Underserved Populations: African Americans Introduction

Underserved Populations African Americansintroductionafrican American

Underserved Populations: African-Americans Introduction African Americans are uniquely the only culture that came to the United States by force rather than choice. More than 4 million people were brought to the US as slaves, a practice which continued from the early 1600s until after the Civil War. In 1863, President Lincoln signed the Emancipation Proclamation stating that all slaves “are and henceforth shall be free.” After Lincoln’s assassination, the Thirteenth Amendment to the US Constitution abolished slavery in the US. Despite the cruel treatment and many hardships, Black Americans maintained their rich culture and family structures. Their traditions, customs, religion, spirituality, and health practices have been passed down from generation to generation and are still evident today.

Although nurses can never fully know all aspects of every culture, it is vital to educate ourselves about those we serve to provide culturally competent care. According to the 2016 Census Bureau, more than 40 million Black Americans live in the United States, comprising about 13% of the total population. The terms Black or African American are based on the definitions used in the 2000 US Census. While these terms were once interchangeable, “Black American” has become the more acceptable terminology, recognizing that not all Black Americans are from Africa. This population now includes African Americans, sub-Saharan Africans such as Kenyans and Nigerians, and Caribbean Blacks from Haiti and Jamaica.

As the Black American population continues to diversify, it becomes increasingly challenging for advanced practice nurses (APNs) to understand and meet the unique healthcare needs of this group. Recognizing the cultural diversity within this population is essential for delivering effective and respectful care. The learning objectives for this module include identifying the impact of culture on healthcare among Black Americans, discussing culturally appropriate care, and recognizing specific health problems prevalent in this community.

Understanding Cultural Perspectives on Health and Illness

Black Americans often define health and illness based on their African roots and traditional healing practices. Their beliefs emphasize harmony among mind, body, and spirit, with health considered a state of balance with nature. Illness may be viewed as a disharmony resulting from spiritual imbalance, possession by evil spirits, or malevolent forces. Consequently, traditional practices such as prayer, rituals, herbal medicine, and consultation with traditional healers remain part of health care in many Black communities, particularly in rural areas and some urban settings.

Many Black Americans trust folk medicine, spiritual healers, or family members who provide remedies using herbs or spices, often accompanied by spiritual rituals. Voodoo, although less widespread today, still exists in some rural southern regions and New Orleans. It involves complex beliefs blending spiritual elements with herbal and ritual practices aimed at healing or protection. The reliance on spiritualism and traditional healers is frequently motivated by mistrust, perceived inadequacies within the mainstream healthcare system, financial barriers, and historical experiences of discrimination and humiliation during medical encounters. Therefore, health interventions that dismiss or overlook these cultural practices risk alienating the population and reducing their willingness to seek formal healthcare services.

Prevalent Health Problems in Black Americans

Numerous studies indicate that African Americans experience higher mortality rates from heart disease, cancer, cerebrovascular diseases, and HIV/AIDS compared to other racial groups. Hypertension is notably prevalent, often beginning earlier in life and exhibiting higher blood pressure levels than in White Americans. Statistics reveal an 80% stroke mortality rate, 50% higher heart disease mortality, and a 320% increased risk of hypertension-related renal disease among Black Americans (Benjamin et al., 2019). Evidence-based treatments suggest that diuretics are effective as initial therapy, often combined with other medications such as beta-blockers, ACE inhibitors, or calcium channel blockers, especially in cases of complex comorbidities like diabetes or post-myocardial infarction conditions (American Heart Association, 2017).

Despite the high burden of cardiovascular diseases, Black Americans are less likely to receive optimal medication therapy, dialysis, renal transplants, or advanced surgical interventions compared to Whites. This disparity reflects systemic barriers, including mistrust of healthcare providers, underrepresentation in healthcare settings, and socioeconomic factors limiting access to care (Ely et al., 2019). Furthermore, Black Americans often delay seeking medical attention, adhere poorly to prescribed medication regimens, and have limited participation in preventive care programs, contributing to worse health outcomes.

Infant mortality rates are 2.5% higher in Black populations, and life expectancy for Black men is approximately 8 years less than that for White men. These disparities are exacerbated by social determinants of health, including poverty, limited educational opportunities, and environmental exposures. Additionally, chronic diseases like diabetes and associated complications are more prevalent among Black Americans—approximately one in 14 individuals is diabetic—yet they are less likely to receive routine screening, including hemoglobin A1C tests, lipid profiles, and regular ophthalmological assessments (Centers for Disease Control and Prevention, 2020). This underdiagnosis and undertreatment contribute to higher rates of cardiovascular disease and stroke within this community.

Health Care Disparities and Systemic Challenges

Systemic disparities extend across mental health services, where Black Americans are more frequently diagnosed with psychosis yet less likely to receive antipsychotic medication (Snowden, 2012). In inpatient settings, they are overrepresented in involuntary hospitalizations, and restraint or isolation use is disproportionately common. The Multi-ethnic Study of Atherosclerosis illustrates that health disparities persist in access to quality care, with Black children experiencing higher rates of undiagnosed or poorly managed asthma. Their death rate from asthma complications is seven times higher than that of white children, partly due to underutilization of recommended single-inhaler therapies (Liu et al., 2019).

Barriers to equitable healthcare include socioeconomic challenges, limited health literacy, and longstanding distrust rooted in historical racism and discrimination. Many Black Americans perceive their lives as undervalued within the medical system, discouraging engagement with healthcare providers and preventive services. Healthcare providers’ implicit biases and stereotypes, such as assumptions regarding substance abuse or noncompliance, further undermine trust and contribute to disparities (Dayer-Berenson, 2014). Moreover, disparities are compounded by the lack of cultural competence among healthcare professionals, which impairs effective communication and culturally sensitive care.

To address these disparities, advanced practice nurses must perform thorough cultural assessments, document findings accurately, and advocate for culturally relevant and accessible healthcare services. Building trust through respectful communication, community engagement, and inclusive health education is essential for reducing health inequities among Black Americans (Kosoko-Lasaki et al., 2009).

Conclusion

Understanding the cultural, social, and systemic factors influencing health among Black Americans is critical for healthcare providers committed to achieving health equity. Recognizing traditional health beliefs and practices, addressing chronic disease burdens effectively, and confronting systemic disparities can improve health outcomes and collaboration with this underserved population. Emphasizing culturally competent care, reducing barriers to access, and fostering trust are vital steps toward eliminating health disparities and promoting better health for Black Americans.

References

• American Heart Association. (2017). Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation, 135(10), e146–e603.
• Centers for Disease Control and Prevention. (2020). Health Disparities and Inequalities Report — United States, 2020. Morbidity and Mortality Weekly Report, 69(3), 1–35.
• Benjamin, E. J., Muntner, P., Alonso, A., et al. (2019). Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. Circulation, 139(10), e56–e528.
• Dayer-Berenson, L. (2014). Cultural competencies for nurses: Impact on health and illness. Jones & Bartlett Learning.
• Ely, B., Dulin, M., McKinney, J., & Mann, L. (2019). Addressing Racial Disparities in Cardiovascular Disease: The Role of the Community and Healthcare System. Journal of Community Health, 44(3), 519–524.
• Liu, A. H., et al. (2019). Asthma disparities in Black children: Insights and solutions. Journal of Allergy and Clinical Immunology, 143(3), 887–896.
• Snowden, L. R. (2012). Health and mental health policies' role in making boundaries and racial inequities worse. American Psychologist, 67(7), 524–531.
• Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.
• Kosoko-Lasaki, S., Cook, C., & O’Brien, R. (2009). Cultural proficiency in addressing health disparities. Jones & Bartlett Learning.
• Andrews, M., & Boyle, J. (2016). Transcultural concepts in nursing care. Walters Kluwer.