n.l._adams.jpgIn 21st century America, race no longer determines where you can get a cool sip of water on a hot day, but it can still mark how long you get to live. On average, whites outlive blacks by five to seven years. That’s about a half billion fewer heart beats for that community.

This staggering health gap is hardly a new phenomenon. President Abraham Lincoln observed that the health of the Negro was worse at emancipation in 1863 than it was at the nation’s founding in 1776. By 1940, Time magazine reported that the “health” of the Negro was “America’s No. 1 public health problem.”

The Civil Rights Movement hinted at a new day, when in 1964 federal courts finally evicted Jim Crow from health care, forcing segregated hospitals to wheel their Negro patients up from the basement and into the “promised land” of American medicine.

So what is the health status of African-Americans today? In many ways, blacks face the best of times and worst of times. In 2002, a committee of experts from the Institute of Medicine found racial inequity in health care for every investigated disease area – even after taking into account such factors as insurance and patient compliance with the doctor’s treatment plan. The committee found that these inequities result in higher death rates for blacks.

Today, blacks still bear the health burden of ex-slaves and still too frequently receive health care in the “basement” of American medicine. So what is the solution? Stewardship in certain key areas:

HIV/AIDS: Blacks make up slightly more than one-tenth of the U.S. population but half of all new AIDS cases. Stewardship means abstinence for those who can, safe sex for those who cannot and HIV testing for those who are sexually active. Stewardship also means that our leaders must step up resources for HIV testing, counseling and treatment for incarcerated populations and provide greater support to community organizations that stand in the trenches of the battle against AIDS.

Obesity: According to the Centers for Disease Control and Prevention, 77 percent of black women and 61 percent of black men are overweight. Proper diet and physical activity are the sure cures for many of the chronic conditions that plague our communities today.

Stewardship means asking your doctor to support your weight-loss effort, collecting heart-healthy recipes and organizing a carpool to shop at the farmer’s market where produce is fresh and affordable.

It also means addressing school menus and the obesity epidemic facing our children, and forming partnerships between parents and school districts in this effort.

Maternal and infant health: There was a time when black women breastfed not only their own babies but also suckled the children of white mothers. Today, we have often failed to transmit the healthy tradition of breastfeeding to young black mothers.

As a practicing obstetrician gynecologist since 1982, I have often seen the toll that this misstep has taken on the lives of young expectant mothers and their newborns. Stewardship means that we must make certain that young women are linked to high-quality prenatal services and are surrounded by a circle of loved ones and community resources that will protect, guide and cherish them.

We must be mindful, however, that even as we do the groundwork necessary to prevent sickness and mortality, we still face deeply entrenched inequities in health care.

We must close the gap in health care access by embracing and nurturing the promises of universal health coverage.
Yet access alone is not good enough. We must also demand that our elected officials support the movement afoot to improve cultural competence among physicians, so that doctors and patients have a more trustful and effective relationship.

Lest we forget, personal responsibility is at the forefront of the matter. Yes, genetics, environment and access to care are critically important determinants of one’s health; but it is the personal choices that we make that overwhelmingly determine the status of our health.

Now is the time to take up the sword of stewardship and take on the behavioral, social, and political forces that undermine the health of blacks, other minorities and, in fact, all of us.

Indeed, our highest calling of stewardship is to envision a nation where racial inequality can no longer be measured in heartbeats. Let us heed the words of our elders: “If you know better, you ought to do better.” Fellow Americans we know better, let’s do better.

N.L. Adams, M.D., is chairman of the Department of Obstetrics and Gynecology at Jackson North Medical Center, and clinical professor of Obstetrics and Gynecology, Florida International University Herbert Wertheim College of Medicine.