Diabetes in African Americans: Disparities and Health Literacy

Introduction

Diabetes is a serious public health issue that disproportionately affects the African-American adult population. According to the Centers for Disease Control and Prevention, African Americans are twice as likely to have type II diabetes as Caucasians (Diabetes, 2011). This is highly significant, given that 90 to 95% of new diabetes cases each year are type II (Diabetes, 2011). Several factors contribute to these cases, including genetics. Additionally, people can develop type II diabetes through obesity, a sedentary lifestyle, advancing age, and poor eating habits. In order to thoroughly address the issue, it is important to examine what African Americans know — and do not know — about diabetes, and how they handle the disease if they develop it or are told they are at risk. Many have pre-diabetes and can avoid the disease if they make conscientious choices (Agurs-Collins et al., 1997). While not every African-American adult with pre-diabetes will go on to develop type II diabetes, it is important that they understand how to lower their risk and what they can do to maintain their health.

This paper addresses the traditional healing methods and folklore practices used by African Americans, some of which are employed to treat or manage diabetes. Additionally, health literacy must be considered. The more people know about health, the healthier they tend to be. African Americans who are proactive about their health and who work to expand their knowledge are more likely to avoid type II diabetes and to keep it under control if they do develop it (Agurs-Collins et al., 1997). Reducing health disparities becomes critically important in this context, because African Americans need good healthcare knowledge but also need access to proper treatment that they can afford from providers they trust. Without all of these elements, their risk for diabetes will remain elevated.

It is well established that African Americans have higher rates of diabetes than Caucasians across all socioeconomic categories (Agurs-Collins et al., 1997). However, not all of them seek out standard medical care. There are many traditional health methods and folklore practices used by the African-American community in the treatment or management of diabetes. These include four distinct elements: dreams, ritual, the power of words, and spirituality (Parks, 2007). These elements are used in culture-specific ways by African Americans dealing with chronic conditions such as diabetes. When folk beliefs and traditional healing methods are studied, it becomes possible to understand how they relate to the management of chronic disease (Parks, 2007). The more they can be connected to disease management, the more they can help people belonging to a particular culture or ethnic group live better lives.

Traditional Healing Methods and Folklore Practices

For African Americans, community, family, and other social relationships are traditionally viewed as among the most important coping strategies for dealing with chronic illness (Parks, 2007). One of the central folklore and healing beliefs is prayer. African Americans as a group tend to be more religious than many other groups, and they are often deeply dedicated to their faith. Through those beliefs, they find patience, comfort, and the opportunity for healing and maintaining a positive outlook (Parks, 2007). Through self-esteem and positive reinforcement, many African Americans are able to better manage chronic conditions because they recognize their value to their communities and to the people who care about them. Many African Americans are also drawn to spirituality and use ritual as part of the practice of those spiritual beliefs (Parks, 2007). This can encourage positive thinking and the belief that their troubles may be overcome through faith and commitment to their convictions (Parks, 2007).

Both dreams and words are also considered powerful in the context of healing beliefs (Parks, 2007). Dreams, for instance, are believed to provide metaphors, information, and truths about a person's condition in the present and future (Parks, 2007). The more a person understands about his or her dreams and how they relate to a chronic medical condition, the more he or she may feel guided to take action regarding that condition or to pursue a particular course in order to maintain or restore good health. In that spirit, a person can use words as powerful symbols of what he or she has experienced in dreams (Parks, 2007). Words carry tremendous power, and positive self-talk has been shown to help people live better lives and even take greater control over their medical conditions and other challenges they face (Parks, 2007). These can all be valuable ways to improve a person's health and outlook on a medical condition, though it is generally accepted that traditional and modern medical treatments are also often necessary.

The higher a person's education level and the more he or she understands about health, the better equipped that person will be to handle and manage diabetes. This is one of the key reasons that diabetes education programs are so important, especially in populations that may be underserved by medical care and health information (McCleary-Jones, 2011). In a study conducted by McCleary-Jones (2011), adult African Americans with greater knowledge of diabetes took better care of themselves overall in relation to their disease. Additionally, self-efficacy played an important role in how well a person managed his or her diabetes (McCleary-Jones, 2011). Self-efficacy was particularly linked to diabetic foot care, while knowledge more broadly was more closely associated with overall self-care among type II diabetic African-American adults (McCleary-Jones, 2011).

Higher knowledge levels correlated with better care of the feet, improved diet, and greater levels of physical activity (McCleary-Jones, 2011). This demonstrates that African Americans with diabetes can benefit substantially from increased knowledge about their condition, allowing them to make better choices regarding diet, exercise, and other factors closely tied to disease management. Because people with diabetes often experience specific complications linked to worsening of their condition, it is critical that anyone who develops type II diabetes receives education on these risks (McCleary-Jones, 2011). Within the African-American community, opportunities for such education are frequently lacking (McCleary-Jones, 2011), which can lead to poorer outcomes compared to their Caucasian counterparts.

While health literacy has been broadly acknowledged as significant in managing chronic conditions, it is important to recognize that understanding a condition is only one part of managing it effectively. People with conditions such as type II diabetes must also be able to access proper information and medical care (McCleary-Jones, 2011). With this in mind, one must consider not only how health literacy is developed, but what the African-American adult with diabetes does with the health information he or she acquires. If that information is not acted upon, it provides little benefit (McCleary-Jones, 2011). Health literacy, therefore, is only the first step toward better management of a person's condition.

Health Literacy and Diabetes Self-Management

There are actionable ways to decrease health disparities in the African-American community so that more people can live healthier lives (Vaccaro & Huffman, 2012). One approach to helping people manage diabetes is through the Affordable Care Act. Having health insurance can make a significant difference in whether a person is willing and able to see a doctor about medical conditions or afford necessary medications (Vaccaro & Huffman, 2012). Seeing a medical professional regularly — and being able to afford to do so — is an excellent way to receive education about a chronic medical condition and to monitor it effectively so that adjustments can be made as needed (Baptiste-Roberts et al., 2007). Unfortunately, many African Americans do not see a doctor regularly despite having chronic medical conditions (Baptiste-Roberts et al., 2007). Some of this is cultural in nature and contributes to the health disparity between African Americans and Caucasians with conditions such as diabetes.

A large part of the problem, however, lies in the cost of medical care (Baptiste-Roberts et al., 2007). With mandated and subsidized insurance, more African-American families will find care for conditions like diabetes more affordable, which will influence both whether and how often they see a doctor. It will also affect what diagnostic tests they can access and which medications they are able to take for their conditions (Vaccaro & Huffman, 2012). All of this is highly significant for people living with diabetes. The more education they have, and the more they are able to act on that education by seeing their doctor and accepting treatment, the better positioned they will be to live longer, healthier lives (Vaccaro & Huffman, 2012). Type II diabetes can be managed, but doing so requires commitment and ongoing understanding of the condition.

Unlike some medical conditions that worsen progressively over time, type II diabetes can be managed and, in some cases, even reversed. Because the African-American population is twice as likely to develop this condition compared to Caucasians, educating them on risk factors, signs and symptoms, and treatment options is critically important. Those who do not have good information about a medical condition cannot make informed decisions about it. When they are unable to make informed decisions, they fail to receive the care they need, which can lead to further medical complications and even a shortened lifespan. One of the primary challenges with type II diabetes in the African-American population has been the difficulty of reaching those who need information most, so that they fully understand their genetic predisposition and the modifiable risk factors associated with the condition.

However, a lack of information is only the beginning of the problem. Those with diabetes need more than education about the disease and its treatment — they also need the resources to pursue proper care. This is another area where significant barriers exist. Many African Americans rely on prayer and community support to navigate difficult times, but these must be coupled with modern medical options in order to effectively manage diabetes. The Affordable Care Act may make a meaningful difference in the quality of life for African Americans with diabetes, simply by making it more affordable to see a doctor regularly and obtain necessary medications. More frequent medical contact may also provide further diabetes education, encouraging dietary and exercise habits that protect long-term health. Improved health habits can additionally help reduce a person's dependence on medication, yielding further financial benefits.

Conclusion

McCleary-Jones, V. (2011). Health literacy and its association with diabetes knowledge, self-efficacy and disease self-management among African Americans with diabetes mellitus. The ABNF Journal, 25–32.

Parks, F. M. (2007). Working with narratives: Coping strategies in African-American folk beliefs and traditional healing practices. Journal of Human Behavior in the Social Environment, 15(1), 135–147.

Vaccaro, J. A., & Huffman, F. G. (2012). Reducing health disparities: Medical advice received for minorities with diabetes. Journal of Health and Human Services Administration, 389–417.