Medical issues among African Americans encourage doctors to discover solutions
King Hospital working to bridge health divide
Merdies Hayes | 7/14/2017, midnight
Martin Luther King Jr. Community Hospital in Watts is taking bold steps to break through the barriers to good health within the African American community. And there is good reason why this proactive stance is so important, because the Black community—nationwide—has been witness to some of the worst health outcomes of any population. Officials at King Hospital are trying to remedy that situation by focusing on preventative measures that, they believe, will not only shine a light on historic health disparities in South Los Angeles, but also foster a better sense of health ownership and well-being.
Most prominent in these health disparities are four diseases which disproportionately strike African Americans: diabetes, high blood pressure (hypertension), heart disease and obesity. These diseases have been a traditional scourge among African Americans—irrespective of socio-economic status—but when undiagnosed for decades, any of them can result in a life-or-death situation that could have been prevented had the person received proper medical care.
‘Moma has a sugar problem’
The American Diabetes Association reported in 2014 that 13.2 percent of all African Americans aged 20 years and older have diagnosed diabetes. Further, African Americans are 1.7 times more likely to have diabetes as are non-Hispanic Whites. Diabetes is associated with an increased risk for a number of serious, sometimes life-threatening complications, and the Black community experiences an even greater threat. There are two types of diabetes: Type 1 diabetes, which usually begins in childhood or adolescence, and Type 2 diabetes (adult onset) which is the most common form of the disease, usually occurring in middle-age adults after age 45 and characterized by high blood glucose levels caused by either the lack of insulin or the body’s ability to use insulin efficiently.
So often within Black households, you’ll hear a phrase such as “Momma has a sugar problem.” What this statement in fact means is that the traditional “soul food” cuisine historically rooted in African American kitchens for generations has less to do with sugar intake and more to do with high amounts of fat brought on by years of substandard nutrition. A high amount of fat intake can be a huge risk factor for diabetes. More sobering is the fact that many African Americans who have diabetes know they have the disease, but continue their same diet. Officials at King Hospital see hundreds of diabetes cases each month, and are working daily to not only warn patients of their risk for the disease, but are leading a community-wide effort to bring about better health outcomes for patients with diabetes.
“Diabetes and high blood pressure are the top two cases we see daily,” said Dr. Elaine Batchlor, CEO of King Hospital who is on a mission to curtail not only rampant diagnoses of diabetes, but other health issues that are prevalent among African Americans and, increasingly, the Latino population of South Los Angeles. The hospital name is a familiar one in Los Angeles. King Hospital opened originally in 1972 with a noble vision of providing health care to residents of South Los Angeles. Decades later, after cases of mismanagement and poor oversight by Los Angeles County, it closed in 2007. After new construction, a new staff and a significant reduction of the bedcount from 461 to 131, the facility reopened in 2016 as two separate entities serving 1.3 million people. MLK Hospital is privately funded, while the MLK Acute Care Clinic next door is operated by the county of Los Angeles.
‘Know Your Basics’
Batchlor explained the unique association of diabetes and African Americans in relation to a shortage of family physicians in the inner city. For generations, she said, Black persons have lived with the disease prior to any diagnosis and that circumstance can lead to more serious health problems, if left unchecked.
“We see so many patients show up at the hospital with bad conditions stemming from diabetes,” she said. “This includes various infections and wounds related to diabetes; some of our patients have never managed their condition. That’s why we have instituted extensive screening procedures through our “Know Your Basics” outreach campaign to have people become more familiar with their health issues.”
The “Know Your Basics” campaign goes into the community to local parks, shopping centers, school campuses, etc. to spread the word about diabetes and how the disease can be a precursor to health issues such as high cholesterol and obesity. Last year, they screened more than 5,000 persons for diabetes, with another 7,000 examinations expected this year.
“The first step is to know your risks,” Batchlor continued. “Our endocrinologist (a specialist in diagnosing diseases related to the glands) screens for diabetes everyday and has concluded that the main contributor to diabetes is obesity and a lack of exercise. Poor nutrition plays a significant role in Type 2 diabetes, so that’s why we continually stress a balanced diet coupled with regular exercise. And this should begin at a young age, not when symptoms begin to appear at age 40.”
The hospital is setting an example in something as simple as the cafeteria. Traditionally fried entrees such as chicken or fish are baked. Fresh fruit and berries have replaced most pastries and sweets. A wide assortment of steamed vegetables are part of the daily menu. Soft drinks are in limited supply. Instead, fruit juice, skim milk and lots of bottled water have been strategically placed to quench your thirst. “We want to set the example of a healthy diet for not only patients and visitors to the hospital, but to the staff itself. And the food is delicious,” she said.
The ‘silent killer’
High blood pressure, commonly referred to as hypertension, is another disease prevalent among patients. Hypertension has been called the “silent killer” because it can cause damage to many body organs without any symptoms. Uncontrolled high blood pressure can cause a heart attack, stroke, kidney failure, vision problems and even death. A report released last year by the Centers for Disease Control and Prevention revealed that 35 percent of African Americans have some form of hypertension, which accounts for 20 percent of this community’s death rate in the United States. That’s twice the percentage of deaths among Whites from hypertension. Further, African Americans with high blood pressure have an 80-percent higher chance of dying from a stroke than the general population.
“This is an ‘asymptomatic’ disease in that you don’t know you have it. It is definitely a contributor to kidney failure,” Batchlor said. “[Hypertension] is an important aspect of our screening process and we are working to educate people on how to manage this condition. Again, exercise, diet modification and the proper medication are keys to addressing this issue. We want to intervene early—get in front of the case—before it becomes a serious condition.”
Scientists have debated the causes of hypertension among African Americans for decades. Two years ago, Vickie M. Mays, Ph.D., a clinical psychologist and professor of health policy and management at UCLA, and her team conducted a study of Black men aged 40 to 65 years on the role that racism may play in increasing stress and what contribution this issue may have in terms of morbidity and mortality in African Americans. Mays explained that in some of the men studied, the cases of hypertension have eventually led to diabetes, heart disease and prostate cancer among the older participants. She added that these and other acquired medical conditions are not the result of coincidence, but have often occurred because of the psychological and emotional impact on the brain and body when consistently faced with experiences of discrimination that “... play a role in the health of these men,” she said.
Racism as stress inducer?
At about the same time as the UCLA study, the American Journal of Preventative Medicine published a study called “Discrimination, Racial Bias and Telomere Length in African American Men.” A group of scientists at the University of Maryland, led by David Chae, an epidemiologist, gathered 95 Black men between the ages of 30 and 50 years and measured their white blood cell telomere lengths. Telomeres are repetitive sequences of DNA that sit like plastic protective caps at the ends of shoelaces. When white blood cells replicate, DNA sequences at the very ends get chewed away and telomeres are there to serve, according to the researchers, as “sacrificial lambs” to protect the more crucial DNA from being damaged. Basically, the shorter they are, the higher the risk of contracting dementia, heart disease and Alzheimer’s disease. Chae said his study demonstrated that telomeres are also sensitive to psychological stress (i.e. hypertension and its connection to racism), which can speed up their depletion.
Heart disease has long been determined as the biggest killer in the United States, and African Americans are at a greater risk for cardiovascular disease and stroke than anyone else. The American Heart Association (AHA) reported in 2014 that Black women (49 percent) and Black men (44 percent) have higher rates of heart disease than White women (32 percent) and White men (37 percent). Between the ages of 45 and 64 years, Black men have a 70-percent higher risk and Black women a 50-percent greater chance of developing heart failure than their White counterparts of the same age. Because African Americans tend to develop high blood pressure (a strong indicator of potential heart failure) earlier in life and their average blood pressure numbers are much greater than Whites, Blacks therefore have a 1.3-times greater rate of non-fatal stroke, a 1.8-times greater rate of fatal stroke, and a 1.5-times greater rate of death attributable to heart disease than Whites.
The AHA suggested that African Americans may carry with them a gene that makes them more sensitive to salt, thereby increasing the risk of high blood pressure which is the most familiar precursor to heart disease. With a direct correlation to hypertension and obesity, Batchlor said a balanced diet, reducing stress—and of course no smoking—can be the most effective methods to reduce the onset of cardiovascular disease.
Lack of family physicians in inner city
“Heart disease is one of the biggest killers of all among African Americans. Dietary habits are the foremost concern when doctors look at people who may have this illness,” Batchlor said. The hospital is taking early steps in combating heart disease among its clientele with its “You Can” program that partners with local schools to encourage good eating habits while simultaneously exposing youngsters to a career in healthcare. For instance, a group of fifth graders from a nearby school were invited to listen to how the hospital chef planned his menu devoid of high fat, salt and sugar. The children learned that fast food burgers and tacos must be eaten in moderation—not everyday—because starting in the teen years fat can build up in the arteries, resulting in high cholesterol counts which, overtime, can force the heart to work harder to pump blood. “It is never too early to instill good health practices, and if we can steer these kids away from junk food and on to a healthy diet, then we’ll see far less cases of heart disease later on.”
Batchlor noted that the lack of family physicians in South Los Angeles, coupled with limited outlets for fresh vegetables and fruit, an “over abundance” of fast food franchises, and limited park space needed for exercise can make it difficult to ward off heart disease, even if the rate of smoking is at all time low for persons aged 20 to 35 years.
The Los Angeles County Department of Public Health published in January its “Key Indicators of Health” report that revealed that South Los Angeles—along with the Antelope Valley—have the poorest nutritional habits of any local region. For instance, only 9.6 percent of children in South LA eat a daily “family meal” (i.e. consumption of five or more servings of fruits and vegetables a day). Forty-one percent of adults (18 to 35 years) will drink one or more sodas or sweetened drinks each day, and an astounding 51.6 percent of South LA children will drink at a minimum of 16 ounces of soda or a sweetened drink each day. Further, 34.1 percent of South Los Angeles adults are categorized as obese or overweight, compared to only 10.1 percent of adults in West Los Angeles, roughly 20 miles away.
“For Black people in the inner city, they often lend themselves as ‘chronic indicators of stress,’” said Tony Iton, a physician and senior vice president of Healthy Communities with the California Endowment. He suggested that the ongoing congressional debate to replace the Affordable Care Act should focus more on the “structural” components of good health, rather than cost effectiveness.
Obesity among Black children
“Low income people become ‘psychologically different’ via chronic stress. Stressful environments can shorten lives from a health standpoint, and blaming the victim is not the correct answer to health disparities between the inner city and the suburbs,” Iton explained. “Anything that increases stress is adverse to good health. These stress indicators can include everything from unemployment and crime, to a lack of good dietary options and green space for exercise. Certain ‘institutionalized’ factors within poor communities all lead to less than desirable health outcomes, and these disparities tend to harm Black children and youth in the worst ways.”
Obesity is the one disease within the African American population that encompasses each of the previous health conditions. Statistics released two years ago from the Office of Minority Health, U.S. Department of Health and Human Services (HHS) point to pervasive dietary, physical fitness and economic barriers within South Los Angeles and similar communities nationwide that have resulted in African American adults being 1.5 times more likely (47.8 percent) to be obese compared to White adults. Specifically, more than 75 percent of African Americans are considered to overweight or obese (including 69 percent of men and 82 percent of women) compared to 67.2 percent of Whites (71.4 percent of men and 63.2 percent of women).
Obesity is an epidemic that spans across all races and ethnicities; however, African-Americans tend to suffer from this disease from childhood. Batchlor said many factors are correlated with obesity with a primary determinant being less access to affordable, healthy food. This begins in childhood and if left unchecked through the teen and young adult years, obesity will lead to Type 2 diabetes and will result in higher cholesterol levels (directly related to high blood pressure), heart disease and stroke. According to the HHS study, 20.2 percent of African-American children and teens 2 to 19 years were categorized as obese, compared to 14.3 percent of Whites of the same age.
Expected surge in emergency room visits
Because lower income and poverty correlate strongly with an increase in obesity, many children residing in South Los Angeles must opt for less nutritious, calorie-dense fast food because it costs less—and is often more abundant—than healthier food. The HHS manages a Youth Risk Behavior Surveillance System that monitors various health risk behaviors that may contribute to the leading causes of death and disability and found that 11.3 percent of African-American youth do not eat vegetables on a weekly basis, and that Black high school students are almost twice as likely as their White peers to not eat breakfast daily. This unbalanced diet among Black youth is said to be a contributing factor in less healthy eating patterns overall, weight gain and poorer performance in school.
“It is unfortunate that we see the end result of obesity here at MLK,” Batchlor explained. “This is clearly the result of a lack of access to healthy food and a lack of green space in Watts and South LA in general. Obesity is the cause of many of the bad health issues Black people experience, be that diabetes, high blood pressure, heart disease and stroke. We can turn that around. It begins with healthy eating and regular exercise, and that has been our mission statement. It’s a community-wide effort that must be instilled at an early age.”
Batchlor, and her many counterparts in Los Angeles County, are concerned with an expected surge in emergency room patients, if cuts to Medicare prove to be as severe as anticipated. She believes an excess of 35,000 additional emergency room visits each year to MLK is not an exaggeration, if more people lose access to health insurance. This new figure does not include the 80,000-plus patients that MLK sees each year.
“Right now, we’re seeing about twice as many people in the emergency department as we had anticipated when we opened,” she said. “That falls back on the lack of outpatient physician care in the area. It would break my heart to see people lose their insurance coverage, but as I’ve said before: ‘MLK Community Hospital will provide excellent medical care regardless of the ability to pay.’”
This article was produced as a project for the USC Center for Health Journalism’s California Fellowship.