Introduction
Black people face higher risks of disease and worse health outcomes across the board, in large part due to structural racism. The long history of discrimination both within the healthcare system and in the world at large has had detrimental impacts on the health of Black communities. Hypertension is just one example where Black people are disproportionately affected. More than 1 billion adults worldwide are estimated to have high blood pressure, but only 1 in 5 have it under control. Having elevated blood pressure puts you at an increased risk for heart disease and stroke. These are some of the leading causes of death, making hypertension a serious cause for concern. According to the CDC, high blood pressure was a contributing cause in nearly 700,000 deaths in 2022.
Hypertension in Black Adults
A study in Journal of the American Heart Association, compared rates of hypertension in Black people compared to White people. They found that the cumulative incidence of hypertension by age 55 was 75.5% in Black men compared to 54.5% in White men. This contrast was even more stark in women, with a cumulative incidence of 75.7% in black women and only 40% in white women. Overall, Black adults had 1.5-2 times higher risk of hypertension, indicating a serious disparity.
These disparities cannot be attributed to an issue of access, according to a study on Hypertension. The researchers found that hypertension prevalence was 45.3% in Black adults compared with 31.4% in White adults. Additionally, blood pressure control rates were around 10% lower in Black adults than their white counterparts. However, awareness and treatment rates were similar between the two groups, indicating that education and access alone are not enough to bridge the gap. Rather, they suggest that impacts of structural racism, including lower socioeconomic status and mistrust in the healthcare system are more important here.
Structural Racism
One major contributing factor to Black adults having disproportionately high rates of hypertension is structural racism. Structural racism is a system of institutional policies that is unfairly advantageous for certain racial groups while perpetuating harmful treatment of others. It has its roots in historical patterns over time that continue to negatively impact the physical, social and economic well-being of disadvantaged groups. Structural racism can have a profound impact on people’s health. This can be as a result of socioeconomic disadvantages as well as discrimination within the healthcare system.
Numerous historical practices have contributed to disadvantaging Black people, and their legacies continue to have an impact today. Historical segregation during the era of Jim Crow has had lasting effects on where Black people live, their economic situation, and more. Despite legislation outlawing discriminatory practices like redlining, Black people continue to be more likely to live in neighborhoods with fewer resources. This perpetuates cycles of poverty and maintains a form of segregation even when it is not the official policy.
Moving Forward
Systemic Changes
Structural racism has its roots in centuries of discrimination; completely dismantling these systems of oppression requires ongoing advocacy for policy changes and education. Addressing structural racism’s impact on hypertension rates specifically requires various different steps. Individual efforts alone are not enough; these changes need to be systemic.
A study from The New England Journal of Medicine examined disparities among people enrolled in Medicare. They compared blood pressure, cholesterol, and glucose levels across races. This research builds upon previous studies, finding that systematic improvements in the healthcare system can significantly reduce racial disparities. This can include changes such as quality monitoring and implementation of technology for electronic medical records and messaging between patients and providers. Preventing advancements in the healthcare sector from only supporting certain groups requires careful care and consideration. With the introduction of such improvements, racial equity needs to center overall advancements that benefit everyone equally.
Community-Based Interventions
Another study from The New England Journal of Medicine took a unique approach to addressing racial disparities in hypertension. The researchers partnered with black-owned barbershops and had them encourage patrons with hypertension to modify their lifestyles, visit their doctors and meet with pharmacists. 63.6% of the participants significantly lowered blood pressure compared with only 11.7% of the control group, proving the effectiveness of the intervention. Such novel interventions underscore the importance of innovative and creative approaches. The history of structural racism in the healthcare system has eroded trust in providers and the traditional medical system for many Black people. Community-based solutions are incredibly useful because they rely on the trust people have built within their communities to help people feel more confident in seeking the medical interventions they need.
Conclusion
Centuries of racist policy and discrimination have put Black people at a significant disadvantage when it comes to health. Structural racism is a major contributing factor to racial disparities in hypertension rates. Through systemic changes and community-based interventions, we can work to address these gaps and move towards a more equitable future.