CHAPTER 1
The U.S. health care system costs 2.7 trillion dollars making it one of the most expensive industries in the U.S. and yet it is the least efficient health care system among all the health care systems of the developed countries in the world.
The U.S. health care system is controlled totally by the health insurance companies.
The HMOs under the control of the men, women and their share holders who run them, devise myriad of devices and high tech soft ware to maximize their profit margins at the expense of Physicians, Dentists, PAs, NPs, Hospitals, Nursing Homes, Pharmacies, and other health care related businesses.
The CEOs who run the HMOs pay themselves exorbitant amount of money and other benefits, while other people who provide health care and other services for patients get the crump off the table literally.
With the help of highly paid lobbyists in Washington DC and state legislatures across the country, these CEOs are guaranteed to remain in control of the health care system in the U.S. by making political contributions to politicians to pass laws in favor of their HMOs' business interests.
Cut in the web of the health care money making skims by the HMOs are Blacks and other minorities who have no one to fight for their health care interests. The price they pay is the receipt of poor health care or no health care at all in many instances.
This book is written to describe some of the common medical problems that afflict black people and to bring to light the differences in the diseases that are more common in African Americans and different tests and treatments that must be employed to diagnose and treat these medical conditions.
There are many differences in the genetic and physiology of many major diseases that make black people sick. Unless physicians understand these differences and consider them in evaluating black patients, they are likely to fail in arriving at the correct diagnoses. Without proper diagnoses, effective treatments cannot be provided.
The medical community by and large remains in the dark as it relates to these issues and continues to evaluate and treat black patients the same way they treat white patients. A classic example is treating black patients with Beta-blockers for hypertension or Calcium channel blockers and angiotensin converting enzyme inhibitor with no thiazide diuretics.
It is time for racial discrimination of medical treatments in medicine is stopped. Physicians ought to take it upon themselves to become familiar with the cultures of their minority patients and culturally sensitized themselves to these patients in order so that they can provide better medical care for them.
Physicians simply cannot provide quality care for patients against whom they discriminate racially and whose cultures they frown upon and consider racially inferior to theirs. This is a formula for the delivery of bad medical care.
In addition, the book shows the many medical disparities that exist between the different medical treatments that are given to African Americans compared to whites in the U.S. Many African Americans in the U.S., the richest, most generous, and greatest country on the planet, do not have health insurance. 19% African Americans, 30% Hispanics, and 9.9 whites have no health insurance. Source: CDC
Altogether, forty-six million individuals in the U.S. live in poverty and twenty million children go to bed hungry every night. A large percentage of the children who go to bed hungry are black and other ethnic minorities.
Fourteen million Americans are unemployed. In December 2013, the unemployment was 7.0%, 14% African Americans were unemployed and 6.6.0% whites were unemployed, according to the U.S. Labor Statistics.
Fifty seven million people are getting food stamps to survive but, 5 billion dollars are being cutted from the food stamps program. 45 trillion dollars of the U.S. Wealth are the hands of the top 2% of the population. Many of those who own the 45 trillion dollars refuse to pay their fair share in taxes to help the poor and the middle class.
Many African Americans in the U.S. lack the necessities of life such as housings, employments, and proper clothing's, and foods to eat. Without any doubt, these things affect their health negatively.
As more people find themselves joining the ranks of the poor, the poverty rate for African Americans, which has always been the highest among all racial groups in the U.S., will grow even higher.
It is quite common for African Americans to present to emergency rooms in the U.S. with chest pain, and get sent home without being admitted to the hospital for evaluation and treatments.
It is hoped that Obama Care will help many African Americans to get health insurance. The strong points of Obama care include:
Young people who are 26 years can still remain on their parents insurance
People with pre-existing diseases cannot be denied health Insurance
Insurance companies must pay for people to undergo general screening for different medical problems etc;
In summary, the Affordable Care Act is a major step in the right direction to improve the U.S. health care system. A system dadly in need of reform.
Most African American women do not have typical symptoms such as chest pain before a heart attack. The most common symptoms women experience before a heart attack are shortness of breath, weakness, fatigue, cold sweat, and dizziness. (Source: Circulation, 2003, 108:2619-2623). In the U.S., African American women are offered cardiac catheterization, bypass surgery, and organ transplants less often than white women are.
African Americans suffer even more discrimination in health care than whites do in the U.S. Hypertension, heart disease, stroke, diabetes, obesity, cancer, AIDS, drug addiction, alcoholism, depression, anemia, arthritis, high cholesterol, emphysema, and osteoporosis are some of the major diseases that affect African Americans and affect African Americans disproportionately. At the same time, it is a genetic fact that generally, women live longer than men do which means that their health needs need to be addressed over a longer life-span.
Much needs to be done to correct the inequities and disparities that create a multi-layered health care delivery system in the U.S. in which, in the main, the rich receive the best health care and the poor receive the worst care.
Poverty is directly related to poor health. According to U.S. Census Bureau and Bureau of Labor statistics, 23% of African Americans and 21% of the Latinos in the U.S. live below the poverty line. Altogether, there are 48 million individuals in the U.S. with no health insurance, which clearly means that, most, if not all, of these people-many of them African Americans are likely to receive sub-par medical care or no medical care at all. The health care system in the U.S. is a very rich business enterprise with a dollar figure totaling 2.7 trillion dollars per year.
Recently, a report was published entitled "Why Not the Best Results" from a National Scorecard on U.S. Health System Performance. The Commonwealth Fund, American Medical News, October 23, 2006 compares the U.S. health care system to that of the top 10% industrialized countries in the world. Thirty-seven indicators were evaluated and the U.S. overall score was 66 on a 100 point scale. The U.S. scored 71 for quality, 71 for equity, 69 for long term health and productive life, 67 for access and 51 for efficiency. This performance by the U.S. health care system is shameful to say the least.
Many factors are responsible for the problems that exist in the U.S. health care system. "Dr. Garth N. Graham, HHS Deputy Assistant Secretary for Minorities, said that health disparities are prevalent in Hispanic Americans, African Americans, and Asian Americans." Source: Kaiser Health News, 4/19/2011.
I propose two fundamental changes in the education of future physicians: first, a radical change in the way medical students are taught in medical schools; and second, a radical change in the way training programs train young doctors.
The U.S. government has a moral, ethical, and social responsibility to do what is necessary to bring about effective changes to correct the things that cause so many African Americans to be unemployed, poor, hungry, homeless, and sick and with no health insurance to pay for their health care needs.
This book is written to highlight the common medical conditions with which African Americans and other minorities are afflicted in the United States and the corresponding health care, social, and economic disparities and inequities. Suggestions and recommendations are made for correcting these disparities and inequities.
CHAPTER 2
Hypertension In African Americans
Hypertension is one of the most common diseases in African Americans and a disease that is associated with other diseases such as obesity, diabetes mellitus, and high lipid in the blood. When left untreated or poorly treated, it causes conditions like stroke, coronary artery disease, heart attack, congestive heart failure, kidney failure, blindness, and dementia.
Seventy-eight million adults 20 years old or older in the U.S. and about 1.5 billion people world-wide have high blood pressure. By 2025, it is said that half a billion more people will develop high blood pressure. Presently, one in four people in the world have high blood pressure. In the U.S., the ratio is one in three people have the disease. Worldwide, seven million people die of high blood pressure every year. "Every year, hypertension contributes to one out of every seven deaths in the United States and to nearly half of all cardiovascular disease related deaths, including stroke." If all hypertensive patients were treated sufficiently to reach the goal specified in current clinical guidelines, 46,000 deaths might be averted each year."
"Thirty percent of patients with hypertension are not being treated pharmacologically, and only 46% of persons with hypertension have their blood pressure under control." The direct and indirect cost of hypertension is $93.5 billion per year. Sources: CDC, MMWR. 2011; 60:103-108, National Health and Nutrition Examination Survey (NHANES)
Fifty percent of people with hypertension in the U.S. are either not being treated or being treated poorly. Source JNC 8
More African Americans have hypertension than whites do. The incidence of the disease is 41% among black Americans and 27% among white Americans.
Forty-eight percent of African American males and 41.4 percent of African American women in the U.S. have high blood pressure. The incidence of high blood pressure in African Americans in the U.S. is higher than in any other ethnic group in the world. African Americans represent 13.6 % or forty-two million one hundred and sixty thousand (42,160,000) of the U.S. population and 15.6 million African Americans have high blood pressure.
High blood pressure develops at an earlier age in African Americans and the complications it causes are more severe and aggressive compared to whites. Fifty percent of African Americans with hypertension die of stroke and eighty percent die of heart disease.
Among the U.S. population with high blood pressure, 78.7 percent are aware that they have the disease, 69% are being treated for the disease, 45.4 % have the blood pressure under control, and 54.6% do not have the blood pressure under control. Roughly 63% of whites, 58% of Hispanics, and only 40% of African Americans have normal blood pressure readings when taking medications for high blood pressure. Source: U.S. Department of Health and Human Services.
Since 2005, the death rates for high blood pressure rose from 25.2% in 1995 to 56.4% in 2005. In 2005, the death rates per 100,000 from high blood pressure were 15.6 for white males, 52.1 for African American males, 15.1 for white females, and 40.3 for black females.
Source: American Heart Association—Heart Disease and stroke Statistics Update 2009.
What is hypertension?
Hypertension is when the blood pressure is higher than normal. The kidney is the organ responsible for the development of hypertension. Hypertension occurs when the systolic part of the blood pressure is higher than normal and the diastolic part of the blood pressure is higher than normal.
What is the systolic part of blood pressure?
The systolic part of the blood pressure is the upper part of the number in the blood pressure reading machine.
What is the diastolic part of blood pressure?
What is a normal systolic blood pressure?
A normal systolic blood pressure ranges from 100 to an upper limit of 139.
What is normal diastolic blood pressure?
A normal diastolic blood pressure ranges from 60 to an upper limit of 89.
What instruments are needed to take the blood pressure?
The instruments that are needed to take the blood pressure are:
1. A blood pressure cuff, which is attached to a manometer on which is listed different numbers from 20 mm/Hg to 300 mm/Hg.
2. A stethoscope, which is placed on a pulsating artery, most often at the bend and on the inside part of the arm.
What are some of the pitfalls in taking the blood pressure?
If the cuff is too small the blood pressure can be falsely high, as much as 10 to 20 mm/Hg systolic or diastolic. If the cuff is too large, the reverse can happen, namely the blood pressure can be too low by as much as 10 to 20 mm, /Hg. The person taking the measurement should make sure the blood pressure cuff is neither too large nor too small. That person should also make sure that the blood pressure cuff is functioning properly before using it. In particular, the blood pressure cuff should not be leaking, because if it is leaking air, then it is sure to give a false reading.
Both errors can have a serious negative impact in the care of a person being treated for hypertension, in that either he or she can receive too much or too little medication, which in either case can be harmful.
A small cuff should be used for a person with a small arm, a medium-size cuff for a person with a medium-sized arm and a large cuff for a person with a large arm. There are also very large cuffs made to suit the needs of very obese individuals, and as just stated above, using an undersized cuff to take the blood pressure of a person with a very large arm can cause a false reading in the blood pressure of that person.
An example of such an error in a blood pressure reading is a person with a large arm with a blood pressure reading of 140/90 measured with an undersized cuff, when in fact the blood pressure is 130/80 when a large blood pressure cuff is used. This type of error must be avoided because the person's psyche can be quite seriously affected when he or she has been told that his or her blood pressure is high when in fact the pressure is perfectly normal when it is taken with the proper cuff. When the person in this situation applies for life insurance, this particular error can adversely affect his or her ability to be insured. If insurance is obtained, higher premiums are likely to be charged because of the falsely taken blood pressure.
One should make sure that the stethoscope being used to take the blood pressure is in good working order, because if it is not, this can also cause improper blood pressure readings. One should be certain that there are no holes in the diaphragm of the stethoscope—the bottom part—and be certain to check the rubber tubing for holes and cracks. If these problems are found in the stethoscope or the blood pressure machine, it should not be used because air will escape while the doctor is trying to listen to the blood pressure, resulting in false blood pressure readings.
