Higher Rate of Heart Disease and Obesity in African Americans
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Studies reveal that African-Americans become easily affected by both cardiovascular and metabolic syndromes such as obesity. In spite of advances in the detection of risk factors concerning heart disease as well as the expansive utilization of evidence-based stratagems to control the condition, ethnic incongruences in the morbidity and mortality still exist in the U.S. Throughout every metric for the condition, as well as obesity, African-Americans have demonstrated poorer health in comparison to their non-Hispanic whites, and the mortality associated with cardiovascular disease is higher amongst their population compared to whites (Ogden et al., 2017). The same suppositions regarding CVD can be extrapolated to obesity amongst this population in the United States. Again, compared to other racial inclinations in the United States, Black Americans have a higher rate of acquiring obesity as well as suffering mortality from the same. The worrying assertions make it fundamentally important for interventions to be formulated in order to prevent the morbidities and mortalities associated with increased heart diseases and obesity among members of the African American community in the United States. Thus, the present paper looks to review the o
ccurrence obesity and cardiovascular diseases in African Americans and the possible intervention plans that can mitigate them.
Identification of the Problem
The rates of heart diseases and obesity has been on the rise in the African American ethnicity over the past couple of years. Statistics reveal that members of this population have a higher chance of suffering from cardiovascular diseases than those of other races with black men at 44% and black women at 49% having higher incidences than white men (37%) as well as white women ( 32%) respectively (Horton, 2015). Additionally, the risk of suffering from CVDs increases with the age of the population as between age 45-65 years, black men show a higher risk of 70% while black women indicate a risk of 50% in contacting the disease in comparison to their white colleagues across both genders (Carnethon et al., 2017). The earlier commencement of heart diseases implies higher hospitalization rates, early onset of disability, as well as prevalence in premature deaths before reaching the age of 65 when it comes to the Black American population. Research has also revealed that the yearly rates of maiden heart attacks are lower in white Americans compared to their Black counterparts.
Moreover, obesity also follows similar trends to cardiovascular diseases when ethnic comparisons are made. The latest data acquired from the U.S Department of Health and Human Services Office of Minority Health reveals that in comparison to whites, the probability of Afro-Americans becoming obese stands at 1.4 (Odgen et al., 2017). The comparison of the role of gender in the prevalence of obesity in this population also revealed that African-American women have a higher chance of becoming obese when compared to other demographics in the United States. Specifically, a study revealed that a whopping 4 out of every five Black American women are either obese or overweight. As of 2015, the likelihood of African-American women becoming obese was 60% when compared to the likelihood of their non-Hispanic counterparts suffering from the same condition. The comparison went further to the girls from the two ethnicities and it was shown that the non-Hispanic white girls had a 50% lesser chance of becoming obese vis-à-vis their African-American peers. Age-adjusted comparison data for Black Americans as well as non-Hispanic whites from the National Health and Nutrition Examination Survey (NHANES) also demonstrated that the former population has higher incidences of obesity for persons who are twenty years of age and above. In specific terms, non-Hispanic Black men were 37.9% more likely to become obese compared to 34.5 % for non-Hispanic whites; non-Hispanic Black women were 56.5 % highly likely to become obese in comparison to 35.3% Caucasian white women (“Obesity and African Americans,” 2017). This translates to a comparison ration of 1.4 in favor of the non-Hispanic black population in terms of prevalence of obesity as posited elsewhere in the present discussion.
The increased rates of obesity amongst the African-American population in the United States has led to a concomitant increase in adverse health effects in this population. Overweight individuals have a high probability of suffering from high levels of LDL cholesterol, diabetes, high levels of fat, and high blood pressure. Research on the above consequences of obesity had associated them with a corresponding increase of heart diseases and even stroke in the present population. The existence of obesity also revealed that in 2015, non-Hispanic whites were 20% more likely to engage in physical activities compared to African Americans, further predisposing the latter group to the identified health hazards (“Adult Obesity Facts,” 2018). As such, death rates from diabetes and cardiovascular diseases are greater in African-American individuals compared to non-Hispanic whites.
Issues Relevant to the Rise of Heart Diseases and Obesity in African-Americans
Description of the African-American Population
According to Carnethon et al. (2017), African Americans constitute the most ancient racial group in the U.S who lack nativity. The huge influx of this portion of this section of the U.S. populace entered the country involuntarily during the infamous trans-Atlantic trade. From this trade period, individuals of African descent have flocked to the United States and made substantial contributions to the cultures, custom and languages of the U.S African-American population (Shiyanbola, Ward, & Brown, 2018). In the present research paper, the term African-American has been elected to refer to the population segment of the United States consisting black Americans with African lineage. The latest statistics reveal that this population accounts for 13.3% of the American people and rank as they are only second to Latinos/Hispanics when it comes to ethnic minorities.
A study conducted in 2012 stated that the life expectancy of whites was 3.4 times higher than that of African-Americans with 78.9 compared to 75.5 respectively (Ogden et al., 2017). The above contrasts assume a more striking nature when looked through the prisms of gender and race since Caucasian women have demonstrated a life expectancy of 81.4, their black counterparts 78.4, white men 76.7, and black men 72.3 years respectively (Carnethon et al., 2017). Statistics on the twenty five major causes of death in the U.S. among African-Americans show that VDs or CVD risk factors such as obesity account for 6 0ut of 10 mortalities. The latest CDC data estimates that cardiovascular diseases were directly responsible for 32% of the existing mortality variation between white men and African-Americans whereas this difference is 49% between women of the two races.
Social Determinants of Health
According to Havraneck et al. (2015), a wealth of literature exists that has explored the social determinants of health and their association to the existence of increased rates of heart diseases and CVD risks such as obesity amongst minority groups including black Americans. A variety of mechanisms have undergone identification regarding their roles in the presence of cardiovascular and metabolic syndromes such as obesity in African-Americans, with the social nature of this population suffering as the main culprit. According to Saab et al. (2014), African-Americans have lower levels of education with 16.1% of them having not completed high school compared to 7.3% of whites, which translates to a ratio of 2: 1. Matinez-Garica et al. (2018) postulate that the existence of such a high level of ignorance amongst this ethnicity exposes them to dietary hazards as they lack the basic understanding of what consists a healthy diet. Consequently, studies have shown the population to consume relatively higher levels of sugar, which plays a crucial role in the acquisition and advancement of obesity hence heart diseases.
Moreover, previous studies have also suggested that the rates of obesity differ by income levels amongst multifarious ethnicities. According to Ogden et al. (2017), the CDC, utilizing the National Health and Nutrition Examination Survey (NHANES) data established in the period 2011-2014, revealed that age-adjusted obesity amongst adults became lower in individuals with high income (32%) compared to other income groups at 40%. The study concluded that this pattern applied consistently among all income groups, including blacks and whites. However, when the comparison was made as per ethnic orientation of groups, it was discovered that Black Americans generally had lower income levels compared to other ethnic minorities and whites. To this end, 16.4% of Americans receive income that falls below the poverty line.
Research has also been conducted to determine the association between cardiovascular diseases and sociological factors amongst varied demographics of the African American population. A study by Winkler, Bennet, and Brandon (2017) showed that social determinants of health such as lower income levels and lower educational levels disproportionately exposed black adolescent girls and women to cardiovascular diseases and cardiovascular disease risk factors such as obesity. Further research such as Horton (2015) reveal that this can be extrapolated to the wider African-American group and it consequently exposes them to inadequate housing, bad social environments, poor nutrition, and poor working conditions as well as inadequate access to the health care system. Winkler, Bennet, and Brandon (2017) show that the existence of poor socioeconomic status also ensures that African-Americans do not access social amenities that directly or indirectly influence their health. Also, since African Americans belong to the lower end of the socio-economic spectrum, they can experience difficulties paying bills and then spending money on healthy diets. Indeed, unhealthy food is not only cheaper but faster to make, which appeals to this population whose income falls below the poverty line. Consequently, Horton (2015) posits that “African-Americans spend an average of $6.7 on food, which makes them contravene the federal government guidelines of intaking 10% of calories from added sugars daily and 7% from saturated fats daily; instead, they statistics indicate that they consume and average of 14% sugar and 12% saturated fats daily” (p. 261). Thus, a conglomeration of social determinants of health negatively impacts African-Americans diet, thereby subjecting them to increased heart disease rates and obesity due to poor diet.
Social Justice
It has already been identified that African-Americans suffer the highest brunt of obesity from both social and economic perspectives. Armed with this information, literature has examined the social justice paradigm of obesity and cardiovascular diseases in the country as related to this population and its association to the rise of the same. Saxena and Kumar (2017) identified discrimination as a fundamental social justice issue that impacts obesity in minority populations. Karasu (2012) asserts that weight bias paves way to social inequality and essentially nullifies the human rights that obese people should enjoy. The stigmatizing experiences that obese African-Americans experience may lead to detrimental societal, physical and psychological consequences, which may act in furtherance of obesity hence CVD prevalence in this population. Indeed, health care authorities have become fixated on the individual responsibility to these conditions independent of the environmental, biological, and social factors.
Moreover, disenfranchisement during the formulation, debating, and discussing obesity and CVD related policies has exacerbated the epidemic of obesity and heart conditions in the United States. This contradicts a policy known as “nihil de nobis, sine nobis”, which translates to that no policy should be crated minus the participation of individuals who will be affected by the same. According to Saxena and Kumar (2017), the existence of disenfranchisement of African-Americans during the policy-making process defeats efforts to effectively combat obesity and CVD outbreaks as existing policies lack the accuracy of the causative factors as seen by this population. Moreover, the presence of economic penalties in terms of access to jobs, nutrition, health care as well as opportunities for African Americans to undertake physical activity directly correlate to the existence of such high levels of these conditions. Indeed, since most of these black individuals are excessively overweight, their access to economic emancipation has been limited, which plunges them further into poverty hence denying them an opportunity to combat the diseases. Thus, the economic penalties imposed on African-Americans by the system is a social justice matter, and it helps exacerbate the worsening problem of increased obesity and cardiovascular diseases among this portion of the American populace.
Epidemiological Perspectives of Heart Diseases and Obesity in African-Americans
Consistent research findings support the position that obesity and cardiovascular diseases have increased among African-Americans compared to Caucasians and other minorities. In fact, Carnethon et al. (2017) assert that cardiovascular disease is a multifactorial condition having both genetic and environmental underpinnings, with close to 300 variables interacting unpredictable. As mentioned elsewhere, 67% and 77% of men and women respectively are overweight among African-Americans. Studies have also revealed that the rates of heart diseases in higher in African-Americans compared to Caucasians, with the former registering 175 per 100 000 cardiac arrests while the latter 84 per 100 000 from 2002 to 2012 (Carnethon et al., 2017) with both traditional and non-traditional factors being responsible.
Whereas behavioral factors, interpersonal factors, community and societal factors have received exploration with regard to the prevalence of obesity and heard diseases in African-Americans, contributions of genetics as a risk factor for the conditions can also prove useful. The conceptual embracing of the notion that genetic segregations could result in variations of multifactorial diseases and their risk factors in varied populations has been explored by research (Wang et al., 2018). Research works genotyping populations have shown that correlations exist between cardiovascular biomarkers and populations. Specifically, studies such as Liu et al. (2016) have found higher levels of CRP in African-American populations compared to Caucasians. Indeed, CRP acts a genetic biomarker of systemic inflammation as well as predictor of CVD in populations. That this gene exists at a higher level in African Americans predisposes them to CVDs. As regards obesity, Liu et al. (2016) and Wang et al. (2018) reveal that African-Americans possess polymorphisms in the CpG sites in leukocytes that are associated with their increased rates of obesity. Thus, genes play a fundamental role in the epidemiologic increase of both heart rates and CVDs in African-Americans.
Collaborative Partnerships for Managing CVD and Obesity in African Americans
The National Center for Biotechnology Information asserts that obesity is a serious health issue with associated risk factors such as heart diseases, depression, and type II diabetes. Declines in mortalities associated with heart diseases and obesity can be achieved through a combination of the application of evidence-based therapies and prevention of risk factors for cardiovascular diseases. In order to achieve this, the role of collaborative partnerships cannot be underestimated. One of the most important interventions that could be applied to the management of this condition is culturally tailored obesity interventions according to Wanda, White, and Knowden (2017). An examination of evidence-based research by these authors revealed that faith-based interventions focused on individual levels resulted in reduced incidences of diabetes. Indeed, constituent-encompassing and sociocultural stratagems show meaningful collaborative interaction with communities and may lead to high attrition rates of obesity hence heart conditions. A study by Blanks et al. (2016) supports the usage of culturally tailored interventions as they posit that formulating and redefining faith-based and e-health approaches inclusive of transferring the Diabetes Prevention Program intervention to community set-ups produces desirable results in managing diabetes. Therefore, collaboration between health care providers and the clergy plays an important role in managing obesity and heart diseases in African-Americans.
Moreover, collaborative intervention using association between communities and families in developing prevention strategies can lead to reduced incidences of diabetes due to behavioral changes. The CDC conducted a study on the effectiveness of collaboration between families and communities in combating the condition (Ziegan et al., 2013). In this study, members of the African American Leadership Coalition formed a partnership with an academic institution to engage families in formulating a procedure that would be utilized in the identification of barriers to diabetes management. The joint development of the community and family action plans was intended to address family cohesion and behavioral change. Further, the study also supported group discussion as a collaborative intervention wherein the participants from both the academic world, community leaders and family representatives encouraged mutual support and also offered suggestions for improved physical exercise and eating habits (Ziegan et al., 2013). Such a collaborative approach to managing the conditions allows stakeholders to work across and within moieties to exchange stories of challenges and success, information, and then offer particular health improvement strategies.
The Health Belief Model
Given that the issue of obesity and its associated effect on increased heart disease rates among African Americans has been confirmed, health care providers need to create stratagems that would be useful in combating the matter using appropriate models. Whereas the genetic predisposition of this population implies that we cannot modulate their risk, educating the at risk population and consequently modifying their risk factors becomes important. One of the models that stakeholders could leverage is the Health Belief Model. The application of this model is based on the premise that obesity and heart diseases occur due to questionable lifestyle choices by African Americans. The arena of preventative health programing has shown the effectiveness of maintaining healthy habits of living. In order to do so, altering the culture of an individual by offering them incentives becomes important. According to Romano and Imani (2014), “The integration of the Health Belief Model via one-on-one health coaching sessions may assist practitioners in explaining and predicting health behaviors within its clients” (p. 708). The HBM encompasses both health education as well as particular interventions that are formulated to enhance alterations to healthy ways of living. The application of this model to the present population will thus enable health care providers and other stakeholders to change the behaviors of African-Americans by making them embrace healthy behaviors including lifestyle changes.
Significance to Nursing
The importance of addressing the issue of increasing obesity and heart rates among African Americans is found in both the mortality rates and social and economic burdens of the same. As mentioned in the discussion, African-Americans are already comparatively poor and the existence of diseases such as obesity pushes them further into mystery. Thus, addressing the issue of obesity through the various collaborative interventions will allow nursing to offer socioeconomic improvements to the African-American constituency (Bleich et al., 2015). The need to offer solutions that would improve the health conditions of African-Americans makes the present study relevant. As a consequence of the body of evidence presented herein, nurses will have the capacity to tailor ethnic-based interventions. The application of the nihil de nobis, sine nobis principle via collaborative approaches will ensure that effective interventions are created to manage obesity hence heart diseases in African-Americans.
However, even with the existence of research on the issue of obesity in African-Americans, such studies are constrained. Indeed, a majority of these studies focus on offering reasons as to why this section of the populace suffers from obesity without offering the much needed interventions. The body of evidence with regard to obesity interventions in black Africans is limited compared to their white counterparts. Thus, future research needs to explore the necessary interventions that are specifically tailored for African Americans suffering from obesity (Edwards, Stapleton, Williams, & Ball, 2015). This will be crucial as it will help to close the gap between evidence of obesity interventions for Caucasians vis-à-vis the ones for African Americans. The availability of such knowledge will aid nursing in improving the quality of care for the specific population. The future knowledge will also ensure that the role of specifically-tailored interventions exist for nurses to adopt.
Conclusion
In summary, obesity is highly prevalent in African-Americans due to various factors. This population has poor socioeconomic status and also suffers social justice inequities, which exposes it to obesity and cardiovascular diseases. However, collaborative intervention approaches using health care models such as the health belief model can help reverse the trends. By examining the condition and the necessary interventions for this group, nursing will undoubtedly benefit from this body of knowledge as it will have new approaches to managing obesity in African-Americans.
References
| Adult obesity facts | Overweight & obesity | CDC. (2018, August). Retrieved from https://www.cdc.gov/obesity/data/adult.html
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