African Americans and Healthcare Dynamics

Healthcare has always been a fundamental pillar for any country’s
wellbeing. It affects the economic, as well as social aspects of
society. In fact, it has always been recognized as a fundamental
determinant of the economic wellbeing of any country especially
considering that only healthy individuals have the capacity to create
wealth for the nation. This should explain why a large number of
governments have had to use a sizeable amount of their finances in
safeguarding the health of the nation. However, as much as the health of
the nation may be determined by the financial investment of the
government the social aspect plays a key role in the same. This is
especially with regard to the decisions that individuals make. It goes
without saying that there exists some disparities in the health status
of individuals of different ethnic and racial backgrounds, gender,
religion and even ages. This difference may be explained by the
influence that these aspects have on numerous other factors that affect
the health of the individual, or even his or her perspective towards
healthcare as a whole. This is the case for Mr. Levy, an 83 year old
African American living in South Carolina.
How race and gender affect the socioeconomic status of Mr. Levy
Race and gender have always been recognized as having an enormous effect
on the social economic status of an individual. It is worth noting that
the social economic status is usually measured as a combination of
income, occupation and education. More often than not, it is
conceptualized in terms of the class or social standing of a person or
group of individuals, with the emphasis being placed on control, power
and privilege in instances where it is viewed via the social class
perspective. Social economic status has been recognized as incredibly
relevant to every realm of social and behavioral science (Brown et al,
2008). While there are numerous elements that affect the social economic
status of an individual, race and gender comes as one of the most
crucial. Research shows that the social economic status of an individual
is intimately intertwined to his social economic status (Brown et al,
2008). The stratification aspect of ethnicity and race often has a
bearing on the socioeconomic status of an individual especially
considering that segregation often occurred within the lines of
ethnicity, race and even gender (Brown et al, 2008).
In Mr. Levy’s case, his being an African American means that there is
a distinctive characteristic that he is likely to exhibit as far as his
social economic status is concerned. For example, research shows that
children have three times likelihood of living in poverty than their
Caucasian counterparts.
In addition, his race is bound to influence his educational status.
While the educational sector has undergone fundamental changes, enormous
gaps exist especially when comparing the educational attainment of
minority groups to that of Caucasians. A study done in 2006 showed that
Latinos and African Americans had a higher likelihood of attending
high-poverty schools compared to Caucasians and Asian Americans (Wang et
al, 2006). On the same note, their dropout rate was rated the highest in
relation to that of Alaska Natives or American Indians. These factors
deprive students of African American descent of valuable resources. On
the same note, the research showed that high-achieving African American
students have a high likelihood of undergoing a less rigorous
curriculum, have instructors who do not expect much from them in terms
of academics, as well as go to schools that have relatively few
resources than their Caucasian counterparts (Wang et al, 2006). Needless
to say, this has a bearing on the quality of life that they live as
education status has been found to determine this. For example, research
shows that race or ethnicity and socioeconomic status are related to
avoidable hospitalization, untreated ailments and avoidable procedures
(Brown et al, 2008). This explains why African Americans stand a higher
possibility of undergoing an involuntary psychiatric commitment compared
to any other race.
What are cultural beliefs/practices related to aging? How might they
affect the person in your scenario?
African Americans have peculiar beliefs pertaining to aging. They
believe that aging well is composed of a strong spiritual life, social
activities, travelling and desisting from taking medications. In
addition, they believe that aging well involved being independent,
cognitively intact, as well as free of serious health problems and
mobility impairment (Wang et al, 2006). It is worth noting that they did
not associate nutrition with aging well, which is one of the
similarities between whites and African Americans.
These beliefs have a bearing on their health. For example, their
distrust for medication means that health strategies that involve taking
medications would be unlikely to be effective unless they are closely
monitored (Mayer et al, 2005). On the same note, their unwillingness to
be dependent on anybody means that they would be unwilling to seek
assistance in time. Deterioration of health is increased by their lack
of interest in exercises and physical activities (Mayer et al, 2005).
However, they would do well in nursing homes or homes for the elderly as
they value family and social bonds.
Effect of socioeconomic status on health behaviors and decisions
As noted earlier, the socioeconomic status of an individual determines
the decisions that he or she makes pertaining to his health. As noted,
their education standards may not be as high as that of other races such
as Caucasians. The systems through which they go do not have an
appropriate curriculum or sufficient resources, not to mention the fact
that their dropout rates are extremely high (Mayer et al, 2005). In this
case, their capacity to make rational decisions based on facts rather
than cultural beliefs is bound to be low. This explains why Mr. Levy
would rather skip medication to save money, whereas rationality demands
that he caters for his health first. On the same note, their low
educational status affects their income (another aspect of socioeconomic
status), which affects their capacity to get quality healthcare. Mr.
Levy’s decision to skip medication, so as to save some money, may be
predicated by some other needs that he considers as more pressing than
safeguarding his health. It is worth noting that the family receives
meals and financial assistance from well-wishers in the community, as
well as the local community center, in which case they are not at the
top as far as the financial ladder is concerned.
Leading causes of death for older persons among African Americans and
the role of gender, ethnicity, and socioeconomic status
African Americans have disproportionate rates of key health problems
that are associated with high mortality and morbidity. One of the key
causes of death among African Americans is heart disease. These are
mainly high blood pressure and arteriosclerosis (Pathman et al, 2006).
Research shows that two United States residents get a heart attack every
minute with one of them succumbing to it. Studies show that African
American men have the highest hypertension rates compared to any group.
In addition, cancer comes as one of the key causes of death among
African Americans. Women usually suffer from breast cancer, while their
men take on colon and prostate cancer than their counterparts in any
other race.
On the same note, African Americans succumb to diabetes more than any
other race (Mayer et al, 2005). This is especially the case for African
American women. It is worth noting that the key risk factor for the
condition is diabetes, in which case it is not wonder then that African
American women have the highest rates as research shows that about 60%
of them are overweight and obese (Pathman et al, 2006).
Their ethnicity has had a bearing on their educational standards and
socioeconomic status and, consequently, their decisions pertaining to
health. It is worth noting that about 50 percent of the chronic diseases
that have high mortality rates among African Americans mainly result
from dietary factors (Mayer et al, 2005). As noted earlier, they do not
hold physical activity in high esteem, which leads to their being
overweight. On the same note, their socioeconomic status means that they
are virtually incapable of seeking quality medical attention early
enough as to save themselves (Mayer et al, 2005). This is worsened by
their cultural practices that do not lay emphasis on medication, in
which case they may not even follow up on health regimen, especially in
instances where it weighs on their pockets.
Mr. Levy’s strengths in his aging experience
The key strengths of Mr. Levy in his aging experience reside in the
strong parent-child and sibling ties. It is noted that Mr. Levy enjoys
the support of his children who take turns to take care of him and his
wife. This is in line with the notion that African Americans have a high
likelihood of having members of the extended family providing social and
economic support, as well as family members taking care of the ill and
dependent family members (Fiscella, 2004). It is noteworthy that a large
part of their income emanates from assistance from the community.
Research shows that, despite the health problems through which African
Americans undergo, they have a significantly less likelihood of residing
in nursing homes than their European American counterparts (Fiscella &
Williams, 2004). This is based on their strong culture-based ethic that
requires the elderly to be taken care of by “blood”.
Mr. Levy’s challenging in his aging experience
While aging, at the face of it, may appear minority or race neutral,
there are challenges that are unique to ethnic or racial groups
different from those encountered by the elderly people in the majority
groups.
One of the key challenges pertaining to African American elders revolves
around the geographical locations of their housing (Fiscella, 2004).
Research shows that African Americans and their elders are predominantly
situated in the inner city areas. These studies show that, the aged
people that live in urban areas, make up over 60% of the entire
population of older persons in the entire United States, with 31% living
in the central areas (Wang et al, 2006). African Americans elderly
constitute about 11% of the entire population of inner cities (Pathman
et al, 2006).
In addition, they face the challenge pertaining to their incomes, which
determines the quality of life that they lead or even the neighborhood
within which their housing is located (Mayer et al, 2005). Research
shows that about 41.1% of African American elders have incomes totaling
less than $6000, with 58.2% of African American women falling in this
category (Pathman et al, 2006). It is, therefore, no wonder that Mr.
Levy and his wife survive through the assistance of their family and the
local community center.
On the same note, African Americans face challenges pertaining to their
living arrangements, which is not independent of the functional status
(Fiscella & Williams, 2004). It is well acknowledged that African
Americans usually live with their spouses and other relatives or friends
rather than signing up in nursing homes. Of course, this underlines the
importance of community and neighborhood to the elderly among African
Americans (Fiscella & Williams, 2004). However, it also exposes the
fragile relationship of aging in place, living alone and income.
Research shows that African Americans face constraining forces that
influence their ability to cope, as well as make decisions pertaining to
their living arrangements (Van Doorslaer & Andrew, 2003). Domestic
competence and health status, alongside geographic availability of their
kin and economic feasibility have a bearing on the choice of living
arrangement (Fiscella & Williams, 2004). African Americans have low
institutionalization rates thanks to the available systems of social
support, poverty, as well as dominance of males among their elderly.
Recommendations for Improving the Aging Experience of Mr. Levy and Their
Rationale
Varied strategies may be used in enhancing the quality of life of Mr.
Levy in his old age. These strategies should not only examine the best
solutions for the problems, but also their customization so that they
can fit into the likes and preference of Mr. Levy or in line with his
beliefs and the way of life. Three strategies could be used to improve
his aging experience.
First, Mr. Levy and his wife could be admitted in the same home for the
elderly. Mr. Levy is already aged and has been suffering from diabetes,
hypertension and Alzheimer. The risk of death is increased by his
tendency to skip medications so as to make some savings (Fiscella,
2004). His admission in a home for the elderly will ensure that he does
not skip his medications. While African Americans favor staying at home
to being admitted in nursing homes, the presence of his wife and the
capacity of his relatives to visit him would make him feel at home
(Knight & Ricciardelli, 2003).
Second, Mr. Levy could have a home care service provider hired for him.
Most African Americans would rather stay at home rather than be admitted
in nursing homes, in which case this experience would not be interrupted
(Van Doorslaer & Andrew, 2003). The nursing professional would ensure
that his healthcare needed are taken care of at home, including meals,
exercising and even medications, which would undoubtedly improve his
health and aging experience (Knight & Ricciardelli, 2003). It is
imperative that the professional is as close to the family as possible,
considering that African Americans prefer to have the “blood” take
care of them.
Third, Mr. Levy should be subjected to independence promoting
strategies. As much as community and family may be crucial to African
Americans, they still prefer to maintain their independence even in old
age (Van Doorslaer & Andrew, 2003). These strategies come in handy in
improving the functioning of the patient as they retain his physical and
mental abilities, while assisting him with daily activities such as
dressing, eating, grooming and hygiene. These will also include strength
or mobility enhancement strategies such as scheduled walking, and simple
stretches so as to decrease any dependency (Knight & Ricciardelli,
2003).
Positive impacts of the recommendations
Having Mr. Levy in a nursing home with his wife, or having a homecare
professional look after him would ensure that his health needs are taken
care of in time. Any healthcare problems that he has may be emanating
from his inability to follow on the treatment regimen for Alzheimer from
which he suffers. On the same note, the health of an individual is
depreciably reduced in instances where he is inactive or unable to take
care of himself (Van Doorslaer & Andrew, 2003). In essence,
incorporating strategies that increase his independence means that his
functionality is increased, which would improve his health.
References
Van Doorslaer, E & Andrew J, (2003). “Inequalities in Self-Reported
Health: Validation of a New Approach to Measurement”. Journal of
Health Economics. 22:61-87.
Brown CA, McGuire, FA & Voelkl J (2008). The link between successful
aging and serious leisure. International Journal of Aging and Human
Development. 66(1):73–95.
Knight,T & Ricciardelli, LA (2003). Successful aging: perceptions of
adults aged between 70 and 101 years. International Journal of Aging and
Human Development. 56(3):223–245.
Fiscella, K (2004). Socioeconomic status disparities in healthcare
outcomes: selection bias or biased treatment? Medical Care
.42(10):939-942.
Wang L., Larson, EB., Bowen JD., & van Belle, G (2006) Performance-based
physical function and future dementia in older people. Archives of
Internal Medicine 166:1115–1120
Pathman, DE., Fowler-Brown, A., & Corbie-Smith G (2006). Differences in
access to outpatient medical care for black and white adults in the
rural South. Medical Care 44:429–438.
Mayer, ML., Slifkin, RT., & Skinner AC (2005). The effects of rural
residence and other social vulnerabilities on subjective measures of
unmet need. Medical Care Research and Review 62:617–628.
Fiscella, K & Williams, DR (2004). Health disparities based on
socioeconomic inequities: implications for urban health care. Academic
Medicine79:1139–1147
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