Imagining the Future for Our Elders

“Our elders quote the cock as saying that ‘it would not be good if one becomes the only person in the world, and that is why they crow every morning to show their number.’” Nigerian proverb. There are 439 million people in the United States. Almost 90 million of them, or 25%, are 65 years old and older. Most of these seniors are white. However, the United States is a majority-minority nation. That was the case for only four states back in 2015 – California, Hawaii, New Mexico, Texas, and the District of Columbia – when racial and ethnic minorities were about a third of the U.S. population, overall. Today, they make up 54%. The majority of the working-age population are racial or ethnic minorities, as are the majority of young-adult eligible voters.

The race-age demographic shift has influenced much of the political and social change that has occurred over the last twenty years, including increased investments in public schools, more supportive programs for youth, families, and children, and increased funding for government programs for seniors.

Because of work like the FrameWorks Institute’s report on ways to change public opinion about aging in America, attitudes about aging changed dramatically over the past few decades. Aging is integrated into discussions of social and economic policy across a wide range of issues, including health care, housing, race, poverty, education, government and human services.

The number of seniors ages 85 and older – the fastest-growing single segment of the population in 2010 – tripled since then to more than 19 million today. Funding for health care was a critical issue until new models of paying for and delivering patient- and family-centered care were developed.

People are living longer and spending less time in retirement. There was concern about this back in 2017, when social security payouts exceeded collections and began to dip into its trust funds to pay benefits. Changes to the system – such as increasing the retirement age to 80 years old – rescued the trust fund. This policy change allows seniors to save more for retirement and companies to capitalize on the skills and loyalty of experienced employees. Phased-retirement programs, flexible work arrangements, core training and workplace ergonomics are ways that many companies have “retired retirement” and adapt to an aging workforce.

The number of multigenerational households have increased significantly since 2015, when they were a mere 20% of all households. “Boomerangs,” “boomerees,” and “boomers” living under one roof is a social and financial safety net for many Americans, especially the most economically vulnerable. Housing developers are working hard to meet the demand for multigenerational housing, which was nothing more than a niche market two decades ago.

Long-term Care Czars, first established in California, have continued to lead federal and state agencies in implementing their long-term care strategic plans, and coordinating integration efforts across health and long-term care services. The Czars’ leadership and the establishment of Departments of Community Living can be credited with increasing access to quality, community-based long-term care services and supports and, consequently, the reduction in the number of nursing home placements and unnecessary nursing home admissions.

Much work is still needed to address income inequality, health disparities and the variety of needs among poor seniors. But, the gaps continue to narrow as minority-majority rules. The year is 2044.

September 18, 2015 at 6:03 pm Leave a comment

Can an “Ideal” Long-term Care System Exist within a Context of Disparities?

On July 8, 2014 I testified before the California State Senate Select Committee on Aging and Long-Term Care. The title of the session was “California’s Service Delivery for Older Adults: Envisioning the Ideal.” Instead of providing theoretical and quite frankly, unachievable ideas about how to create the “ideal” long-term care system, I focused my remarks on the need for legislators to remain aware of the diversity of the state’s population and to invest in preventative health services.

Here is my testimony to Committee Chair Senator Carol Liu (D-La Cañada, Flintridge) and the Committee:

Good morning. Thank you for the opportunity to share my ideas about how to achieve the ideal long term care system. I have to admit that don’t know whether a truly ideal long-term care system will ever exist. There are quite a few moving parts, not the least of which are the needs of the consumers. However, there are certain essential characteristics that should be present in an ideal system. And we’ve heard about a few of these characteristics today. It’s not simply the sheer number of older adults and persons with disabilities that compound the need for a comprehensive system of long-term care. It’s the constellation of these persons.

One of the factors that adds a particular level of complexity to the long-term care dilemma is the racial and ethnic diversity of older adults in California. Older adults of color are not just one of the moving parts in the long-term care system, they are a moving target. As their numbers increase, so too will the number of multiple, complex chronic conditions and co-occurring disorders, the rates Alzheimer’s disease and other dementias, and the complex social needs.
So, my approach to discussing an “ideal” long-term care system is to talk about the current gaps in older adult services and programs that seniors are experiencing now. In other words, I am suggesting that we also focus on “prevention” as another potential solution to the long-term care crisis in California.

Just two months ago, Advocates for African American Elders completed our Community Survey that identified the service needs of African American seniors in Los Angeles County. We began collecting data on November 21, 2013. We asked African American seniors about their access, utilization, need, quality, and satisfaction with older adult services in their communities. We also asked them about their social and economic conditions, health and computer literacy, and knowledge about important healthcare policies and programs, such as the Affordable Care Act and the Coordinated Care Initiative.

As you can see from the Table of Contents, the report is fairly extensive and the findings too plentiful to cover in the time allowed. However, I would like to highlight a few that are relevant for our conversation today. A total of 550 African American seniors throughout LA County participated in our study. Findings indicate that many African American seniors are healthy, connected, engaged and receiving services that meet their needs. However, findings also reveal service needs and gaps for many African American seniors. Moreover, results revealed low computer and health literacy levels across age groups and educational levels. There was also a lack of knowledge of important healthcare initiatives and of available services and programs for seniors in their neighborhoods. The most disadvantaged groups tended to be seniors with low levels of education, those of advanced years, those who lived alone and those with poor physical and mental health.

We made a number of recommendations based on the findings about how to increase access to services and programs for African American seniors and how to improve outreach, education and engagement strategies to increase the level of knowledge about important healthcare policies and available services and programs in their communities. I should note that 81.5% of African American seniors surveyed had never heard of the Coordinated Care Initiative. We also made recommendations about how to improve the quality and increase the quantity of services and programs to better meet the needs of African American seniors as they defined them. 27% of African American seniors were not aware of programs for seniors in their neighborhood, and only 52% were currently participating in them. 35% indicated that there were services missing from their neighborhood that they needed, including In-home Supportive Services and Adult Day Care.

We recommended strategies for increasing the health and computer literacy of African American seniors, as finding clearly documented a technology divide that places African American seniors of all ages and education levels at a disadvantage. Almost 44% of African American seniors did not know how to use a computer and 43% did not have access to the internet in their home or anyplace else. This has huge implications for access to health care information and one’s ability to manage their health conditions.

Twenty-four percent of African American seniors were not happy with the quality of services in their neighborhoods and 91% indicated that more needs to be done to provide quality services to African American seniors.

In our recommendations, we identified particular policies, such as the California Homes and Jobs Act, the Supplemental Security Income Restoration Act and the Positive Aging Act, that are needed to improve the economic and living conditions of African American seniors and increase their access to quality mental health services in their communities. Housing and income were identified as barriers to access to services by African American seniors in our study. In addition, those who rated their mental health as “fair” or “poor” were disadvantaged across a number of domains.

And finally, we stressed the need for advocacy at the federal level to support programs that strengthen the aging workforce and improve quality of care for African American seniors and all older adults, such as Titles V, VII and VIII, which provide funding for Geriatrics Health Professions Education and Training programs.
Since the number of older adults of color in nursing homes is increasing faster than their rate in the population overall, it is important to address the workforce shortage but to also ensure that those providing the services are culturally competent and have the skills to do so. This includes competency to address the physical, mental, cognitive, behavioral and social needs of older adults.

In 2012, more than half a million direct-care workers provided an estimated 70-80% of the paid hands-on care for older adults and those living with disabilities or other chronic conditions; 376,000 of which were independent providers employed in the In-Home Supportive Services program. The demand for direct care workers is great and will increase exponentially over the next 15 years. By 2030, 3.5 million additional health care professionals and direct-care workers will be needed nationwide. California will also experience a shortage, as the growth projections for the eldercare workforce will significantly exceed that of all other occupations.
While the demand for direct care workers steadily increases, the supply will dwindle. Nationally, between 2010 and 2030, women aged 25 to 44 (the typical direct care worker) will increase by only 7%, creating a large care gap.

Locally, LA County will be experiencing a demographic shift that will radically decrease the supply of workers. Over the next two decades, Los Angeles County will gain 867,000 older adults and lose 630,000 people younger than 25 years old. So it seem as though we will have a workforce issue for some time to come.

The Affordable Care Act extends coverage to millions of previously uninsured Americans. But, coverage does not necessarily equal care. By next year, the U.S. could have nearly 63,000 fewer doctors than needed, and that number could double by 2025. With the shortage of physicians, it is expected that the most vulnerable patients will have access problems. These patients will most often be the Medicaid population because Medicaid reimbursement rates are so low.

So, let’s put these numbers in perspective. Currently, there are 4.41 million older adults in California. In 2011, there were 739 certified geriatricians. That works out to approximately one geriatrician for every 6,000 older adult in California. We need to train 2,813 geriatricians between now and 2030 just to provide the minimum level of care.

Currently 80% of care is provided informally by friends and family members.
In 2009, more than 4,000,000 family members provided care to an older adult in California, which equates to approximately $47 billion in unpaid contributions. 46% of family caregivers performed medical and nursing tasks for care recipients with multiple chronic physical and cognitive conditions. Based on the funding made available to support family caregivers in 2013, each caregiver would have received $3.75 for the year. In 2010, the family caregiver ratio was 7.7 to 1. This ratio reflects the number of potential caregivers aged 45-64 for every person in the high-risk years of 80-plus. In 2030, the ratio will be 4.4 to 1. And in 2050, it will be 2.7 to 1. Until we can better support family caregivers, while also improving our system of long-term care, families will continue to struggle to pay for long-term care services and supports, often impoverishing themselves financially and emotionally to get the services that they need.

Clearly, much needs to be done to address the shortfall in the eldercare workforce in California and nationwide. In the meantime, current older adult services and programs are not meeting the needs of some consumers. So, what does this mean for long-term care? Here is a likely scenario: A low income senior with multiple and complex chronic conditions is admitted to the hospital and instead of returning home, transitions to a low quality nursing home and remains there until his or her death.

There are disparities in nursing home care – both in who is more likely to transition to one as well as the quality of care they will receive. While the number of whites in nursing homes is declining, the rates for African Americans, Asians and Latino seniors are increasing by as much as 55%. A recent study of 11,500 nursing homes found that those with a high proportion of African American residents had lower costs, but also had lower revenues, tighter operating margins, quality-of-care deficiencies and many deficiency citations.

While the ACA does not directly address the racial disparities in the long-term care sector or the financing of long-term care, the law might help ensure that people have better access to preventative care. It is the direct benefit of prevention, high quality and accessible older adult services that can potentially limit the duration of nursing home stays. Better continuity of care earlier in the life course could reduce costs and complications as seniors age and enter a nursing home, which unfortunately, is the most likely long-term care option for many African Americans and many other older adults who rely on public insurance.

Is there an “ideal” long-term system of care? Perhaps. However, given the number of challenges, we have quite a way to go before achieving anything close to an ideal. We might even need another “baby boom” to meet the future demand for and eldercare workforce. So, it seems that reducing the number of older adults enrolled in nursing homes, as well as reducing the duration of their stay will not only lower the cost of long-term care but it just might increase the quality of life for the most vulnerable seniors by allowing them to age in their homes and in their communities.
Findings from our Community Survey suggest that we have a bit more work to do to support our most vulnerable older adults in the community. Why not start improving our long-term care system by improving the access and quality of services for seniors in under-resourced communities to potentially limit the number of preventable and expensive hospitalizations and inadequate support in transitioning from a nursing home back into the community.

How do we maintain our most vulnerable seniors in their homes and in their communities for as long as we possibly can? The answer to that question is the semblance of an ideal long-term care system. And that is what we should be aiming for.

To your health,

KDL

August 3, 2014 at 8:08 pm Leave a comment

The Affordable Care Act and African Americans: Translating Law into Practice

The Affordable Care Act and African Americans: Translating Law into Practice

On March 23, 2010, President Obama signed the Affordable Care Act (ACA), informally referred to as “Obamacare.” Together with the Health Care and Education Reconciliation Act, the ACA represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.

The ACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees, to employers and individuals to increase coverage. Additional reforms are aimed at improving healthcare outcomes and streamlining the delivery of health care.

In response to the passage of this historical law, a number of parties sued, claiming that the reform law was unconstitutional. A coalition of 26 states participated in the lawsuit against the ACA. The challenge was based upon three of the Affordable Care Act’s core provisions: 1) the significant Medicaid expansion, which is expected to make available health care coverage to 16 million new people; 2) the employer mandate, which requires firms employing 50 or more people to offer health insurance or pay a shared responsibility requirement if the government has to subsidize an employee’s health care; and 3) the individual mandate, which requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty (unless the individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship).

On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.

The Governors of Florida, South Carolina, Texas, Louisiana, and Wisconsin have opted out of the plan, despite the fact that the vast majority of the costs are covered by the federal government, including taxes their citizens will pay, regardless of whether the state opts out or not. Opting out of the plan would leave a significant portion of their citizens without health care. Texas boasts the highest percentage of uninsured residents in the country, at 27.6% (over 6 million residents), followed by Florida (21% or 3.85 million people); the expansion of Medicaid in this state would have covered 951,622 people.

Historically, African Americans have faced significant barriers to accessing affordable health insurance and these barriers have contributed to significant health disparities, including the highest all-cause death rate of all races and ethnicities, and the highest death rate for heart disease, cancer, and diabetes than any group in the U.S. There are also disparities in access to care; 21% of African Americans are uninsured and 20% do not have a regular doctor, compared with less than 16% of whites. Consequently, African Americans are more likely to use the emergency department as their regular place of care than their white counterparts or delay or forego medical and dental care and prescription drugs. At a 13.7% death rate per 1000 births, African American babies are dying at twice, and sometimes three times the rate of any other racial or ethnic group. Of all women living with HIV/AIDS, 65% are African American and African Americans as a whole represent 40% of people with HIV/AIDS who die. We desperately need affordable health care.

Under the Affordable Care Act, millions of African Americans are already benefiting:
Ban on discrimination based on pre-existing conditions: Insurance companies are banned from discriminating against anyone with a pre-existing condition, such as cancer or having been pregnant.

Free preventive services to help you stay healthy or prevent a condition from getting worse: All Americans joining a new health care plan can receive recommended preventive services, such as cancer, diabetes and blood pressure screenings, with no out-of-pocket costs.

No lifetime dollar limits on claims: Insurance companies are banned from imposing lifetime dollar limits on health benefits: freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 10.4 million African Americans are free from worry as a result of this law.

Access to coverage for young people: Insurance companies are now required to allow parents to keep their children up to age 26 on their insurance plans. This means that 410,000 African American young adults have gained coverage because of the new health care law.

Freedom to choose a plan and provider: African Americans joining new insurance plans have the freedom to choose from any primary care provider and OB-GYN in their health plan’s network, without a referral. Affordable Insurance Exchanges (one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs) will offer to the public the same kinds of insurance choices members of Congress will have. The new law also provides middle-class tax credits to families to help pay for private health insurance. And it expands the Medicaid program to families of four with incomes of up to $29,000. This will result in as many as 6.8 million African Americans becoming eligible for health coverage.

Increased health security for seniors and people with disabilities: Seniors can receive recommended preventive services such as flu shots, diabetes screenings, as well as a new Annual Wellness Visit, free of charge. So far, more than 2.4 million African Americans with Medicare have already received one or more free preventive service, including the new Annual Wellness Visit. In addition, millions of people with Medicare will receive a 50% discount until the gap in prescription drug coverage is closed (in 2020) on their brand name prescription drugs.

Funding for community clinics: Increased funding for more than 1,100 community health centers in all 50 states, enabling them to double the number of patients they serve from 19 million to nearly 40 million by 2015. Nearly 26% of patients served by community health centers in 2010 were African American.

More health providers in underserved communities: New resources to boost the number of doctors, nurses and health care providers in communities where they are needed most, as well as diversify the workforce, so racial and ethnic minorities are better represented. Investments have been made in the National Health Service Corps (NHSC) program that has allowed for nearly three times the number of NHSC clinicians working in underserved communities across America than there were 3 years ago. While African Americans make up 5.7% of doctors, they make up 22% of the NHSC loan repayment program recipients.

When all is said and done, the ACA will result in 6.8 million more African Americans becoming eligible for health care coverage. However, advocacy is needed to continue to educate and outreach to African Americans to ensure that we have a voice in the way that the new healthcare law is implemented in our state. Yes, we must advocate for a fair and equal application of the law to reap the full benefits. So, get involved! Partner with organizations, agencies, and churches to bring information about the Affordable Care Act into African American communities, teaching them about the benefits, how to access benefits, and how to train and teach others. Dedicate sermons to the issue of health. Talk about prevention and wellness and how to build healthy African American communities. Host healthy potlucks and spend the afternoon in creative and fun exercise activities designed for the entire congregation. Contact the California Black Health Network to find out how you can get involved: cablackhealthnetwork.org.

The Affordable Care Act was designed so that all Americans can make health insurance choices that work for them while guaranteeing access to care for the most vulnerable in our county. Exercise your rights. Educate yourself. Get involved. Vote!

To your health,

KDL

September 1, 2012 at 11:51 pm 1 comment

Changing Hues and the Baby Boom

Every 30 seconds someone turns 65…

Over the last few months, I’ve been speaking at conferences and workshops about the aging population. We are all aging; a process that begins as soon as we’re born. But, more recently, our focus has turned to an impressive and dare I say, imposing subgroup of the aging population; The Baby Boomers.

In 2011, the first baby boomers – the generation born between 1946 and 1964 – reached their 65th birthdays. This group will total an estimated 80 million people by 2050 and will have a significant impact on life as we know it.

The folklore around baby boomers was that they would be healthier, wealthier and better educated than their parents were. Images of baby boomers on the golf course and traveling throughout the world were quite popular. In reality, much of this is true. Many baby boomers are in fact, more highly educated and more likely to occupy professional and managerial positions than their predecessors. On average, they are healthier and will live longer. But they also have had more varied work histories, longer transitions out of the labor force, and work for more of their adult years than previous generations. Sixty percent of baby boomers lost value in investments because of the economic crisis, 42% are delaying retirement and 25% of those currently working claim they’ll never retire. Higher rates of separation and divorce among baby boomers, their lower rates of marriage, and fewer children have serious implications for the traditional safety net that families provided for their elders.

Baby boomers are also more racially and ethnically diverse than their predecessors. More than 9 million baby boomers are African American. While some African American baby boomers are building on the gains made through generations of struggle in areas like education, employment and financial empowerment, the reality for others is a bit more concerning. Blacks in the boomer generation, as a whole, are no better off relative to whites than their parents and grandparents. Black baby boomers are still earning about 66% of what their white age peers earn. African Americans, as a whole, have the lowest rates of marriage than any other racial or ethnic group in the U.S.

What does this mean for the health and well-being of older African Americans? The three-fold increase of African Americans age 65 and older by 2050 will be accompanied by increases in chronic health conditions like diabetes, hypertension, cardiovascular disease and cancer, mental health disorders like depression, and cognitive impairment such as dementia and Alzheimer’s disease. Dramatic cuts and defunding of programs serving older adults will have devastating effects on our most vulnerable elders. The economic and time squeeze on our families has created wider holes in our traditional safety net.

So, who will serve our elders? For the first time, four generations are present in an increasingly racially and ethnically diverse workforce. Among children in the U.S., the multiracial population has increased almost 50%, to 4.2 million, since 2000, making it the fastest growing youth group in the country. The number of people of all ages who identified themselves as both white and Black soared by 134% since 2000 to 1.8 million people.

Now is the time for an intergenerational and cross-cultural perspective. Instead of the usual discourse around intergenerational transmission of poverty, trauma and disadvantage, let’s engage in conversations around intergenerational strategies that will mobilize people across the lifespan to support one another and address critical social issues in our communities. Let’s talk about how to leverage resources and assets of organizations and community members at all stages of life to support community change efforts. Let’s develop alliances across diverse organizations, systems and communities and engage community residents of all ages in leadership roles. Let’s identify ways to engage our elders in the lives of our youth and youth in the lives of our elders. Older adults can serve as literacy tutors, child advocates, youth and family mentors, parent outreach workers, and oral historians. Young people can help lessen the divide between our elders and technology, provide companionship and respite services to frail elderly and their families, and volunteer at senior centers and nursing homes.

At the same time, new spaces, practices and policies that promote interaction across the age divide should be created. So, instead of more senior centers, why not design community centers that engage and accommodate all members of the community in activities that allow old and young to interact. Instead of more adult day care facilities, why not cafés with tasty and healthy food, good customer service and affordable prices connected with learning and wellness programs and community projects to engage all ages. Of course, in order for any of this to be successful, we much engage in a bit of myth and stereotype busting about young folks and old folks along with opportunities for socialization.

When you know better, you’ll do better. As we head toward a brave old world where grandparents outnumber grandchildren, do your best to stay healthy and encourage policies that provide for a healthy lifestyle for the young and the old. Continue to support education and research to identify ways to provide better care to those who need it. Have a plan for retirement and long-term care; you’ll need it and your family will be grateful. And finally, stay involved and engaged. A change is gonna come…

To your health,

KDL

May 13, 2012 at 2:31 am Leave a comment

Is Being Black Bad for Your Health?

Will Ferrell recently tweeted, “I live in a country where a chick that threw flour on Kim Kardashian was arrested on site but the man who killed Trayvon Martin is still free.”

The shooting of Trayvon Martin, a 17 year-old unarmed African American male, by George Zimmerman, a 28 year-old white man, has sparked conversations and debates across the country regarding race in America. This tragedy has also ignited a “hoodie” movement that silently expresses solidarity and anger over justice delayed.
While the nation protests and the Justice Department continues its investigation, we must ask ourselves: how much better off are we today than we were 4 years ago? This is a question typically posed in reference to our economy. But, the question is also relevant for our social condition. With the election of President Obama came heightened anxiety by whites and a collective culture of fear that has manifested in rising gun sales and cries of self-defense in response to shooting an unarmed Black teenager.

The killing of Trayvon Martin is not about a suspicious Black male in a hoodie, a racial slur during a 911 call or Florida’s “Stand Your Ground” law. The fact that a Black male is not safe in a public space is a reflection of a history of violence against African Americans and institutionalized racism in the United States. The vulnerability of African Americans, Black men in particular, is demonstrated by a pattern of racism by the Sanford police department against African Americans and its decision to try a case according to legislation rather than using probable cause – the standard by which an officer has the grounds to make an arrest – and allowing a jury to decide.

Is being Black bad for your health? Race-related stressors such as experiences of discrimination, have been consistently linked to poor physical and mental health among African Americans, including cardiovascular disease, hypertension, depression and anxiety (see my paper titled “Racial Discrimination, Mood Disorders and Cardiovascular Disease Among Black Americans” in Annals of Epidemiology). Racial discrimination is also linked to mortality rates. According to the Centers for Disease Control and Prevention, African American men have the lowest life expectancy than any other gender, racial or ethnic group in the U.S. Even more telling is that African Americans, as a whole, have the highest rate of premature death – as measured by years of potential life lost (YPLL). YPLL is a summary measure of premature mortality or early death. It represents the total number of years not lived by people who die before reaching age 75. Deaths among younger persons contribute more to the YPLL measure than deaths among older persons. The YPLL rate for African Americans is approximately two times the rate for whites. In other words, twice as many African Americans die before their time than whites.

No doubt the stress associated with being a Black male in America is an underlying cause of their reported higher morbidity and mortality rates. And stress in contagious. Not only does it affect each of us directly in our homes, workplaces and neighborhoods, but it affects us indirectly as it reverberates across families and communities with each assault committed against a Black body.

As we all wait for the impending arrest of George Zimmerman and witness along with the nation and the world, the spectacle of his trial that will be laced with racial politics, anger and demands for justice, may we continue to heal from our losses, pray for the living and rally for justice.

To your health,

KDL

March 26, 2012 at 3:17 pm 1 comment

My Inspiration? A Healthy Black America

As I left the gym today, determined not to let another two weeks go by without working out, I was relieved that I wouldn’t have to deal with the guilt of sitting down for the rest of the day to work without doing something active. The truth is, if I don’t make the time to go to the gym, I would have very little physical activity for the day. The majority of my work requires that I sit in front of a computer. Being gluten- and dairy-free, consuming fresh and often organic fruits and vegetables, eliminating fried foods, shellfish and pork from my diet unfortunately does not automatically translate into being thin. Keeping the weight off is a constant struggle for me. It’s a battle that I fight every day and I often wonder if I will ever win. Being thin is not the goal. But, being healthy is. Diabetes, stroke, hypertension, cardiovascular disease and cancer – the leading causes of death for African Americans – have gravely impacted by family. So, being slightly obsessive about my weight is less about appearance and more about living.

Black women have the highest prevalence rate of obesity in the United States. Nearly 50% of us are overweight or obese. As we age, the prevalence rate increases to over 60% for Black women over 60 years of age. It is estimated that if current trends persist, all Black women will be overweight or obese by 2034. Many researchers are now identifying obesity as the main factor driving racial disparities in health among women.

I started this blog because of the obesity epidemic and the host of other chronic health conditions and mental health problems that exist in Black communities across the country. In Los Angeles, the 10th most segregated city in the U.S. where over 3.7 million people reside, disparities in health by race and income are ubiquitous and systematically distributed by zip code. South Los Angeles (formerly South Central LA), where of 31% of African American Los Angelenos live (down from 71% since 1980) has the highest rate of obesity, diabetes, cardiovascular diseases, cancer, hypertension, and mental distress in Los Angeles County. South LA also has the highest adult sedentary behavior and the poorest adult nutrition ratings in the County.

Several factors contribute to poor physical and mental health in South LA and other predominantly Black and low-income neighborhoods across the country; many of which I will be discussing in future blogs. But it’s safe to say that factors range from the level of policy to individual behavior; individual behavior being the primary focus of policy makers and interventions. First Lady Michelle Obama’s Let’s Move! campaign highlights the importance of physical activity, access and consumption of healthy foods to combat childhood obesity. Less discussed, however, is the impact of segregation, food deserts, the high cost of fresh produce and organic foods, social stress, the dearth of safe places to walk, the marketing of high-calorie and low nutrient-dense food, the higher prevalence of fast food restaurants and convenience stores, and the general lack of health supportive resources in Black and low-income neighborhoods compared to non-Hispanic white and more affluent neighborhoods.

It is important for individuals to make healthy choices. But, wouldn’t it be easier to make those choices if there were more healthy options? Many of the barriers to good health can be manipulated at different levels of government using the traditional policy levers, including regulations, taxes, subsidies, and information campaigns focusing on education, transportation, urban planning, healthcare, agriculture and food assistance programs. But we can’t wait for policies. We need to take our health – physical and mental – into our own hands. Educate, advocate, lead, support. Let’s move. Let’s act!

To your health,

KDL

March 17, 2012 at 5:56 pm Leave a comment

Welcome to Healthy Black America!

Greetings!

Here is where I’ll be posting my musings and observations about a variety of health-related topics.  Please be sure you are subscribed to both this post and my newsletter at www.karendlincoln.com for updates and news!

Best,

KDL

March 4, 2012 at 8:30 pm Leave a comment


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