Leandris Liburd

Eliminating Health Disparities in the African American Population: The Interface of Culture, Gender, and Power

Since the release of former Secretary Margaret Heckler’s Secretary’s Task Force Report on Black and Minority Health more than two decades ago, excess death from chronic diseases and other conditions between African Americans and Whites have increased. The conclusion of that report emphasized excess death and thus clinical care, paying little attention to the sociocultural environment and its effects on risk of disease. The authors of this article contend that eliminating health disparities between the African American and White populations in the United States requires a focus on improving the social environment of African Americans. They examine the interface of culture, gender, and power and how those are central to analysis of the root causes of health disparities. The REACH 2010 project of the Centers for Disease Control offers examples on how a coalition of community and research organizations can infuse community interventions with informed considerations of culture, gender, and power to eliminate health disparities

Heuristic Model Linking Contextual Processes to Self-Management in African American Adults With Type 2 Diabetes

PURPOSE This article examines the influence of various environmental factors on the diabetes self-care practices of African American adults with type 2 diabetes. METHODS A heuristic model was developed that considers how community barriers and supports, availability and use of insurance, diabetes education, medical provider-patient relationships, extended family processes, and psychological functioning may indirectly affect metabolic control through the patients ability to regulate diabetes. RESULTS The proposed model offers a framework to demonstrate the complexity of diabetes management that may be unique to the African American experience. CONCLUSIONS A comprehensive view of the environmental context will lead to new and more effective approaches in diabetes education and counseling for African American adults with type 2 diabetes.

Use of diabetes preventive care and complications risk in two African-American communities

BACKGROUND We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. METHODS Cross-sectional, population-based study of 625 African-American adults with diagnosed diabetes. Participants had a household interview to determine receipt of preventive care services including glycosylated hemoglobin (HbA(1c)), blood pressure, lipid, foot, dilated eye, and dental examinations; diabetes education; and health promotion counseling. A total of 383 gave blood samples to determine HbA(1c) and lipid values. RESULTS Annual dilated eye, foot, and lipid examinations were reported by 70% to 80% of the population, but only 46% reported HbA(1c) tests. Rates of regular physical activity (31%) and daily self-monitoring of blood glucose (40%) were low. Sixty percent of the population had an HbA(1c) level >8% and one fourth had an HbA(1c) level >10%. Half of the population had a low-density lipoprotein value >130 mg/dL. Lack of insurance was the most consistent correlate of inadequate care (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.3-3.9), having HbA(1c) >9.5% (OR=2.1, 95% CI=1.1-4.2), and LDL levels >130 mg/dL (OR=2.1; 95% CI=1.0-4.5). CONCLUSIONS Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.

Rethinking diabetes prevention and control in racial and ethnic communities.

The growing and disproportionate burden of type 2 diabetes experienced by racial and ethnic minority groups in the United States demands a refocusing of public health research and interventions if health outcomes are to improve. Public health research and practice must address the social production of diabetes, broaden the boundaries of how diabetes risk and causation are understood and articulated, and establish community health models that reflect the changing complexion and sociopolitical dynamics of contemporary urban communities. Relying on the traditional one-on-one clinical relationship that has characterized diabetes care in the past will not eliminate the diabetes epidemic in racial and ethnic communities.

Decreasing disparity in cholesterol screening in minority communities—findings from the Racial and Ethnic Approaches to Community Health 2010

Background Highly controlled research projects demonstrated success in preventing and controlling cardiovascular diseases. Community-based programs have yet to demonstrate significant influence. Data on large-scale community-level interventions targeting minority communities are limited. The aim of this study is to measure the impact of the Racial and Ethnic Approaches to Community Health (REACH 2010) project, a community-based intervention to eliminate racial/ethnic disparities in blood cholesterol screening in minority communities. Methods Annual survey data from 2001 to 2006 were gathered in 22 communities. Trends in the prevalence of age-standardised blood cholesterol screening were examined for four racial/ethnic groups (black, Hispanic, Asian and American Indian/Alaska Native), stratified by education level, and compared with national data from the Behavioral Risk Factor Surveillance System. Results The prevalence of cholesterol screening increased among persons in black, Hispanic and Asian REACH communities (p<0.001), whereas prevalence decreased in the total US and Hispanic populations (p<0.001) and remained similar among blacks and Asians nationwide. The relative disparity between the total US population and most REACH communities decreased (p<0.05). Relative disparity in cholesterol screening related to education level decreased (p<0.05) within REACH communities, whereas relative disparity related to education level nationwide remained similar in blacks and increased (p<0.001) in Hispanics. Conclusion The REACH project decreased racial and ethnic disparities in cholesterol screening between REACH communities and the total US population, as well as disparities related to education level within REACH communities.

Environmental and policy approaches to increasing physical activity Improving access to places for physical activity and dissemination of information

The Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) program funded 40 communities in the United States during 1999—2007. Three of these communities implemented interventions to increase physical activity among African Americans. This case study looks at these interventions and the evidence-based recommendations from the CDC’s Community Guide for Preventive Services. These recommendations address creating or improving access to physical activity and the dissemination of information via media campaigns. Findings suggest that although the evidence could not be applied in every respect, culturallytailored change strategies can meet unique characteristics of African Americans with or at risk for heart disease and may contribute to increased physical activity. (Global Health Promotion, 2011; 18(1): pp. 43—46)