More whites have coronary heart disease; more blacks die

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Coronary heart disease is a huge problem for Mississippians. White Mississippians, in particular, wrestle with the condition. In fact, 5.6 percent of white Mississippians say they have the disease, compared with just four percent of black Mississippians.

But when it comes to dying, coronary heart disease kills far more black Mississippians than white. In 2015, black Mississippians died at a rate of 265 per 100,000. White Mississippians died at a rate of 230.5 per 100,000.

 

White Mississippians have a higher prevalence of heart disease compared to African Americans. Source: US. Centers for Disease Control and Prevention

 

Black Mississippians are more likely to die from coronary heart disease even though the prevalence for the disease is higher among whites

 

The reason for this difference is straightforward: black Mississippians often don’t have access to the same level of health care that many whites in the state do, according to Lamees El-sadek, who spoke at Millsaps College Friday on the social and economic conditions that lead to health disparities in Mississippi.

El-sadek, a former epidemiologist for the Mississippi State Department of Health who is currently pursuing a doctoral degree in public health at Harvard, spoke as part of the annual Rabbi Perry Nussbaum Lecture Series. She said such stark differences in health outcomes for the two races make it clear that “there’s no such thing as a post-racial world.”

Lamees El-sadek speaking at Millsaps College on Friday

“So even though fewer blacks report heart disease, more blacks die,” El-sadek said. “This leaves us to ask, why do people seek emergency care versus primary care?  Where do blacks live? How close do they live to (hospitals and doctors)? What types of jobs do they occupy? How supportive are their jobs and is their wage and salary sufficient for them to seek care?”

A longtime rallying point for health-care advocates in Mississippi has been the Department of Health, which saw its state funds slashed 30 percent this year, going from $36 million at the beginning of 2017 to $24.5 million for fiscal year 2018, which starts July 1. While the Department of Health provides some preventative services in clinics, the majority of its services are geared towards community health, such as water and restaurant inspections, vaccinations and health and nutritional initiatives.

But Mississippi’s Department of Health currently receives less funding per capita than all but three other state health agencies in this country, at a rate of $12.28. Neighbor Alabama spends $59.22 per resident.

In 2015, the Department of Health published a statewide report identifying health disparities in Mississippi and their causes with the goal of finding solutions for these differences. It is unclear whether another one is in the works, but El-sadek said consistent data collection provides baseline measurements for evaluation.

“So we know how much we have or haven’t improved,” El-sadek said. “If we don’t count people as they deserve to be counted, their lives don’t count in our effective awareness.”

Liz Sharlot, director of communications for the Department of Health, said eliminating health disparities continues to be a priority for the department.

“There should not be certain segments of the population that continue to be unhealthy,” Sharlot said.

And yet, certain segments, particularly black Mississippians, continue to lag in many health indicators, according to El-sadek.

Type 2 diabetes, which is the eighth leading cause of death in the state, is largely considered a preventable disease. Good nutrition and regular exercise reduce the risk to almost zero. The prevalence of diabetes also decreases as a person’s level of education increases.

But black Mississippians are more than twice as likely as white Mississippians to die from Type 2 diabetes. The disease is particularly savage with black men in the state, who die at a rate of 60.5 per 100,000 versus 28.8 for white men. Black men are also 50 percent more likely to drop out of high school than white men.

“So if this is a controllable disease that has nothing to do with the innate or inherent qualities of the people who have it, what is gong on in these communities that lead to shorter lives and faster deaths?” El-sadek said.

For El-sadek, all of these questions, have one answer: racial minorities in Mississippi need better access to care.

  • LB

    I’d be very curious to know Ms. El-Sadek’s opinion of how cultural differences play a role in racial health disparities. Based on a cursory reading of current studies, it appears that black Americans are less likely to exercise regularly and more likely to eat a diet high in sodium and saturated fats with fewer fruits and vegetables.
    I tend to think a bottom-up cultural approach would be much more cost effective and have a longer-lasting effect than a top-down bureaucratic approach.

    • Lamees

      black Americans, especially in the Deep South, are less likely to regularly exercise and consume a healthy diet due to a few factors: including the historical deprivation of financial power to which we have subjected this population (think slavery, Jim Crow, New Jim Crow). a bottom up approach places blame and responsibility to change upon the victims of our political legacy, when the victims– in this case, black Mississippians– still don’t have the resources to make truly independent decisions for theirselves and their families. the responsibility and agency to change lays upon the actors who imposed inadequate living conditions upon black Americans (and other marginalized communities). to this day, in 2017, as a population, black Mississippians simply do not *earn enough* for us to responsibly or fairly make the argument that we are far enough removed from our oppressive past.

      • LB

        Interesting. You’ve given me a lot to consider.
        I must say, though, I object to your use of the first person plural (we/our). I can say with a high degree of integrity that I’ve never taken agency from anyone.
        It also seems to me that most of the “actors who imposed” atrocities upon black Americans are dead and gone, as Jim Crow ended 2 generations ago and slavery about 150 years ago.
        It is absolutely true that black Americans, in many cases, start from a disadvantaged place given this nation’s recent history. But doesn’t it infantilize black Americans to impose a top-down fix? In other words, doesn’t it speak to a view that sees black Americans as being incapable of creating their own solutions?
        I will certainly consider what you’ve said, but for now I remain convinced that the best thing any one of us can do for any other group is level the playing field legally (which it is) and stay out of their way – allow solutions to arise internally. Anything less is condescending and disempowering.

        • Lamees

          I use we/our, because we are individual entities as we are simultaneously social entities. It’s not a matter of whether we choose, want, or agree to participate in this world as social beings. We are. Our actions, lifestyles, and consumption have effect on others’ actions, lifestyles, and freedom to consume. If we take the we/our out of the conversation, we fail to recognize how our individual decisions impact the agency of others to make truly autonomous decisions.

          I’m not sure what you mean when you say “I’ve never taken agency from anyone,” but what I’m specifically referring to is political agency.

          It’s true that a lot of segregationists are gone. Some still exist. Some still teach those separationist values to their next generation. Those folks tend to have power and money to keep those ideologies alive. and while the formalized old Jim Crow is dead, other forces such as the new Jim Crow, residential segregation, employment bias, income/wealth inequality (despite merit, and which is associated with race) and barriers to decent and affordable education at both primary and secondary levels….all these realities continue to exist, effectively ensuring a second class America.

          and your point about it being condescending to not allow things to internally arise is legitimate only if the population of reference is adequately equipped to be autonomous. Again, this is where it’s crucial that we recognize how our oppressive history translates into an oppressive present. To be very specific, there’s a political and social distribution of power and resources in MS (but not necessarily unique to MS) that’s predestined the black community to uniquely struggle. it’s condescending (as you put it) to tell an already ill-equipped community to ‘deal with yourselves’ when the causes of the suffering are manufactured. again, we are social beings. there’s responsibility that comes with being in a social contract.

          • LB

            I really appreciate this exchange. I know you must be busy, and I’m sure you must have a tremendous workload, so thanks for being willing to exchange ideas. But I’m really having a hard time trying to see the world from your perspective.
            The residential segregation that exists today is self-selected. Distasteful as it may be, unless people are forcibly moved, self-segregation will exist to a certain extent. The right to free association is non-negotiable in my mind.

            As far as employer-biases, I can’t see it. I’ve been in private industry my entire working life, and our biggest concern is one’s impact on a P&L, not one’s skin color. Merit is very much the driving factor in every company with which I have done business. Us capitalists simply can’t afford to be racist.

            I am fully unconcerned about income inequality. Frankly, I am thankful to live under a set of laws that allow me to enjoy the surplus of my economic contribution. The political ideologies that seek to create income equality (communism, socialism) never seem to end well – they typically result in widespread misery. I am deeply concerned with legal equality, and we seem to have achieved that as a nation. Again, if you can find an example where the law makes distinction between the races today, I’d love to hear it.

            I’m not totally naïve, there are still racists in our nation. Thankfully they are socially isolated and despised roundly. Even among my middle-class, middle-aged white peers in Mississippi, it is uncouth to show feelings of racism. I see no tenable to eliminate racism entirely without policing an individual’s thoughts – there will always be individuals with bad ideas (there are still people who believe the world is flat). Politically, all we can control are the laws by which we operate.

            In the end, I simply fail to see how my individual actions result in black people dying of heart attacks with greater frequency than white people. That’s a circle I cannot square, but if you can get me there, I’m listening.

            For the sake of argument, I’m willing to set all my ideas aside to hear your solutions to the problems you’ve presented. Perhaps your solutions are such that I’m willing to move forward with them in spite of our differing perspectives. So, if you’re willing, I’d love to hear how to fix the problems you perceive.

          • Lamees

            civility in discourse seems rare (perhaps an indicator of our abysmal standards of human decency?). you brought up a few different points:

            racial residential segregation exists because of exclusionary zoning, redlining, and steering…not self-selection. and there’s an indirect relationship between how much we invest in schools and the colorfulness of the neighborhood in which those schools exist. education is 1 of the 2 greatest ways to thrive despite circumstances and the right to access quality edu shouldn’t be contingent on zip code.

            to directly speak to potential solutions to “black people dying of heart attacks with greater frequency than white people.” First, everyone should have health insurance. Everyone should have affordable health insurance. and MS should expand the Medicaid ceiling. Second, all workers are workers. It doesn’t matter our specific title—whether we are blue or white collar. We work. and we each keep society functioning in one way or another. in return, we deserve to be able to function. our wages and our salaries (think teachers’ salary to state the most egregious compensation) both should be livable. community efforts to raise our minimum wage (and salaries) are met with strong opposition. so, don’t stand in the way of unions who organize the powerless. Third, adequately fund public education so that people can truly, realistically ‘pull yourself up by your bootstraps’ as the argument goes.

            those are a few short term (insurance) and long term (wages/salaries, education) solutions. you can make the argument that hospitals are built in wealthier communities and so we also need to build more hospitals in poorer areas. that’s a valid argument. but hospitals are reactionary, tertiary support systems. our goal should be to prevent the health issues from developing.

          • LB

            Education may be a perfect middle-ground on which we can find agreement. People from all points on the political spectrum can see the need for education reform. I’d venture to guess that most on the right, who typically oppose all spending programs, can see the value in investing in education. The beauty of this approach is it doesn’t require that we agree on our above presuppositions.

            Also, I couldn’t agree more about healthcare reform, though I’m not sure an insurance mandate will cut it – the ACA has been more costly than expected and had generally poor results. Though I an center-right, and I generally oppose expansions of government spending, I think we can make a very strong argument that a single-payer system is the most cost effective (which appeals to the right) and humane (which appeals to the left). Again, fixing healthcare is something that we can all agree on without having to hold the same beliefs regarding critical race theory.

            I still think segregation today is largely by choice. Race based zoning, steering and red-lining are all illegal, and companies caught using such practices recently have been punished swiftly and severely, as they should be. Next time you visit a school, check out the seating arrangements in the lunch room – even kids tend to self-segregate.

            Don’t give up hope for civil and rational discourse. I believe we have seen the peak of partisanship, at least I hope…