every day, you have to remain in control of your lifestyle and the decisions that will affect your health. To achieve this, you need a blueprint for improving your health and maintaining it. That is what Black Health Matters is all about. It is easy enough to say “Black health matters.” But when we go by the numbers, the extent of poor health among our Black population becomes painfully evident. According to the Centers for Disease Control (CDC), health disparities continue to exist due to poverty, unequal access to care, and unequal representation in medical research. That painful truth was just as evident to Martin Luther King, Jr., when he said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” However, we have to understand that this inequality goes back hundreds of years. 2 Black Health Matters BLACK HEALTHCARE VERSUS WHITE HEALTHCARE Throughout American history, healthcare for White Americans has always been shamefully better than that for Black Americans, contributing to a greater number of Blacks with chronic illness and early deaths. If you take the same chronic diseases that White Americans die from as seniors—that is, at sixty-five-plus years— you will find Black Americans dying of these conditions in their twenties, thirties, and forties. That is because, as a group, Black Americans get chronic diseases earlier in life than White Americans, and this earlier onset leads to disabilities and earlier deaths. Unfortunately, there are many reasons for this. Cost Since costs and/or the lack of health insurance determines if you see a doctor early and often, it is, without a doubt, a major contributor to the problem now faced by African Americans. First, let’s look at the inequality in healthcare insurance. Coverage by health insurance for Blacks at all ages has been persistently lower than that for Whites. Many hourly jobs that Blacks hold do not include health insurance, and lack of coverage is a barrier for receiving health services. The cost of insurance is higher for Blacks than for Whites, and if you don’t have health insurance, a doctor may require substantially higher payments to see and treat you. After the Affordable Care Act (ACA) was passed in 2014, more Blacks Americans had insurance coverage. However, 30 million people, half of them persons of color, remained uninsured in the United States. Fourteen states, mostly in the South, refused to expand Medicaid, depriving many Blacks of coverage. Medicaid coverage is crucial for elderly and underserved Blacks. However, it still does not pay the full cost of hospital stays and doctor’s visits, nor does it fully cover prescription drugs. Furthermore, many doctors will not accept patients who have Medicaid because it pays them peanuts, if they get paid at all. Out-ofpocket costs are a burden for recipients with low incomes and high healthcare needs. Introduction 3 The Lack of Local Medical Facilities In some cases, adequate medical facilities may be far away from Black communities, especially in rural areas. Added to that is the lack of transportation to the medical facility due to high costs or the lack of routes in neighborhoods. Too often, in urban communities, the only option for immediate healthcare may be a visit to a hospital emergency room, which becomes their main source of healthcare. And once there, a patient may likely wait hours to be seen. The harsh reality is that many of these medical care centers and doctors’ offices avoid opening in poorer communities because of economic reasons or perceived safety concerns. And while this great divide of medical care may not have been based on racism or ethnicity, it has excluded poorer communities from getting essential services. Keeping Appointments For Black hourly workers, keeping a healthcare appointment during a work day is often discouraged or even disallowed by many employers. This is due to the long time it takes to see a doctor. In fact, the average wait time for Black folks is roughly seventy minutes versus fifty-three minutes for Whites. Try explaining that to an employer when you are two or three hours late. And even when workers try to get an appointment before work begins or after it ends, they need to be fitted into the doctor’s schedule—which may require weeks or even months of waiting. Too often, the result of these negative experiences is to simply avoid seeing a doctor. What occurs is a snowballing effect. The delay in seeing the doctor allows the health condition to get worse, which means more time needed for follow-up appointments, which means more absences from work. Then, as all this is occurring, the cost of the care increases due to the frequency of visits and probably more medications. This, in turn, means there may not be enough money to pay the extra costs involved, so patients don’t get their appointments completed. This results in the condition progressing from 4 Black Health Matters a slowly evolving disease to an immediate and severe condition requiring attention in the Emergency Department, often leading to hospital admissions. Too often this becomes a dangerous cycle. Poorer Quality of Healthcare Black people are simply not receiving the fair and impartial healthcare that their White counterparts receive. Even if health insurance, income, age, and severity of conditions are equal to a similar group of Whites, Black care is inferior. The American Bar Association has reported that minority persons are less likely than White persons to receive appropriate cardiac care; kidney dialysis or transplants; and the best treatments for stroke, cancer, or AIDS. Further, the report concluded that conscious or unconscious racism by the doctors plays a role. Covid-19: A Case in Point The racial inequities of the healthcare system—and of American society in general—was highlighted by the COVID-19 pandemic, a global pandemic that began in 2019. Communities of color bore the brunt of the pandemic because of higher-risk work environments, crowded urban living conditions, and a higher rate of preexisting conditions. In fact, African American and Latinos were three times more likely than Whites to contract COVID-19. People of color also found it harder to find testing, receive adequate treatment, and—when vaccines became available—to access them. This led to a higher rate of Black and Latino deaths. For instance, in Louisiana, Blacks represented about one-third of the state population but 70 percent of COVID-19 deaths. At the national level, Pacific Islander, Latino, Indigenous, and Black Americans had a COVID-19 death rate of double or more that of Whites and Asian Americans. As Kim Blankenship, Professor of Sociology at American University, said, this is “the price we pay for inequality.” Never has the need for societal change been clearer. Introduction 5 Higher Incidence of Chronic Disease Blacks are at much higher risk for many chronic diseases, yet their ability to have them monitored is far less than Whites. For example, hypertension affects 75 percent of Blacks compared with 55 percent of White men and 40 percent of White women. Hypertension occurs earlier in life for Blacks. Even African American children have higher blood pressure than White children. For the Black community to receive help with this common disorder, their hypertension must be diagnosed early, and their blood pressure monitored regularly by their doctor and themselves. If they receive this diagnosis, their doctor may prescribe blood pressure medicine that effectively lowers blood pressure. While many relatively cheaper drugs are available, drugs are only part of the solution. Patients must understand that they can dramatically lower their blood pressure by lowering their salt intake, losing weight, and exercising. These lifestyle changes rest on the patient’s shoulders. Like hypertension, obesity and type 2 diabetes also affect many more Blacks than Whites. These chronic diseases need to be controlled or eliminated, requiring the input of doctors and their guidance for life-changing efforts. Again, your doctor can only do so much. Much rests on you, the patient. Inherited Illnesses Various ethnicities are predisposed to certain conditions. Blacks are genetically more at risk than Whites for some diseases, such as sickle cell disease (SCD), a devastating illness for many Black Americans. In fact, one baby in every 365 Black people is born with SCD. I will talk more about this disease in Chapter 11. However, for the most part, chronic health conditions experienced by African Americans are more strongly related to obesity and poor diet than to genetics. Poor Diets Poor diet—due to bad food choices, poverty, and unhealthy eating traditions (sorry)—are major contributing factors in all the chronic diseases that plague Blacks more than Whites. And while 6 Black Health Matters processed foods that are high in sugars, “bad” fats, and salt may taste good, they lack basic nutrients—the very cause of so many of the common illnesses we suffer. In many areas of the United States, Black neighborhoods lack major grocery store chains. Instead, local food shops (bodegas) offer lots of expensive processed foods with no fresh fruits and vegetables and whole grains. Some Blacks cannot afford healthier foods. But if you don’t feed your brain and body well, over time, you are likely to develop a chronic illness. With help from this book, you will learn the components of a good diet and avoid the “junk” foods that are all too common in our communities. There’s more about this in Chapters 2 and 9. LIVING HEALTHIER If you adopt a healthier lifestyle, you may be able to lessen or eliminate the need for chronic healthcare interventions such as medications. Let’s be clear about what I mean: I am not saying that you should avoid seeing your physician, getting annual exams, and taking prescribed medications. To the contrary, it’s essential to get blood work, mammograms, pap smears, prostate exams, regular annual checkups, etc. However, it’s also important to stop doing those things that are drivers of ill health. Type 2 diabetes doesn’t have to be. Severe hypertension doesn’t have to be. Most of all, being overweight or obese doesn’t have to be. What you will read repeatedly is that obesity is a gateway disease, meaning that with this condition come most of the other chronic diseases we see in the Black community. There are basic actions you should take to ensure that your body becomes as healthy as God meant it to be! First, eat a nutritious diet that provides the proper amounts of protein, carbohydrates, fiber, “good” fats, and, perhaps, supplements of vitamins, minerals, essential fatty acids, and other nutrients, depending on your unique health needs. You will also need to exercise and get adequate sleep. It is crucial to reduce the stress in your life—just being Black in America is stressful! Learn to relax, perhaps by Introduction 7 walking, taking up yoga or tai chi, or listening to calming music. If you want to achieve good health, all these things are critical for your success. As a bonus, when you start feeling better, you may feel less stressed. On the other hand, to achieve good health, you must change some harmful behaviors. If you are overweight or obese, you need to eat less. Also avoid processed foods that are loaded with white flour, too many calories, too much salt, excessive sugar and corn syrup, “bad” fats, and artificial chemicals. The latter are added by manufacturers to deceive you, the consumer. Don’t play their game! They are just out to make more money by selling nutritionally empty foods that are cheap to manufacture. Second, you must decrease your indoor and outdoor exposure to toxic chemicals, because these substances can make you sick. If you smoke, you must stop. You already know that, and on numerous occasions, you may have promised yourself and others to kick the habit. This time, you need to follow through. Constant exposure to poor foods and harmful chemicals will eventually mean that your body stops working properly, causing an early development of chronic disease and an untimely death. You must take advantage of today’s technology to learn as much as you can about your health and how to change it. Then you need to act on that knowledge. You cannot be ignorant of currently available information and then say, “The devil made me do it” or “I can hardly move because I weigh too much, but I just love food! I can’t stop myself!” That is a myth, and the continued belief that the problem is someone else’s fault, that change is someone else’s responsibility, or that change is just too difficult will keep you from reaching your goal of better health and a better life. WHAT’S TO COME In the following chapters, I will share the knowledge you need to improve your health and I will outline the steps you must take. You will need to find a healthcare practitioner to assess your health, monitor your progress, prescribe vital medications, and, hopefully, 8 Black Health Matters cheer you on. With his or her input, you must also take control of your own health. How do you that? Reading the following chapters should be a good start. Chapter 1 discusses the microscopic organisms that populate your gut. I know it’s hard to believe, but there are trillions of these one-celled organisms! When they are in balance, your body works well, but when they get out of balance, your health suffers. This chapter introduces you to the microbiome—the community of microbes (bacteria, more commonly known as germs) in your body—and aids you in keeping that community healthy. The obesity epidemic is sweeping this country. Obesity contributes to heart disease, stroke, type 2 diabetes, and some cancers. Blacks, especially Black women, are more likely to be overweight, obese, and even morbidly obese than Whites. Chapter 2 discusses the problem of obesity and provides the steps you can take to achieve a thinner you. Chapter 3 discusses another epidemic: hypertension. Hypertension, or high blood pressure, is a silent killer. It doesn’t have symptoms to warn you to get medical help, and it is associated with many serious disorders. In this chapter, you will learn why hypertension is so dangerous, what causes it, and how you can lower your risks of getting this insidious disease. Diabetes is a major public health problem that is approaching epidemic proportions globally, and is found in high numbers in the African-American community. Chapter 4 takes a close look at this disorder—its causes, its diagnosis, and its complications. Most important, it tells you the many simple steps you can take to lower your risk or, if you already have diabetes, to help control it. Cardiovascular disease consistently remains the leading cause of death in the United States. Worse still, nearly 48 percent of Black women and 44 percent of Black men have some form of this disease. Chapter 5 explains what cardiovascular disease is, what causes it, and what you can do—from improving your diet to exercising—to avoid heart disease, heart attack, and stroke. Statistics show that Black Americans are four times more likely to fall victim to kidney disease than White Americans—even Introduction 9 though Blacks make up only about 13 percent of the population. Chapter 6 explores the many risk factors associated with kidney disease, explains how it is connected to other disorders that plague the Black community, and lists its early symptoms so that you can help identify this problem and stop it in its tracks. Although the overall cancer death rates have dropped faster in Blacks than in Whites, African Americans with cancer still have the shortest survival rates of any racial and ethnic group in the country. Fortunately, there are many things you can do to protect yourself and your loved ones from this terrible disease. Chapter 7 starts by explaining what cancer is. It then discusses the many causes of cancer and, most important, the ways in which you can reduce your risk. The focus of Chapter 8 is the issue of aging. Although no one can stay young forever, it is possible to get older without being disabled by age-related disorders, and it’s also possible to lengthen your life span. This chapter first explains how the natural process of aging affects the body. It then shows you that by making simple lifestyle changes and taking selected supplements, you can live longer and, just as important, live healthier. In almost every chapter of this book, we highlight how good nutrition can help you avoid or better manage many common health disorders. Chapter 9 focuses on this issue, telling you everything you need to know to improve your diet and your health. You’ll first learn about the history of Black nutrition in America, see why our communities eat the way they do, and understand how this impacts our health. The chapter then guides you in choosing nutritious foods—vegetables, fruits, whole grains, lean proteins, beans, nuts, dairy products, and other foods that if prepared properly can help you avoid all those nasty disorders discussed throughout this book. Following this, you discover how specific diets—including the American Heart Association Diet, Mediterranean Diet, DASH Diet, and vegetarian diets—can help treat specific medical conditions, such as obesity and hypertension, as well as improve your overall well-being. Finally, Chapter 9 examines fasting, which many people successfully use to lose weight, detoxify their cells, lower 10 Black Health Matters blood pressure, and provide many other benefits. Throughout, you’ll learn interesting information about probiotic foods, complex carbohydrates, flavonoids, and other foods and food components that can make your body the best it can be. Chapter 10 is all about your environment, including the apartment or house where you live, your neighborhood, your children’s schools, and your work place. For decades, if not centuries, Black communities have suffered from some of the most harmful environments in the United States. This chapter looks at how the environment profoundly affects our health, and examines the specific substances—such as asbestos, lead, mold, and plastics—that are harming us and our children. Finally, it suggests practical changes you can make to improve the quality of your air, remove toxins from your diet, and detoxify your body. Just as important, it urges you to demand actions that would improve the environment of Black communities. Chapter 11 tackles the problem of sickle cell disease (SCD), a genetic disorder that plagues the Black community, causing an endless list of problems, such as severe pain, frequent infection, vision problems, and organ damage. After explaining sickle cell disease and its effects on the body, this chapter discusses testing, symptoms and complications, and standard treatments. Finally, it explores two cutting-edge procedures that show great promise in the treatment of SCD, and in some cases, may even eliminate the disease. In Chapter 12, you will learn about common dental and oral problems and explore how poor dental health can affect your overall health—how, amazingly, it can even damage the heart, the kidneys, blood sugar levels, blood pressure, and more. Unfortunately, Black communities usually have little access to good affordable dental care. This chapter provides tips for improving your oral health on your own and also offers practical suggestions for finding a good reasonably priced dentist in your area. The Conclusion takes a hard look at healthcare, race, and racial disparities in the healthcare system. It examines long-standing racial disparities in our nation’s healthcare and looks at this pivotal Introduction 11 moment in our country, when African Americans must not only take responsibility for their own health but also call for change in the way they are treated by medical professionals. Before you begin reading the chapters on specific disorders, such as hypertension and diabetes, I want you to understand that although I sometimes touch on the standard medical treatments that are used in the management of these disorders, that is not my focus in this book. Although medication is necessary to treat certain ailments, I have learned in my practice that it is often possible to avoid these illnesses or manage them with less medication if the individual is willing to modify diet, increase exercise, and make other lifestyle changes. With that being said, I want to caution you that if you are using medications prescribed for you by your doctor, you should not stop taking these drugs—even if you feel that your health has improved—without contacting your physician and determining if it would be safe to do so. Similarly, if you are being treated for a medical condition, you should not begin taking nutritional supplements before discussing the specifics with your healthcare provider. Some supplements interact poorly with certain medications. Following the Conclusion of Black Health Matters, you will find a wealth of material that can help you better understand the issues discussed in this book and take the first step towards better health. The Glossary explains many of the terms used in the book that may be new to you. The Guide to Dietary Supplements provides important information about choosing and using supplements, and recommends the best nutrients for treating the diseases covered in the book. A Resources section guides you to organizations, websites, books, and other resources that can provide you with further information about diet, environmental toxins, and much more. And if you’re interested in looking at the studies and articles on which this book was based, you can turn to the References section. Throughout the book I have included Black health Timelines. All too often, we hear stories about the exploitation of Blacks 12 Black Health Matters throughout history. Rarely do we learn about how our community has endured years of suffering due to medical mistreatment and abuse. We are where we are because of this history. While I have made the stories brief, each one is telling. As survivors, we must learn from the past so that we never have to repeat it. CONCLUSION I understand that many African-American families have achieved a level of economic success, giving them access to better healthcare. That being said, they are just as susceptible to each and every health issue discussed in this book. This is why Black Health Matters is designed to help every Black person achieve better health, just as I have successfully guided my own patients to greater well-being during my many years as a practicing physician. By following the advice offered in this book, you can turn your life around, feel better—perhaps better than you have in a long time—and enjoy many happy, healthy years to come.