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After a rousing, choir-led gospel number at Christ Our Redeemer Church in Irvine last Sunday, Rev. Mark Whitlock announced that it was time for a “praise break.”
And by that he meant “workout.”
Two fitness leaders stood before the predominantly African-American congregation and began demonstrating an abdominal exercise. Following their example, worshipers assumed a plié position and pivoted their upper bodies from right to left and back – fists raised in a boxer stance – while clenching core muscles.
The two-minute workouts are part of a larger wellness program that also includes exercise classes and beach walks that Whitlock organizes at the church.
His goal is to raise health awareness among Orange County’s African Americans, who have some of the area’s highest rates of hypertension, breast cancer deaths, HIV infection for men and women, child asthma hospitalization and other illnesses.
Nationally, African American health disparities are often ascribed to economic disadvantage: in particular, lack of access to medical care and the pricier fixtures of a healthy lifestyle such as fresh food, exercise options and safe neighborhood parks.
But income alone doesn’t fully explain race-based health disparities in the OC, where African Americans enjoy relative prosperity.
The median income of an African-American family in Orange County is about $79,000 annually, according to the U.S. Census, compared to about $52,000 in Los Angeles.
The median Latino family income of about $54,000 in Orange County is well under that of African Americans, and the rate of uninsured Latinos is higher than that of African Americans. Yet Latinos enjoy better health in a number of key areas.
“What you find is that regardless of socioeconomic status, blacks tend to have more cardiovascular disease, have lower life expectancy and higher rates of certain cancers…” said Dr. William Cunningham of UCLA’s David Geffen School of Medicine. “Whether you look at the overall effect of life expectancy or disease presenting in advanced stages, blacks definitely have an overall disadvantage.”
Health disparities in spite of wealth and access to medical care are not fully understood, said Dr. Helene Calvet, deputy health officer of the Orange County Health Care Agency.
“The ‘why’ for that is difficult to answer,” Calvet said. “Data suggest some possible reasons. There are theories.”
These include what Rev. Whitlock calls “bad habits” that have been passed down over generations, such as a southern culinary tradition heavy in fats and salt, which would contribute to high blood pressure.
“We have to learn how to push away from the table, learn to drink less, not take salt, eat out less,” Whitlock said. “We must take a proactive stance to change our diets, how we live.”
Other explanations are emerging in research though not yet conclusive. For example, Calvet said, some studies show that African Americans can respond differently to medicines for asthma and high blood pressure.
African Americans are also more likely to face more aggressive forms of breast cancer, according to Portia Jackson, DrPH, who spearheads an initiative to improve detection and care among black breast cancer patients in Orange County. The initiative, called the Circle of Promise, is supported by Susan G. Komen Orange County.
“The most important statistic is that although an African-American woman is less likely to have breast cancer than a white woman, she is more likely to die from it,” Jackson said. “Mortality rates for black breast cancer patients are 41 percent higher in Orange County than for their Caucasian counterparts.”
When it comes to higher rates of HIV transmission among African Americans in Orange County, experts say the odds of contracting the virus are higher in a smaller ethnic group since people tend to pair up with people in their same ethnic group.
Nationally, explanations for higher HIV rates are linked to greater rates of incarceration, less access to health care, needle use and fear of disclosing sexual orientation.
A Legacy of Mistrust
Researchers believe that mistrust of doctors is more common among African Americans than other ethnicities. Historical injustices giving rise to such concerns include an infamous government medical experiment that allowed African Americans to spread syphilis without their knowledge in Tuskegee, Alabama.
Orange County resident Orlando Guillory said many African Americans view Tuskegee as part of a larger pattern. He and others interviewed cited beliefs that the government contributed to the spread of the HIV virus and use of crack cocaine among African Americans.
Guillory, the director of engineering in a medical device company, approaches the medical establishment with skepticism.
“Overall I think that many African-Americans, especially males, are very apprehensive of going to doctor. We’ve grown up we’ve heard the horror stories of experimentation, drugs and therapies on African Americans,” Guillory said. “Believe me, that’s affected some of my decision making. For instance, I don’t take flu shots. I don’t even bother because I don’t know what’s in that tube.”
Even when trust is not the issue, experts sometimes refer to a type of cancer pessimism or fatalism that inhibits African Americans from seeking help when it comes to early detection of breast and prostate cancers.
“A lot of people are afraid of what they’re going to find. It is imperative that people go and have themselves checked,” said Patsy Bates, who takes part in Komen’s Circle of Promise initiative. Bates has lost multiple family members to cancer and was herself diagnosed with Stage 3 breast cancer in 2003.
But it’s not always easy to do outreach in Orange County’s small and geographically dispersed African-American community. Churches and social organizations are key, health experts say.
It Gets ‘Lonely’
Real estate agent Donald Drake of Fullerton runs two organizations with an African-American cultural focus: Black in Orange County and the SoCal African American Film Connection.
Ata recent beach party sponsored by Black in Orange County, Drake said, numerous attendees were former residents of the county who had moved away.
“They said, ‘I was here but I couldn’t take it’…People have left Orange County because it’s lonely,” he said.
He added: “My son went to preschool in Orange County, through high school. In all his years he has never had a black teacher in any of his classes…At work there are very few of us, probably three out of 1,000 people. If you have a decent job position, you will be the only engineer in your unit. You tend not to see many of you at work.”
For Drake the isolation also extended to his health care. He used to drive to Long Beach in order to see an African-American doctor. When he had to switch physicians due to a change in his coverage, he sought a doctor whose name suggested that he or she was a person of color.
This is not unusual, and something the medical establishment needs to take into account, experts say.
While doctors don’t have to be the same ethnicity as their patients, they do need to be aware of the different ways that illness plays out in populations — meaning they might test for hypertension more readily with an African-American patient, or take more care to explain the benefits of a mammogram.
Racism and Stress
In addition to social isolation, experts agree that racism remains a factor in African-American health.
Hate crimes in Orange County, though on the decline, still disproportionately target African Americans. While just 2 percent of the county’s population, they have been the victims of more hate crimes since 1991 than any other racial or ethnic group,
In 2011, an African-American couple who moved into their Yorba Linda home appeared to be victims of hate crimes that drew national attention.
And beyond hate crimes, scientists are studying whether the day-to-day indignities of racism and the pressures of living in the minority fuel unhealthy stress.
Drake can rattle off several instances in which his family has suffered from overt racism from both his neighbors and police.
He recalled the time a police officer pulled him over for obstruction of his vision due to a chain with a gemstone hanging from his rear view window. Or the time neighbors called police about a suspicious woman in a Lexus parked in front of his house — she was his wife. He worries about his son, a young adult, being pulled over and possibly harmed by police.
“Chronic stress can turn on the flight or fight hormones in a body chronically,” said UCLA’s Cunningham. “Those hormones are very helpful if you’re going to go into battle or if you’re facing imminent danger, but when they’re turned on for long periods of time it puts a strain on the vascular system and wears down immunity, which is important in fighting cancer. This could happen whatever your income or status.”
Amy DePaul is a Voice of OC contributing writer and lecturer in the University of California, Irvine Literary Journalism program. You can reach her directly at firstname.lastname@example.org