Dr. Sylvia Flack has been facing down a crisis in health disparities that disadvantage people of color since she joined the administration of Winston-Salem State University in 1989. Her first job, as coordinator of the nursing program, was to halt a plan by the NC Board of Nursing, UNC Board of Governors and state lawmakers to close the program at the historically black institution. Even though the university leadership considered the program a lost cause, she saved it.
Short in stature but with a bright disposition and engaging manner, she hinted during a workshop on Oct. 24 that she wouldn’t mind passing the baton, but still clearly sees the state of black health as profoundly unacceptable.
Hers was only one of the breakout sessions after lunch at the Cross-Systems Equity Summit hosted by Neighbors for Better Neighborhoods and funded by the United Way of Forsyth County that examined how various systems interact to perpetuate institutional racism and oppression. Flack said it’s important to be frank: People of color are more likely to be sick and die prematurely than their white counterparts, and face significant barriers to healthcare. This challenge intertwines, reinforces and compounds worse outcomes in education, employment, criminal justice and access to finance.
The basic facts about minority health disparities are not in dispute and have long been established. By 1980, the National Institutes of Health reports, there was a growing awareness that blacks, Latinos, American Indians, Asian Americans and Pacific Islanders were likely to die younger while suffering from higher rates of diabetes, cancer, heart disease, stroke, infant mortality and low birth weight.
Local health leaders have evidence that those disparities continue to this day, and are actually more acute in Forsyth County than in North Carolina as a whole. The 2014 Forsyth County Community Health Assessment Report, which was published in July, found that black residents were 23.1 percent more likely to die of cancer and 48.1 percent more likely to die of heart disease — the two leading causes of death in the county. Black residents also had higher death rates for diabetes and kidney disease than their white counterparts.
The report indicated that “the strongest predictors of better or poorer health status are better or poorer socioeconomic conditions respectively,” adding that “the racial differences in socioeconomic status, neighborhood residential conditions, and access to medical care are important contributors to health disparities.”
The report outlines a correlation between health, poverty and race that should be obvious: “The distressed areas located within the community were in the low-income people of color neighborhoods.”
What accounts for the disparities? Certainly environment. Flack mentioned lack of transportation allowing people to get to doctor’s offices and hospitals, and showed a slide that indicated blacks and Latinos are significantly more likely to live near waste management facilities. The same risks to people of color come into play with major highways. Anyone who is familiar with the geography of Winston-Salem knows that the neighborhoods flanking Highway 52 are predominantly black and Latino.
The Health Disparities and Inequalities Report, published by the federal Centers for Disease Control in November 2013, found that “traffic-related air pollution is a main contributor to unhealthy ambient air quality… with the highest concentrations of risk of exposure occurring near roads.” This exposure is associated with asthma, cardiovascular disease, poor reproductive outcomes and mortality. The report goes on to say that “in the United States, it is widely accepted that economically disadvantaged and minority populations share a disproportionate burden of air pollution exposure and risk.”
But environment and poverty don’t explain everything, Flack said, adding that lack of trust, experiences of racism in the medical establishment and misdiagnosis because of stereotyping all play a role. She mentioned in particular that black women experiencing abdominal pain have been misdiagnosed with pelvic inflammatory disease, a condition typically caused by sexual activity.
As a testament to the murkiness that surrounds minority health research, I found three references to a study indicating that black women were being misdiagnosed with pelvic inflammatory disease as recently as 1993, but the so-called study was a news article in a feminist health journal, not a peer-reviewed scientific research paper. The original research appears to have been conducted by Dr. Donald Chatman in 1976. I couldn’t find any additional studies replicating Chatman’s findings. I’m not sure if that means the research lacks credibility, or that the racial stereotyping is so pervasive that there’s no interest in the medical establishment in correcting the record.
Whatever the truth of the allegation of black women being misdiagnosed with pelvic inflammatory disease, mistrust of the medical establishment among African Americans is well founded and historically rooted. To mention only a few well-known examples, right in Winston-Salem, white community leaders promoted forced sterilization, a program that lasted into the 1970s and predominantly affected poor women of color. Similarly, the US Public Health Service allowed black men to remain untreated for syphilis at the Tuskegee Institute in Alabama from 1932 to 1972 without the patients’ knowledge so they could study the progression of the disease.
At the end of the workshop, Flack mentioned to me that black people are often hesitant to go to a local clinic in Winston-Salem, and suggested that I try to find out why. A woman who had previously worked with the federal Women Infants & Children food and nutrition program, who had overheard our conversation, posited some theories.
“Black people are tired of feeling like they’re the subject of a research study,” she said. “And they keep getting prescribed medications that don’t make them feel better. So they stop going back.”