National Minority Health Month: Be the Change!

To wrap up National Minority Health Month, it is important to outline some of the steps we can take to help eliminate health disparities. These steps all include you! Age, sex, ethnicity, religion, language, sexual orientation and socioeconomic background do not matter when it comes to making a positive change in your life!

Take Charge of Your Health

Change begins with you! Though there are many external factors that can have an impact on our health, we have the power to make little changes that can make a big difference in our lives. For example, getting regular exercise does not always have to involve long hours at the gym. Walking instead of taking the train to work or school, or taking the stairs instead of the elevator can add physical activity to your day. Invest in a pedometer and/or use a calculator for an estimate of the calories you’ve burned. Work with your physician to come up with a safe exercise plan.

Making small changes to your diet can also have a big impact on your health. Control the amount of food you eat at each meal. Reduce your intake of sugary drinks like soda and artificial fruit juice, and instead drink water. Eat less processed junk food like fast food, potato chips, cookies, and sugary candy. You can treat yourself to your small “guilty pleasure” snacks a few times a week. Don’t completely cut out treats as this can make you feel deprived, but greatly reduce unhealthy food packed with sugar, fat and preservatives. Balance is the key! Also, use of a free, online calorie counter such as My Fitness Pal to keep track of your diet and physical activity habits. This website also allows you to access a free app on your phone. Quit smoking and reduce your alcohol intake. These two steps paired with physical activity and a good diet can lower your risk of obesity, cancer, heart disease, diabetes, high cholesterol and high blood pressure. Work with your physician or a nutritionist to develop a regular healthy diet!

Go for regular check-ups. Whether you visit a physician in her private practice, or visit your local health clinic—go regularly! The best way to stay healthy is to prevent disease before it begins. In the case you have developed a health problem, treating it early can yield better health outcomes. Make sure to be tested regularly for high cholesterol, high blood pressure, heart disease, HIV/AIDS and other sexually transmitted infections, and keep your immunizations current. In addition to a primary care provider, women can see a gynecologist at least once a year. The American College of Obstetricians and Gynecologists recommends that teenage girls start seeing a gynecologist between the ages of 13 and 15. Developing a relationship with your physician early on can have a positive impact on your health! Please note that your health needs change as you age. Please visit this website for recommendations for your age group: http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm

Stay Informed

Keep an eye out for current events and stories related to health (and all other issues). Before we can come up with a solution, we must know the problem! In the case of health disparities, exploring the problem and devising a solution will happen simultaneously but we must stay informed and aware. Reading the paper or online news articles, even if just for a few minutes a day, will empower you to formulate your own ideas about the world!

Spread the Word

You can be the teacher! Once you have taken control of your health and have been informed of the issues affecting your health, you can spread the word. By taking charge of your health you may inspire others to do the same. Even if you do not have a career in health care, just by talking and raising awareness about health disparities can help enact change!

For a list of resources regarding health disparities visit: http://www.nlm.nih.gov/hsrinfo/disparities.html

National Minority Health Month: Kidney Disease and Transplantation

This weekend I visited the Mount Sinai School of Medicine on the Upper East Side of Manhattan. Among many other interesting sessions, the faculty presented a session aimed to highlight health disparities. The specific topic was kidney transplantation. The brief conversation that took place made me want to do a bit of research and learn more about kidney disease and transplantation.

Certain diseases such as diabetes and high blood pressure can greatly damage kidneys. Unfortunately, minority populations are disparately affected by these diseases and thus by kidney disease. According to statistics from the University of Cincinnati, the number of new kidney failure cases diagnosed in 1997 was 873 per million in African Americans and 218 per million in whites; 73% of all cases among African Americans resulted from high blood pressure and diabetes; African Americans made up about 13% of the US population but 30% of all kidney failure cases. Obesity, diabetes and high blood pressure among African Americans has become a bigger problem since 1997, and today the health disparities continue to be rampant.

Kidneys are organs essential to life as they filter toxins from our blood, regulate our blood pressure and help our bodies remain healthy. High blood pressure and high levels of sugar in the blood can damage the blood vessels within the kidney. Once damaged, the kidney cannot keep useful substances (like proteins) in the blood. If protein is instead found in urine, it can be the mark of kidney disease.

Over time, kidney disease gets worse and worse. Chronic kidney disease progresses to end-stage kidney disease in which these vital organs completely shut down. When this happens, hemodialysis (an artificial process that  filters blood) can be a life-saver. However, over time the hemodialysis process also takes a toll on the patients’ body and quality of life. Many patients must spend up to four hours a day on hemodialysis which interferes with their daily lives. Patients leave the clinic feeling exhausted. Hemodialysis patients must also follow a strict diet which may be especially difficult for patients who already have uncontrolled blood pressure and diabetes. For people with end-stage kidney disease, organ transplantation may be their only chance at life; many die waiting for an organ.

Organ transplantation is not a cure-all solution. Finding a good organ match, undergoing the surgery and the aftercare that is required are difficult processes. According to Dr. Susan Lerner, a transplant surgeon at Mount Sinai, New York State has one of the longest waiting periods for a kidney. This is the result of a higher number of people needing a kidney combined with a fewer number of donors. While patients wait to be matched to a donated kidney, they can spend more than five years on hemodialysis and remain very ill.

Some studies have found that minority patients are less likely to be referred for kidney transplantation by their physicians. Even if referred, patients must pass a series of physical and mental health assessments. The tests also seek to evaluate the patient's emotional support system and the likelihood that the patient will adhere to the post-operative care plan, including taking prescribed medications. Aside from passing these screening processes, patients must match to a donor-kidney with similar tissue and blood type. Finally, the financial aspects of the surgical procedure must be sorted out before the transplantation can take place. The entire screening, match and transplant process can take nine years!

Social determinants of health such as socioeconomic background and level of education can interfere with a minority patient's ability to pass the physical and mental health tests. Furthermore, the process is long and arduous and many minorities fail to even complete the testing process. Even though African American patients are not required to be matched to organs from African American donors, minorities do not donate organs and tissues at the same rate as their white-counterparts. This fact only decreases the likelihood of minorities finding a perfect match.

Lack of financial resources can also affect a patient's ability to find an donor-organ match. Consider the case of the late Steve Jobs, co-founder and former chairman of Apple, Inc. Mr. Jobs came from an affluent background and was thus able to benefit from being on liver transplant waiting-lists in multiple states. Since he was on multiple lists, Mr. Jobs was able to find a match more quickly and travel to Tennessee to undergo the transplant operation. I am sure that many Americans cannot afford this luxury. Furthermore, after organ transplantation, the medications necessary to prevent the body from rejecting the organ and to treat infections, cost a lot of money. Health insurance, even public health insurance, can help cover the cost of the medication but often cannot cover everything. A patient who actually underwent kidney transplantation visited students at Mount Sinai and said that he had cleaned out his savings of more than $20,000 to pay for one year's medication.

For all that has been described here, it is very important for the medical community and society at large to work harder to raise awareness about health disparities. We must keep raising awareness to encourage research and policy change necessary to help eliminate the growing gap in health equality.

National Minority Health Month: Child Asthma

According to the CDC, 7 million children suffer from asthma nationwide. According to the New York City Department of Health and Mental Hygiene, children in New York City were almost twice as likely to be hospitalized for asthma as children in the United States as a whole. Even more alarming, in recent years, the Bronx has been the New York City borough with the highest overall rates of asthma hospitalizations, deaths and prevalence among children as well as adults. Clearly, disparities exist.

Asthma is a chronic lung disease that can cause the airways to become inflamed and narrow. This can result in coughing, wheezing and tightness of the chest which may make it difficult to breathe. Asthma attacks are often triggered by illness, strenuous activity and the environment; smoke, allergies, pets, mold, dust and pollution can be a trigger. Cockroaches can also trigger asthma attacks, as many children are allergic to the material associated with decaying roaches, and live roaches' excrement. Partners Healthcare, a team of doctors, nurses, respiratory therapists and other health care professionals, cites cockroaches as a bigger trigger than pet dander and dust. Though asthma cannot be cured, it can be treated with regular long-acting medications, and fast-acting medications in the event of an attack.

Children with asthma tend to have family members with asthma, implying that the condition is inherited. However, it is difficult to establish a link between inheritance and an entire race because race is a social construct that cannot be clearly defined by genetics. Asthma can be inherited by any child, regardless of their ethnic background, depending on the child's family history. However, asthma affects children from ethnic minority groups at disparate rates. For example, non-Hispanic black children have a higher prevalence of asthma and die at higher rates from asthma than non-Hispanic white children. Hispanic children have a higher prevalence of asthma compared to non-Hispanic white children.

Many ethnic minority children tend to live in areas in which smoke, mold, dust, pollution and roach infestation may be a problem. These triggers can greatly exacerbate asthma. Due to a lack of health insurance or a regular primary care physician, minority children suffering from asthma may be forced to use a hospital's emergency department for care. Also, due to lack of insurance and/or family instability, it may be difficult for children to regularly take required long-acting asthma medication, as prescribed. One study actually examined the degree to which instability within a family can negatively impact a child's health. Investigators found that family instability is related to poor child health, including asthma.

Additionally, cultural boundaries may contribute to disparities if they result in poor communication between the physician and patient or sub-par care. Poorly controlled asthma has also been linked to poorer performance in school (for example, more absenteeism), and may even help explain the academic achievement gap that exists among children from different ethnic groups. The aforementioned factors contribute to health disparities but are really symptoms of much greater social injustices. In order to rectify the problem, we must more closely examine our society.

National Minority Health Month: HPV and Cervical Cancer

At the American Association for Cancer Research (AACR) annual meeting on April 1, researchers said that the human papillomavirus (HPV) lasts longer in African-American women than in their white counterparts. This may shed light on some of the disparities that exist among women from different ethnic groups regarding HPV and cervical cancer.

HPV is a virus that is contracted through sexual contact. According to the Center for Disease Control and Prevention (CDC), there are over 40 types of HPV that can infect the genital area, throat and mouth. Condoms lower the risk of transmitting the virus, but areas not covered by condoms can still become infected. The CDC estimates that 20 million Americans are currently infected with HPV.

In addition to causing genital warts, another major health problem that results from HPV is cervical cancer and other genital cancers. Cancer and warts result from the body's inability to return the infected cells back to normal. In addition to the use of condoms, a vaccine (i.e. Gardasil) can lower your risk of developing warts and/or cancer. Gardasil protects against 4 types of HPV. Condoms should still be used because other types of HPV exist, and to protect against other sexually transmitted infections. Gardasil is recommended for girls and boys ages 9-26. Prevention means working to stop something before it occurs. Even if an individual has not yet had her first sexual contact, she should still be vaccinated.

In recognition of National Minority Health Month, it is important to outline the disparities associated with HPV and cervical cancer among women. While the incidence of cervical cancer among non-Hispanic white women was 8.5 in 100,000 women, the incidence was 13.8 and 11.4 for Hispanic and African-American women respectively. Despite the fact that Asians and Native Americans and Alaskins had a lower incidence of cervical cancer than their white counterparts, these minority groups were more likely to die from cervical cancer; Hispanics and African-Americans were more likely to die as well.These disparities may stem from several issues. Regardless of race, uninsured women are less likely to have regular PAP smears, and thus may not learn they have cervical cancer until it is advanced. However, it is also true that many uninsured women happen to come from low socioeconomic backgrounds and/or are from ethnic minority groups. Health and Human Services (HHS) said in a report that in 2005 many uninsured people were just above, at or well below the poverty line. The same HHS report said that Hispanics are disproportionately uninsured as they represent 14% of the general population but 30% of the uninsured population. As a group, Hispanics, African Americans, American Indians and Asians/Pacfiic Islanders constituted 52% of the uninsured population.

Many cases of cervical cancer are related to HPV. Many minority groups are not well-educated about how HPV is contracted, spread and treated. This may relate to the level of access to general education and health care. Even among minority women that are educated and have access to regular health care, cultural attitudes toward Western medicine and the health care system may contribute to these disparities. These same factors can also influence whether or not a woman chooses to be vaccinated for HPV. Lower vaccination rates can lead to an increased risk for contracting HPV, and the development of cervical cancer.

The study presented at the AACR annual meeting found a biological factor that may also contribute to disparities related to HPV. The investigators found that African-American women hold on to HPV longer in the body than their white counterparts; this may be a reflection of their genes and immune systems. Kim Creek, vice-chair and professor of pharmaceutical and biomedical sciences at South Carolina College of Pharmacy said, " [the] body recognizes it [HPV] as a viral infection and usually clears the virus within one or two years...It is those women who have difficulty clearing it that are at higher risk of cervical disease and cervical cancer." This recent finding may help explain the higher prevalence of cervical cancer among African-Americans. It would be interesting to study whether other minority groups disparately affected by HPV and cervical cancer, also hold on to the HPV virus longer than their white counterparts.

In summary, access to health insurance, education, health care, cultural attitudes and genetics are all factors that contribute to health disparities related to HPV and cervical cancer. It is clear that this is a complex problem. Cultural competency within the health care system, and initiatives that target high-risk populations will help us make great strides toward the elimination of health disparities.