Reclaiming Our Health: A Guide to African American Wellness

Reclaiming Our Health

YALE UNIVERSITY PRESS HEALTH & WELLNESS

A Yale University Press Health & Wellness book is an authoritative, accessible source of information on a health-related topic. It may provide guidance to help you lead a healthy life, examine your treatment options for a specific condition or disease, situate a healthcare issue in the context of your life as a whole, or address questions or concerns that linger after visits to your healthcare provider.

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PATRICK CONLON, The Essential Hospital Handbook: How to Be an Effective Partner in a Loved One’s Care

RICHARD C. FRANK, M.D., Fighting Cancer with Knowledge and Hope: A Guide for Patients, Families, and Health Care Providers

MICHELLE A. GOURDINE, M.D., Reclaiming Our Health: A Guide to African American Wellness

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RUTH H. GROBSTEIN, M.D., Ph.D., The Breast Cancer Book: What You Need to Know to Make Informed Decisions

JAMES W. HICKS, M.D., Fifty Signs of Mental Illness: A Guide to Understanding Mental Health

STEVEN L. MASKIN, M.D., Reversing Dry Eye Syndrome: Practical Ways to Improve Your Comfort, Vision, and Appearance

MARY JANE MINKIN, M.D., and CAROL V. WRIGHT, Ph.D., A Woman’s Guide to Menopause and Perimenopause

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Reclaiming Our Health

A Guide to African American Wellness

MICHELLE A. GOURDINE, M.D.

Illustrations by Catharine L. Love

Published on the foundation established in memory of William Chauncey Williams of the Class of 1822, Yale Medical School, and of William Cook Williams of the Class of 1850, Yale Medical School.

Copyright © 2011 by Michelle A. Gourdine, M.D.

All rights reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviewers for the public press), without written permission from the publishers.

The information and suggestions contained in this book are not intended to replace the services of your physician or caregiver. Because each person and each medical situation is unique, you should consult your own physician to get answers to your personal questions, to evaluate any symptoms you may have, or to receive suggestions for appropriate medications.

The author has attempted to make this book as accurate and up to date as possible, but it may nevertheless contain errors, omissions, or material that is out of date at the time you read it. Neither the author nor the publisher has any legal responsibility or liability for errors, omissions, out-of-date material, or the reader’s application of the medical information or advice contained in this book.

Yale University Press books may be purchased in quantity for educational, business, or promotional use. For information, please e-mail [email protected] (US office) or [email protected] (UK office).

Designed by Mary Valencia.

Set in Minion type by Integrated Publishing Solutions, Grand Rapids, Michigan.

Printed in the United States of America by Sheridan Books, Ann Arbor, Michigan.

Library of Congress Cataloging-in-Publication Data

Gourdine, Michelle A., 1962–

Reclaiming our health : a guide to African American wellness / Michelle A. Gourdine.

p. cm.—(Yale University Press health & wellness)

Includes bibliographical references and index.

ISBN 978-0-300-14582-3 (clothbound : alk. paper)—ISBN 978-0-300-13705-7

(paperbound : alk. paper) 1. African Americans—Health and hygiene. I. Title.

RA778.4.A36G385 2011

362.1089’96073—dc22          2010044397

A catalogue record for this book is available from the British Library.

This paper meets the requirements of ANSI/NISO Z39.48–1992 (Permanence of Paper).

10 9 8 7 6 5 4 3 2 1

For my mother, Gloria Abram,

my husband, Derek Gourdine, and my children.

This book would not have been possible

without your love, patience, and encouragement.

CONTENTS

Preface

Part I: AN UNFINISHED CIVIL RIGHTS BATTLE

1. An American Injustice: The State of African American Health

Part II: REWRITING OUR HEALTH HISTORY: A NEW

VISION OF BETTER HEALTH

2. Lose Weight and Win: Fighting Obesity

3. From Soul Food to Food for the Soul: The Keys to

Eating Well

4. Make the Right Moves: How to Burn Fat and Be Fit

5. Detoxify Your Life: Managing the Three Ss (Stress, Sleep,

and Smoking)

6. Change Your World: Righting the Wrongs of Social Inequity

Part III: NAVIGATING THE HEALTH CARE SYSTEM:

WHAT EVERY AFRICAN AMERICAN MUST DO NOW

7. Know Your Family History

8. Understand Your Health Insurance

9. Choose the Right Doctor

10. Schedule a Physical Exam

Epilogue

Frequently Asked Questions

Glossary

Notes

Resources

Acknowledgments

Index

PREFACE

Every year, tens of thousands of African Americans die from diseases we know how to prevent. This is unacceptable. Frankly, like many of you, I have grown tired of opening the newspaper and reading how African Americans are always the sickest, the latest to be diagnosed, and the earliest to die. For the nearly four hundred years since blacks arrived from the shores of West Africa, we have occupied the lowest rungs on the ladder of health. So how is it that in the decades since the civil rights movement, black men and women have made so much progress politically, educationally, and economically, yet our poor health status persists?

During the fall of 2008, the United States and the world were on the brink of economic disaster. Once-venerable financial institutions were collapsing faster than imploded buildings. Consumers panicked, and the stock market plummeted. Do something was the outcry from the public to governmental leaders. In response, the president and his cabinet devised a seven-hundred-billion-dollar plan to bail out financial institutions and stabilize our economy. This state of the economy and the plan to repair it were presented to lawmakers in stark and blunt detail. This crisis allowed no time to sugarcoat the facts.

In the same way, I will not gloss over the facts of African American health. We are in full-blown crisis and have been for some time now. The signs of our health crisis were depicted in full relief during my medical training. I treated many black patients who were suffering from complications of chronic disease—mothers relying on dialysis machines to cleanse their bodies from the toxins that their kidneys, damaged by high blood pressure, could no longer handle; wheelchair-bound fathers who lost a leg to diabetes; young women bravely enduring chemotherapy treatments for cancer; grandmothers struggling to climb stairs with painful knees crippled by obesity-related arthritis.

OBSTACLES ON THE PATH TO WELLNESS

It seems illogical that in a country where the life expectancy of all Americans increased by thirty years over the past century, African Americans would remain at such high risk from preventable diseases. So why do we bear a greater burden of disease and death? Some say that lack of health insurance is to blame. Although a higher percentage of African Americans is uninsured compared with whites, almost 80 percent of African Americans have some form of health care coverage. Others suggest that blacks are genetically predisposed to be sicker. Yet race is socially, not genetically assigned. Still others blame African Americans for not taking better care of themselves. But the ability to live a healthy lifestyle is influenced not only by individual motivation but also by environmental resources. Many reasons have been posited, but they all boil down to this: the likelihood of getting a particular disease is ultimately influenced by the number of risk factors you have. African Americans, it turns out, have a higher number of risk factors for virtually every major chronic disease—risk factors such as high obesity rates, low physical activity rates, and so forth. These risk factors are influenced by cultural and social elements that determine what we eat, whether we exercise, how we view ourselves, how we handle stress, and whether we have access to the resources needed to be healthy (that is, income, education, employment, high-quality health care, and safe and supportive neighborhoods).

When I began writing this book in 2006, I was overwhelmed by the volumes of information—hundreds, even thousands of pages of scientific articles, newspaper and magazine articles, chapters of books and entire books, not to mention hundreds of websites—on African American health that have been published. Without question, many authors have attempted to condense this vast body of scientific information into practical advice and recommendations for the African American community. But what makes Reclaiming Our Health different is its examination of how African American culture shapes the health choices we make. For many of us, the things we believe, the traditions we treasure, and the values we hold dear influence what we eat, whether we exercise, and when we seek medical attention. For example, cooking big soul food meals is a traditional expression of love. How, then, do we reconcile our need to eat healthier with our desire to enjoy a way of eating that has become an entrenched part of our culture? Must we give up our sense of community and history in order to live healthier lives? Here’s another example. African Americans have traditionally celebrated and accepted men and women of all sizes, including those of us who are overweight and obese. How do we reconcile our desire to encourage each other no matter our size with the real health threat that extra body weight poses? Must we give up our positive self-image in order to live healthier? This book is my humble attempt to address these important but often ignored obstacles that stand between African Americans and the better health we deserve.

You see, although many of my medical colleagues understand the challenges of African American health on an intellectual level, for me, poor African American health is more than just a concept. I live it every day. I see it at my church on the growing list of members who are sick and shut-in; in my neighborhood, where I see too many little children with big waistlines; in my family, where we have been touched by almost every single leading cause of death. I wrote this book to empower our community to solve our own health problems and save our own lives.

In this book, you will learn easy steps to live a healthier life. Here are just some of the few benefits you’ll gain by reading this book and applying its principles to your own life:

• Our traditional diet carries great sentimental meaning, but it places us at higher risk of serious disease. Rather than being scolded about what you shouldn’t eat, you will learn how to modify your diet to make it better.

• We all lead hectic and busy lives. This book will show you how to fit the exercise you need into your daily routine.

• Stress has become an all too common part of life. You will learn healthier ways to cope with stress, including the unique racial stress that African Americans face.

• You will learn how to determine the healthiest weight for you and the best way to reach it.

• By practicing these practical tips, you will leave a legacy of good health and set a positive example for your children and their children.

Reclaiming Our Health starts with a description of our current state of health by answering the following questions:

• Exactly how sick are we?

• Who in our community is at greatest risk of illness?

• Which diseases are primarily responsible for our poor health?

In plain language, Part One establishes our starting point by outlining African Americans’ health problems and the main diseases that cause them.

FIVE RISK FACTORS

Part Two moves us toward the goal of reclaiming our health by describing the five leading factors affecting the health of African Americans. Diseases like diabetes and high blood pressure—conditions that are well known in our community—are the end result of obesity, malnutrition, inactivity, toxicity, and social inequity. Four of these factors—obesity, malnutrition, inactivity, and toxicity—address the relationship between our cultural attitudes and beliefs and our health practices. The fifth risk factor, social inequity, addresses the social resources we need to be healthy.

Obesity. As a nation, we’re heavier than ever, with two out of every three Americans overweight or obese. But African Americans are the heaviest racial and ethnic group in this country. About eight out of every ten black women and seven out of every ten black men are overweight or obese. If you have too much fat—especially in your waist area—you’re at higher risk for heart disease and stroke. Excess weight also raises your blood pressure and blood cholesterol levels, increases your risk for developing diabetes and cancer, and worsens arthritis.

Malnutrition. A healthy diet is necessary to keep the body running smoothly, keep the immune system in top condition, and reduce the risk of chronic diseases. A balanced diet provides the body with the proper combination of vitamins, minerals, and calories. Our traditional soul food diet—full of fat, salt, and calories—contributes to the increased prevalence of disease in the black community. Saturated fat from red meat and fried foods clogs arteries and increases the risk of heart attack or stroke. Salt raises blood pressure, and processed foods high in calories and low in nutrients increase the risk of cancer and contribute to blacks being the heaviest group in the nation.

Inactivity. Regular physical activity lowers blood pressure and cholesterol, prevents diabetes, controls your weight, and relieves depression and anxiety. The recommended level of exercise is thirty minutes of moderate physical activity (for example, brisk walking) per day for most days of the week. But most Americans find it difficult to achieve this level of physical activity, including African Americans. Lack of exercise contributes to obesity, heart disease, diabetes, and high blood pressure.

Toxicity. As a nation, we are overworked and stressed. Working long hours, juggling family responsibilities, and dealing with financial difficulties are major causes of stress. For many African Americans, perceived racism is an added stressor. Chronic stress causes insomnia, elevates blood pressure, raises blood sugar, weakens the body’s defenses, and ultimately increases the risk of heart disease, obesity, diabetes, and infections.

Social inequity. The ability to live a healthier life is influenced in part by an environment that supports healthy eating, regular activity, and less stress. African American neighborhoods disproportionately lack these environmental supports.

The chapters of Part Two answer the following questions:

• What is the history behind our food choices?

• What are the main barriers to exercise in our community?

• Does the stress of racism play a role in our health?

• Is our race weaker and genetically predisposed to be sicker?

• How do our living and working environments contribute to our poor health?

Next, each chapter includes a self-assessment to help you determine how the factor is currently affecting your health. Finally, each chapter ends with simple steps you can take to maintain a healthy weight, improve your nutrition, move more, stress less, and improve the health of your community. Reading this section will equip you with the skills to improve your health, and the health of your community.

The final section of this book acknowledges that in addition to selfcare, good health also involves getting regular medical care. The chapters in this section show you how to make the most out of your interactions with the health care system by being an informed patient. You will learn how to collect and use your family history to protect your health, how to choose the best doctor for you, and a simple way to understand your options for health care coverage, including an overview of the new health care reform law. Finally, you’ll learn the importance of getting regular checkups, even if you believe you are in the best of health.

AN OPPORTUNITY TO REWRITE OUR HEALTH HISTORY

Make no mistake. This book’s outline of the reasons for the current state of African American health is not an exercise in finger-pointing or self-pity. No, the purpose of understanding how we got here is to find our way out of our current situation. This book is not a laundry list of things that the government or society must do to help us become healthier; its purpose is not to lay blame, but to empower. As the old saying goes, once you know better, you can do better. The following chapters will provide you with the information you need to make your life better.

What would it look like if all African Americans—men, women, and children—decided to reject our legacy of sickness? If we suddenly decided to create a new legacy of wellness, where would we start? What would we do?

This book offers