SUPPOSE the entire population of Birmingham, Ala., vanished. Just imagine that in one instant everyone who lived there was suddenly gone. By this time next year, that's about the number of African-Americans (more than a quarter million people) who will die from the 10 biggest killers of Blacks of all ages--heart disease, cancer, stroke, AIDS, accidents, homicide, diabetes, pneumonia and influenza, chronic pulmonary diseases such as asthma and bronchitis, and infant mortality.
Fortunately, experts say, with regular checkups and simple changes in lifestyle and nutrition, many of these health threats can be avoided.
The No. 1 medical threat to African-Americans is heart disease. A silent killer, this illness primarily strikes when fat collects in the coronary arteries and reduces the flow of blood to the heart. Obesity and high blood pressure make Blacks waiting victims for not only heart problems but also cancer and stroke, a condition caused when blood vessels rupture in the brain or blood clots prevent oxygen from reaching the brain. These top three diseases are the same leading health threats for Whites. But, doctors say, Blacks are more likely to die.
The top killers vary by gender and by age. For young African-Americans (ages 25-44), the leading threat remains AIDS, a disease this group contracts four times more often than Whites. And for Blacks in their late teens to early 20s, the biggest danger is homicide.
Although research from the Centers for Disease Control and Prevention (CDC) in Atlanta indicates that America's health has improved overall, the health status of Blacks is frightening, even with recent advancements. The death rate of middle-aged to elderly African-American women from coronary heart disease is more than 70 percent than that for White women. Blacks have almost twice as many strokes as Whites. And according to the American Cancer Society, Black men have the highest rate of prostate cancer in the world.
The situation doesn't look any better when you consider the other health threats in the Top 10 affecting Blacks of all ages--AIDS, accidents, homicide, diabetes, pneumonia and influenza, chronic pulmonary diseases such as asthma and bronchitis, and infant mortality. "When we see a new problem on the front, we know it will probably be worse for our people," says Wilma Johnson of the CDC. "If White people cough, Black people develop pneumonia."
These statistics are even more sobering when you compare the life expectancy of Blacks to Whites. Even though the average African-American is living to an all-time high of age 70, that's still about six years fewer than Whites. And African-Americans who live past 70 often face more disabling conditions in their golden years, including amputation, paralysis and glaucoma.
Chicago internist Dr. Fred Daniels believes that ignorance about what's needed to maintain health is one of the greatest barriers to preventing major diseases in Blacks. "Most patients only come to me when something is wrong," says Dr. Daniels. "Patients come to me when they have chest pains, blood in the stool. But I want to see them when they're healthy. I try to get patients to see that once health is lost, it can never be regained."
The veteran doctor recalls a female patient who had high blood pressure. She stopped smoking, but despite his warnings, skipped a few weeks of taking her medicine. On a weekend when her family was out of town, the woman had a stroke and ended up alone and helpless for 48 hours. Now at just 60 years old, the left side of her body is completely paralyzed.
"That's unnecessary,” says Dr. Daniels. "But patients only listen to about 30 percent to 40 percent of what you ask them to do."
Experts suggest that regular examinations and honest communication with a doctor could reduce the number of deaths by diseases Blacks face. Some physicians say they are astounded to find their patients still believe myths such as diabetes is caused by eating too many sweets or that you can feel when your blood pressure is rising.
But Gloria Bonner says a lot of the confusion is due to a legacy of racism by the medical community. Echoes of the Tuskegee Experiment, a study funded in part by the federal government that denied hundreds of African-Americans treatment for syphilis, and other horror stories still haunt some people's minds.
Other concerns about inequities of medical treatment are rooted in firsthand experience, Bonner says. The registered nurse remembers the frustration of an elderly woman who was confined to a wheelchair with no family to drive her to the hospital. The woman had to wait to be picked up by a special van. Next, it was a waiting game for the doctor. A line for the pharmacy. And more waiting to be taken home.
"It's all part of a lack of access to proper health care," Bonner says. "Some Blacks have such long waits to see a physician, and when they finally see the doctor, they may not feel they are being treated with respect." She says physicians are sometimes rushed or they explain medical problems in unnecessarily complex terms. Another of the barriers to health care, she says, is poverty.
Unclean tenement buildings with cockroaches and dust pose health threats like asthma to young children. For some, the ubiquity of drugs and alcohol can be a hard temptation to escape. Expensive prescriptions leave poor people with the tough choice between medicine and food.
Still, most experts agree that education is the best cure, to prevent the growing ills among African-Americans. Wilma Johnson points to diet and nutrition as an easy place to make a change.
About one-third of cancer deaths, according to the American Cancer Society, are caused by improper diets. Our bodies need balanced meals with high proportions of fruit, vegetables and fiber.
Black America is fat, health experts say. Statistics show that more than a quarter of African-American men and women are overweight. Losing those extra pounds can take Blacks out of the high-risk group for health problems like diabetes, heart disease and stroke.
"We have a tradition of eating fatty, high-salt diets that come from slavery when we had to eat what was left over from someone else's table or what we could grow," Johnson says. "But the food can still taste good without the excess fat."
African-Americans also need to start exercising. The American Heart Association reports that, in terms of working out, Black women are the least active among all ethnic groups, and Black men aren't far behind. Just exercising for a few minutes every day can create lasting, positive effects.
Along with establishing a balanced diet and a regular exercise regimen, experts say, Blacks (and other groups) should stop smoking, refrain from unprotected sex, drink in moderation and stay away from drugs. Dr. Daniels says many people don't get worried about their health until their first or even second life-threatening experience. But the earlier you start making changes, the better chance you have for a longer life.
Johnson adds, “We can help Black America's poor by lobbying medical providers to give equal access to health care through reliable transportation and affordable insurance.”
Dr. Daniels and other medical experts say we hold the key to good health in our hands because much of our fate depends on the decisions we make. "What I see in my office are problems acquired by poor choices," Dr. Daniels says. "If my patients followed [simple guidelines], two out of every three health problems I see would disappear."