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African Americans bodies were used without consent

Forced to participate in dissections and medical exams

Tuskegee syphiliis study, hundreds of black men were administered syphillis (without their consent), and denied treatment

Less likely to receive certain medicine for their condition compared to whites

Less likely to be offered better -tolerated medicine called atypical antipsychotics

For example: Clozapine considered the “CADILLAC” of psychiatric medicine because of superior effectiveness is prescribed less in minorities

Black patients are more likely then whites to receive lower triage scores for the same complaints

Less serious complaints equal longer wait times

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Mental health within the black community | Davonte Sanders-Funches | TEDxNorthCentralCollege

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The verdict is in: Food deserts don't drive nutritional disparities in the United States the way we thought. Over the past decade, study after study has shown that differences in access to healthy food can't fully explain why wealthy Americans consume a healthier diet than poor Americans.

If food deserts aren't to blame, then what is?

I've spent the better part of a decade working to answer this question. I interviewed 73 California families - more than 150 parents and kids - and spent more than 100 hours observing their daily dietary habits, tagging along to grocery stores and drive-through windows. My research suggests that families' socioeconomic status affected not just their access to healthy food, but something even more fundamental: the meaning of food.

Most of the parents I interviewed - poor and affluent - wanted their kids to eat nutritious food and believed in the importance of a healthy diet.

But parents were also constantly bombarded with requests for junk food from their kids. Across households, children asked for foods high in sugar, salt and fat. They wanted Cheetos and Dr. Pepper, not broccoli and sweet potatoes. One mom echoed countless others when she told me that her kids "always want junk."

While both wealthy and poor kids asked for junk food, the parents responded differently to these pleas.

An overwhelming majority of the wealthy parents told me that they routinely said "no" to requests for junk food. In 96% of high-income families, at least one parent reported that they regularly decline such requests.

Poor parents honored their kids' junk food requests to nourish them emotionally, not to harm their health.

Parents from poor families, however, almost always said "yes" to junk food. Only 13% of low-income families had a parent that reported regularly declining their kids' requests.

One reason for this disparity is that kids' food requests meant drastically different things to the parents.

For parents raising their kids in poverty, having to say "no" was a part of daily life. Their financial circumstances forced them to deny their children's requests - for a new pair of Nikes, say, or a trip to Disneyland - all the time. This wasn't tough for the kids alone; it also left the poor parents feeling guilty and inadequate.

Next to all the things poor parents truly couldn't afford, junk food was something they could often say "yes" to. Poor parents told me they could almost always scrounge up a dollar to buy their kids a can of soda or a bag of chips. So when poor parents could afford to oblige such requests, they did.

Honoring requests for junk food allowed poor parents to show their children that they loved them, heard them and could meet their needs. As one low-income single mother told me: "They want it, they'll get it. One day they'll know. They'll know I love them, and that's all that matters."

Junk food purchases not only brought smiles to kids' faces, but also gave parents something equally vital: a sense of worth and competence as parents in an environment where those feelings were constantly jeopardized.

To wealthy parents, kids' food requests meant something entirely different. Raising their kids in affluent environment, wealthy parents were regularly able to meet most of their children's material needs and wants. Wealthy parents could almost always say "yes," whether it was to the latest iPhone or a college education.

With an abundance of opportunities to honor their kids' desires, high-income parents could more readily stomach saying "no" to requests for junk food. Doing so wasn't always easy, but it also wasn't nearly as distressing for wealthy parents as for poor ones.

Denying kids Skittles and Oreos wasn't just emotionally easier for wealthy parents. These parents also saw withholding junk food as an act of responsible parenting. Wealthy parents told me that saying "no" to kids' pleas for candy was a way to teach kids how to say "no" themselves. Wealthy parents denied junk food to instill healthy dietary habits, such as portion control, as well as more general values, such as willpower.

Both wealthy and poor parents used food to care for their children. But the different meanings they attached to food shaped how they pursued this goal.

Poor parents honored their kids' junk food requests to nourish them emotionally, not to harm their health. Similarly, wealthy parents who denied their kids processed foods did so to teach them healthy lifelong habits, not to deprive them.

Nutritional inequality in the U.S. has more to do with people's socioeconomic status than their geographic location. Living in poverty or affluence affects more than our access to healthy food: It shapes the very meanings we attach to food.

Tackling nutritional inequality will require more than putting supermarkets in low-income neighborhoods. These interventions won't change what food means to the poor families I met.

But lifting them out of poverty could. If low-income parents had the resources to consistently meet their kids' desires, maybe a bag of Doritos would be just a bag of Doritos, rather than a uniquely potent symbol of parental love and care.

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Why do poor Americans eat so unhealthfully? Because junk food is the only indulgence they can afford

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The verdict is in: Food deserts don't drive nutritional disparities in the United States the way we thought. Over the past decade, study after study has shown that differences in access to healthy food can't fully explain why wealthy Americans consume a healthier diet than poor Americans.

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Black seniors are more likely than whites and Latinos to forgo hospice care. Due to deeply felt religious beliefs and a long history of discrimination in the U.S., African-American patients are often reluctant to plan for the end of their lives, and more skeptical when doctors suggest stopping treatment. Special correspondent Sarah Varney reports on efforts to change some of those beliefs.

JUDY WOODRUFF:
End-of-life planning is gaining favor with more and more Americans. But lagging behind this trend are African-Americans, who research shows are, more so than whites and Latinos, skeptical of options like hospice and advance directives.

Special correspondent Sarah Varney begins our report in Los Angeles.

This story was produced in collaboration with our partner Kaiser Health News.

SARAH VARNEY, Kaiser Health News:
Dr. Maisha Robinson, a neurologist at the University of California, Los Angeles, is on a mission to change how black seniors die in America.

Dr. Robinson grew up a pastor's daughter in Tennessee. Now she's working with pastors like Bishop Gwendolyn Stone in Los Angeles to urge black families to plan for the end of their lives.

DR. MAISHA ROBINSON, University of California, Los Angeles: If you look kind of in the Bible, all the people, of course, that Jesus healed, all died. They went on to die.

SARAH VARNEY:
There is an ideal image of a good death in America, a clearly worded legal directive reflecting a patient's wishes, avoiding painful and unnecessary medical treatments. But that ideal image is often at odds with the realities of black spiritual life and the lessons African-Americans carry forward from their painful history.

As late as the mid-1960s, segregated hospitals were common, and legal, throughout the United States. Even in so-called mixed race hospitals, black patients were often housed on separate floors. The notorious Tuskegee syphilis study, a government-led experiment on black males, lasted until 1972 and killed more than 100 men.

Dr. Kimberly Johnson is a geriatrician and associate professor of medicine at Duke University. She says, for African-Americans, the history of abuse is not a cultural artifact. The toxic distrust of the health care system is still deeply felt today.

DR. KIMBERLY JOHNSON, Duke University School of Medicine: They receive care in facilities that were largely either segregated or facilities where they - they or their parents or their grandparents wouldn't have been allowed to have received care. And, as a result, they are really suspicious of the kind of care they receive.

SARAH VARNEY:
Dr. Johnson says black patients and their families then are understandably skeptical when a physician suggests withdrawing medical treatment or stating their wishes in advance.

Researchers have found about 8 percent of African-Americans, compared to 43 percent of whites, have an advance directive or living will. And, regardless of income, black patients are more likely than whites and Latinos to forgo hospice and say they want to be kept alive on life support, even when there's little chance of survival.

Hospice has been much more successful reaching white middle-class patients. But here in Buffalo, New York, an influential group of African-American pastors and their wives are confronting the skepticism and fears about hospice in the black community through personal stories and prayer.

Narseary Harris and her husband, Pastor Vernal Harris lead the Prince of Peace Temple Church of God in Christ in Buffalo. Two of the Harrises' three sons, Paul and Solomon, died from sickle cell disease, an incurable condition that causes the red blood cells to break down. Paul endured a painful and prolonged death at age 26.

NARSEARY HARRIS:
He said, Mrs. Harris, Solomon doesn't have a lot more time. And I really want to recommend hospice care for you. I said, 'We don't want hospice.' He said, 'Mrs. Harris, you don't have to make a decision right now, but let me just introduce you to Hospice Buffalo.' And I said, 'OK, well, we can - we will do that.' I said, 'Solomon, you OK with that?' And he said, 'OK.'

He wanted to be cremated, and this is actually his urn.

SARAH VARNEY:
Narseary Harris has been sharing her story with the wives of black pastors across western New York and urging them to help reshape the community's views about hospice.

But, back in Los Angeles, at a gathering of black seniors, the challenge Dr. Maisha Robinson faces in changing minds is unmistakably on display.

SARAH VARNEY:
Changing those beliefs seems a daunting challenge, especially when startling racial health disparities remain. But, for pastors like Gwendolyn Stone, easing the pain of death is a worthy calling.

For the PBS NewsHour, I'm Sarah Varney in Los Angeles.

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Why African-American seniors are less likely to use hospice

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Black seniors are more likely than whites and Latinos to forgo hospice care. Due to deeply felt religious beliefs and a long history of discrimination in the U.S., African-American patients are often reluctant to plan for the end of their lives, and more skeptical when doctors suggest stopping treatment.

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Even in this age of information, some African Americans equate good health with luck or success. An illness or disease, viewed as undesirable, may be equated with bad luck, chance, fate, poverty, domestic turmoil, or unemployment, and in such case, Black Americans will consult a physician only after attempts with home remedies have failed.
Studies in health disparities show residents of disadvantaged neighborhoods often have little to no environmental support for healthy behaviors which increases their risk for health disparities. For most African Americans and others residing in low-income neighborhoods, the abundance of fast food chains (fast food companies have specifically targeted African American communities as a growing market for their products), high-priced food marts, and a lack of access to healthy affordable foods contributes to the prevalence of obesity and chronic illness. Convenience and cost have an especially strong influence on low-income individuals’ likelihood of adopting healthy dietary behaviors; fresh fruits and vegetables and lean meat are more expensive than packaged processed foods. Similarly, lack of transportation can be a pressing problem for low-income families, something middle class Americans of all ethnic groups are spared. If you have to take a bus to do real grocery shopping, it is more likely you will rely on the corner 7-11 for convenience food. Obesity, especially in children, is an enormous problem across America.
Understanding a patient’s practice of cultural norms can allow providers to more quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities among African Americans must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Again, get to know your patients on an individual level. Generalizations in this material may not apply to your patients.

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African Americans' Distrust in the Health Care System: Past and Present

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It's not easy to stay healthy when your home is surrounded by pools of feces. And that's only one of Barbara Thomas's health problems.

I meet Thomas in the Washington Heights neighborhood, a patchwork of dusty streets surrounded by farmland, less than 5 miles from Ferriday, a small town in Concordia Parish, central Louisiana.

Every day, Thomas, who is 60, wakes up fearing rain. If the skies pour down on her brown-brick bungalow, the pools of wastewater that have gathered in her backyard will swell. On hot and humid days - of which there are many in Louisiana - they release the rank scent of raw sewage.

Thomas has been living with this fetid water in her yard for three years. It's there because the oxidation pond on her street, which is supposed to clean the neighborhood sewage, is broken and hasn't been fixed. When I visited, the pond was completely overgrown with trees, weeds, and grass. "People are throwing dead dogs and stuff in here," a neighbor, Vernon Smith, tells me.

If Thomas flushes her toilets or runs her sinks and shower, the runoff doesn't enter a waste treatment facility - the bedrock of modern sanitation - it just flows right onto her land, where her grandchildren play. (She has to warn the kids to stay away from the water.) The sewer on her property also backs up and overflows, putting her community at risk for a range of illnesses - diarrhea, cholera - we typically associate with extreme poverty in developing countries.

This fact was not lost on Smith, who's been suffering with breathing problems lately. "It's the 21st century, and we still got our sewers backing up," she says.

Life in one of America's least healthy - and most forgotten - counties

When you drive up to Concordia Parish from nearby Alexandria, you pass through miles of rolling flatland dotted with green swamps, bales of hay, and pine and pecan trees. The edges of the roads are dusted with white plumes of cotton blown in from the fields - plantations where African Americans were once forced to work.

Concordia has another distinction: It's one of America's sickest counties.

Louisiana ranks 50th out of 50 states for overall health in America because of its astoundingly high rates of heart disease, smoking, obesity, drug overdose deaths, diabetes, cancer, and infant mortality. And Concordia regularly features at or near the bottom of the list of Louisiana parishes for health outcomes, according to the County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Concordia is a place where infants die at rates that are three times higher than in Montgomery, a high-income county in Maryland with the best health outcomes. Concordia is a place where 40 percent of the adult population is obese, nearly half of the children live in poverty, and a quarter never finish high school. Concordia's unemployment rate stands at 8.7 percent, and the median household income, at $31,800, is about 40 percent less than the national average.

As in other rural counties in America, people in Concordia have been dying earlier in recent years - but they were already dying young compared with national life expectancy. In the Bayou State, men and women can expect to live to 76, compared with the 81 years Californians live to on average - a gap similar to the one you'd find between the United States and a developing country like Colombia. It's no stretch to call this patch of the Deep South one of the most shocking examples of how bad health can get in the wealthiest country in the world.

I wanted to go to Concordia to understand why it was so unhealthy, and what its future might look like under Donald Trump. (Concordia's 60 percent white majority voted for Donald Trump.) While there, I spent most of my time in Ferriday, one of Concordia's largest hubs, which is 75 percent African American. If health outcomes are poor all over Louisiana, they are generally worse among the African-American population.

I visited clinics, homes, hospitals, restaurants, even a local funeral home. I spoke to the current and former mayor, doctors, nurses, a pastor, health activists, a hospital CEO, and patients - poor and rich, white and black. Unlike many other rural communities that are sliding backward on health these days, Concordia wasn't ravaged by trade or technological change. It isn't buffeted by immigration. Globalization mostly skipped right over it. Instead, this is a low-income place that seems to be locked in time and forgotten by Washington, with a state government that's been shredding its basic safety net.

Most of the people I met here don't feel served by President Obama, nor do they think Trump will help them. But some believe the president-elect could make their lives worse. Among Concordia's many distinctions are a history of slavery and longstanding racial tensions and disparities. And the African Americans here are terrified about living under an administration that was endorsed by the Ku Klux Klan.

I left the Deep South with a worry in my gut: If the conditions these people were living in are already very bad, they are likely about to get much worse.

A problem with basic sanitation

The sanitation emergency in Washington Heights is not the only health issue Barbara Thomas is dealing with right now. As a girl, she shot herself in the foot with a gun by accident and has hobbled around ever since. (This winter, she's finally going to have an operation to get that bullet removed.) She's also been in and out of the hospital for her bad heart, and has already had four stents put in to improve her circulation.

"I'm not feeling good at all," she said, standing next to a small coffee table, which held a fly swatter, pill bottles, and two Bibles. For all these illnesses, she's on disability, but sometimes, for extra cash, she picks pecans from trees in Concordia and sells them to local food stores for 80 cents a pound.

She and her neighbors have gone to the mayor of Ferriday, as well as the mayors of neighboring towns, local lawmakers, and the health department, for help getting their sewage system fixed. And they say no one will help them. They keep hearing that local officials don't have the budgets to address the problem, that they should buy septic tanks (which Thomas and her neighbors can't afford), and that their street is a private development and not the government's responsibility (the owner of the development went bankrupt).

So the people of Washington Heights are left with their own feces spread around outside their homes.

While extreme, this was one of the many examples of the state's failure to provide the basics for people here.

The residents of Ferriday have long endured periods without access to clean water, relying on green water tanks shipped in by the Louisiana National Guard. They only got a functioning water treatment facility early this year, in February. This makes Ferriday a lot like other communities of color, which are more likely to be afflicted with environmental health hazards like lead poisoning, air pollution, and water contamination.

The state of Louisiana has also failed to regulate for public health in other key ways - it has some of the most permissive alcohol and tobacco laws in the country. It's a place where you can buy booze in supermarkets, drugstores, gas stations, convenience stores, or even at drive-thrus. (Daiquiri stands selling frozen boozy confections with names like "DUI" to drivers are common throughout Louisiana.)

In my time in Louisiana, I could see no biological reasons that might explain why the people of Concordia - or Louisiana, for that matter - are sicker than in any other place in America. But I did see many clear political failures that explain how the people here wound up at the bottom of America's health rankings.

If Louisiana were a patient, "you would say the patient is dead"

If there's one person Louisianans point to for the state's current failures to protect the poor and public health, it's the former governor (and onetime Republican presidential hopeful) Bobby Jindal.

The gravity of the damage Jindal wreaked on the health sector became clear when I met the medical director for central Louisiana, Dr. David Holcombe, who looks after public health for Concordia and some of the state's other least healthy parishes.

One evening in Holcombe's colorful home, brimming with artwork that he and his wife Nicole purchased from local artists, he pulled out a painting of his own. Holcombe had depicted Jindal as Lucifer. "I was not overly impressed by his compassion," he said. "I'm putting this delicately."

As governor, between2008 and 2016, Jindal cut 30,000 jobs from the state's workforce. When Holcombe took his post, in 2006, he had 121 employees for central Louisiana's public health units, which act as safety nets for people who don't have health insurance or money to pay for care. He's now down to 83, after being forced to lay off nurses who cared for the poor patients.

Because Holcombe was worried about all the people who might fall through the cracks, he stepped beyond his role as medical director and started to care for patients himself. While he's required to see three per month to keep his Medicaid affiliation, he now cares for up to 100. When I asked why a Californian son of a prominent dentist chose to practice medicine in Louisiana, he joked, "Mother Theresa only went to the Calcutta slums; she wouldn't go to the suburbs of Washington, DC."

Jindal did other things to tear up Louisiana's health safety net. He closed down the state-run hospital system for the poor, and replaced it with public-private partnerships, which have increased hospital costs for Louisiana. Since 2008, he nearly halved the staff of the Department of Children and Family Services and slashed funding for higher education by 44 percent.

An outspoken critic of Obamacare, Jindal refused funding to expand Medicaid in his state. (Medicaid and Medicare are the government's safety net health insurance programs that provide care to the poor and the elderly. The Affordable Care Act broadened Medicaid eligibility to cover millions more low-income Americans, and offered states federal money to recoup the costs.) Jindal also declined nearly $100 million in federal government stimulus spending for the state's unemployed residents.

At the same time, he introduced tax cuts for the rich and financial incentives to lure oil companies to Louisiana. Tax revenue from oil companies fell from $703 million in 2008 to $290 million in 2012. And, contrary to his bet on the industry, oil prices collapsed. So instead of attracting business and raising money for Louisiana, his scheme helped carve a massive dent in one of the state's main sources of income, resulting in a budget deficit that reaches $2 billion.

"This was years of mismanagement by a governor who was more concerned about satisfying a national audience in a presidential race," Jay Dardenne, the lieutenant governor under Jindal, told the Washington Post in March.

By the time Jindal's successor, Democrat John Bel Edwards, came to power in 2016, the state was facing a "historic fiscal crisis." On his second day on the job in January, Edwards introduced Medicaid expansion through an executive order, and more than 336,000 of Louisiana's poor finally got health insurance.

The forthcoming Trump administration poses a threat to these people, too.Like Jindal, the president-elect is no fan of the Affordable Care Act. He's run on a platform that promises to r epeal and replace Obamacare, and he's chosen as head of the Department of Health and Human Services Tom Price, who's intent on carrying out that promise. (As Vox's Sarah Kliff wrote, Price has a robust plan for how to repeal Medicaid expansion and replace it with nothing.) Trump has also endorsed Paul Ryan's plan to gut Medicaid.

The impact of the years of Jindal'scuts will take some time to show up in the health statistics, but I could already see early signs of trouble. Emerson Slain, one of the men I met in Ferriday, was going blind in one eye from Type 2 diabetes. He had private insurance switched to Medicaid during Louisiana's expansion earlier this year. Finding a doctor who would accept his new health plan delayed the eye surgery he needed by five months. Trump and Price's stated plans put Slain, and the hundreds of thousands of people who recently got Medicaid in Louisiana, in limbo again.

Jindal's Louisiana may be a preview of what's coming to other vulnerable communities across the United States under the Trump administration, said Arlie Hochschild, author of a new book on Louisiana politics, Strangers in their Own Land. "Jindal bet on industry and didn't protect the people at all. Just give them their tax money back. And never mind schools. And never mind hospitals. That is the dark bargain of Tea Party politics." She estimates that he cut $1.6 billion from hospitals and education.

"This is an example we should study up close now that Donald Trump will be our president," said Hochschild.

Holcombe, the regional medical director, is also bracing himself. "So much funding for public health comes from federal sources," he said. "If there's really a change in direction ... it'll affect maternal child care, nutrition, STDs, tuberculosis."

This in a state that's long been stagnating. "When you look at the state health rankings - they were started in 1990 - they were like this for Louisiana," Holcombe said, holding his hand out in a horizontal wave. "If you were in the ICU, you would say it's a flat line. You would say the patient is dead."

The past is the present on the Mississippi

Louisiana's political climate has certainly exacerbated the poor health here. But if you really want to understand why Concordia is so sick, you have to look at its history of racial inequality. It's woven into a map of the state's health statistics today.

The four sickest parishes, including Concordia, are all clustered together, along the Mississippi River in the central and northeastern edge of Louisiana's L-shape. "That area was just about as classic a Southern cotton plantation as you can find," Louisiana historian John Rodrigue told me. The Mississippi Delta was home to some of the largest slave holdings in the US - the quintessential model of a small white minority ruling over a large black, impoverished majority.

The legacy carried into sharecropping (black people rented plots of land from white people in return for part of their crop), Jim Crow laws (which enforced racial segregation until the 1960s), and long-lasting gaps in educational and employment opportunities - as well as health outcomes - between black and white people.

When I went to meet another resident of Washington Heights, Robert Lewis Jr., who was in Ferriday's hospital, he described a Concordia that's been frozen in time. That day, he was getting treatment for a pressure ulcer on his feet, which were hanging from his wheelchair, wrapped in white gauze, and looking bluish.

Lewis, who is 79, started his career as a water boy on a plantation run by white people; his mom and older sister worked in the "big house" as cooks for the plantation owners. Lewis has had a series of different jobs over his life, including working as a safety engineer on an oil rig, which landed him in hospital and on disability. (He slipped on a wet platform and broke his neck and back.)

"You cannot talk about the conditions in Ferriday [or] in Washington Heights," he said, "without talking about race, because race is a major problem." And he worried that the kind of treatment black people in the South get - as well as any fragile gains in basic civil rights - were about to slide back under Trump.

"It looks like at this point in time, [Trump] won't be better for the country because the country is divided. ... It's only going to make those racist skinheads, the KKK come out," Lewis said. "The racists feel like they have a man in office who is supporting 'em, backing 'em up."

Devils Walking, a book about murders by Klansmen on the Mississippi in the 1960s, was spread open on his hospital table that day. Lewis and his family were nearly counted among the casualties. A civil rights campaigner, Lewis was thrown in jail and charged with aggravated battery - after Klan members bombed his house in November 1965. The cops justified the prison sentence because he was holding a gun when they showed up, according to the record in the book.

His past grounds the present in Louisiana. A steady stream of boys and men, most of them black, help keep Louisiana's prison industry thriving. Louisiana has been dubbed "the world's prison capital" with the highest per capita incarceration rate, nearly five times Iran's incarceration rate, 13 times China's, and 20 times Germany's, according to a Times-Picayune investigation.

Louisiana also has the longest prison sentences in America: It's a place where a two-time car burglar can face 20 years in jail without parole. It's home to Angola, the largest maximum-security prison in the US, located 70 miles south of Ferriday. Like the hospitals here, prisons have been increasingly privatized over the past 20 years. So there are economic incentives to keep people in jail for as long as possible.

Mass incarceration breaks up families and makes communities sicker, Duke researcher Susan Reif told me, contributing to the racial health disparities. Consider HIV. "Incarceration is a significant driver of HIV and STDs," and when you have people coming in and out of jail, it disrupts sexual networks, she explained. Prisons have higher rates of STDs, and when prisoners return to the community, they can bring with them any diseases they may have picked up while incarcerated.

Seventy percent of those diagnosed with HIV in Louisiana are black, and the state has the highest rate of HIV in the US. In Concordia, black people have about four times the number of chlamydia and gonorrhea infections as white people.

Earlier in the week, Louisiana's racial history came up in a meetingat Holcombe's central Louisiana health unit in Alexandria, an hour and a half drive from Concordia. Holcombe and his colleagues gathered around a plastic table in a beige meeting room, and talked about how Louisiana has the lowest rate of breastfeeding in the country (only 57 percent of mothers have ever breastfed, as opposed to 80 percent in the US overall). Among African Americans, only 30 percent breastfeed their babies.

"I ask every woman - did you breastfeed?" Holcombe explained. The women tell him they don't want to. The reason: the memory of black nannies breastfeeding white children, an institution of the antebellum South. "People are very much aware of that [history]," he said. "It's still in that community consciousness."

Infant mortality is twice as high among black people as it is among white people, all over Louisiana. Black people in Louisiana are nearly three times as likely as whites to be poor. Nearly 30 percent report being in fair or poor health compared with 19 percent of whites. Of all the states, black people in Louisiana have the highest mortality rate - 1,017 deaths per 100,000 population - which is double the death rate for black people in Idaho or Hawaii. So Louisiana, with its rock-bottom health outcomes, is also an extreme example of the black-white health gap.

"You have an African-American population that was subservient during the times of slavery. It was subservient during the time of Jim Crow," Holcombe said. "These were sharecroppers who worked on other people's land. Now we're in a new era - but there's still a large disenfranchised population living in these areas that track right up the Mississippi River."

Things are going to get worse - and not just for Concordia

When I asked Vernon Smith, a resident of Washington Heights, why she believes the sewage system in her neighborhood has gone unfixed all these years, she put it plainly: "It's majority black and low-income."

"I know because another neighborhood - called Panola Woods - that's mostly white, they have a sewer system, and they don't live too far from me," she added.

Smith doesn't think the government is going to answer the calls of her neighbors in Washington Heights anytime soon. So she's turning to her faith. "I think God is going to send someone to help us."

Smith has good reason to feel unheard. Much has been made of the plight of the But not a shred of attention during the election went to people like her: the poor black working class of the South who, arguably, have always been left behind. white working class in America's Rust Belt who are grappling with economic troubles wrought by globalization, and changes in trade, and technology.

Concordia, and in particular the African Americans here, has been on the losing end of the American dream for - forever. And no one is talking about how to make life better for them. Echoing Smith, Holcombe said, "We have been living with bad outcome statistics and horrible disparities in Louisiana for decades. The amount of attention paid to a problem is generally proportional to the population's economic impact and educational levels." He added: "When blacks die at the same rate as whites, we know we will have made some real progress."

The gap between black and white mortality seems to be closing in recent years, but in absolute terms, African Americans, particularly in Louisiana, still have worse health outcomes overall compared with whites. They are more likely to die young. They are more likely to experience chronic disease. They are more likely to lack health insurance. They are dealing with infinitely complicated, pervasive, and longstanding problems, yet they've gotten lost in the conversations about struggling white communities in Pennsylvania and Ohio.

"I'm not that pleased with President Obama," Gene Allen, the African-American two-time former mayor of Ferriday, told me, "because this is one of the poorest regions in the nation. President Obama, [he's] never been in this area."

Allen was tired when I met him, and had a gray pallor. He was still recovering from a quintuple bypass surgery on his heart. But he wasn't thinking about his health that day. He wanted to talk about being left behind. "Trump said something that was very important: We never got nothing from the Democratic Party either," Allen told me.

Allen's major concerns were the poor economic prospects for his community and what he called the "plantation mentality," which he believes stops African Americans in Concordia from expecting much for themselves. The fixes for Concordia's stagnation, in his view, would be a strengthening of the social compact between Concordia and the government. "We need education here in these rural communities," he said. "Our school systems are poor."

What Allen didn't acknowledge is the difficulty of implementing social policies - more funding for early childhood education, a stronger social safety net, job retraining - in states with Republican governors who, like Jindal, believe in minimal government intervention.

He also didn't acknowledge that we're entering a period when the federal government is poised to further weaken the basic safety net.

"People [who voted for Trump] don't want [a strong safety net]," said Princeton economist Angus Deaton. "The safety net makes them really angry. And that's one of the things that makes the whole thing so hard to deal with."

The majority of Louisianans, and the majority of Southerners, voted for Trump, and Trump has made no secret of his belief in privatizing public goods, including prisons and health care. He has said he thinks privately-owned prisons "work a lot better" than public ones, and he's expected to expand them during his tenure. His pledge to gut Obamacare would take health insurance away from millions of Americans.

It would require a herculean effort - and real political will - to turn things around for Concordia. But it won't take much to ratchet up the suffering. Cutting Medicaid, inflaming longstanding racial tensions, throwing more young black men in prison - this would hurt people here. And if Trump runs the country in the manner many anticipate, the people in Concordia will be among his first victims.

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We visited one of America's sickest counties. We're afraid it's about to get worse.

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It's not easy to stay healthy when your home is surrounded by pools of feces. And that's only one of Barbara Thomas's health problems. I meet Thomas in the Washington Heights neighborhood, a patchwork of dusty streets surrounded by farmland, less than 5 miles from Ferriday, a small town in Concordia Parish, central Louisiana.

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Black Women’s Maternal Mortality Rate 3 Times Higher Than That Of White Women

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Cardiovascular Disease: due to lack of exercise, poor nutrition (not acessible due to cost), cigarette smoking and family history
Diabetes: Can be prevented with nutritional counseling. Also due to the non-accessibility to healthy affordable food.
Vitamin D Deficiency: Can be prevented by taking supplements.
HIV/AIDS: Can be prevented with mass education and outreach.
Cancer: Lung, breast, colon & prostate 35% more likely in African Americans. Prevention includes: annual physical exams, nutritional counseling and physicians being more open to listening.
Sickle cell anemia: 1 in 12 chances in African Americans. Life expectancy is 50 years of age.
Asthma: African Americans are more frequently hospitalized, 33% are children and parents who smoke out children at higher risk. Need smoke free and toxin free environment.
Hepatitis C: Leads to chronic liver disease and liver cancer.
Depression: High incidents of depression leads to suicide. Preventative measures are to discuss everything with physicians

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Minority Health Disparities | Michelle's Story

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Lack of good quality healthcare due to lack of finances.

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(Photo: Elvert Barnes/Flickr)

One of the prevailing views on the disparities between whites and blacks in terms of medical care and mortality is that people of color suffer from worse health outcomes solely due to a lack of financial resources. It is true that low education and socioeconomic status are often associated with worse health outcomes, and the correlation is quite high. Additionally, people of color are substantially more likely to reside in areas with low economic opportunity, and are also significantly more likely than their white counterparts to be in a position where they lack adequate health coverage and mental-health care.

However, this data has been used only to equate the disparities of struggle and poverty between varying ethnic groups. The resulting logic is that, by targeting income inequality, we can directly solve racism. But the large number of black Americans who don't struggle from economic inequality? They're facing worsened health outcomes too.

Income inequality is not the end-all-be-all of issues experienced by black Americans, yet is often implied to be the case. Believing black American struggles are solely rooted in financial security overlooks the effects that racism has on the physical and mental health of people of color in the United States. Centering the conversation around financial issues also ignores data that relates to the physical and mental health of black Americans with high economic and educational success.

The exact reasons for why educated black Americans with high earnings are still suffering from worsened outcomes aren't fully known, but researchers at Ohio State University are making significant progress in demystifying why. In a recently released study, they look at racial disparities in non-poor African Americans and Hispanics, and analyzed the effects that chronic and widespread discrimination and misinformation has on health outcomes.

"I've had this long-standing theory that members of underrepresented racial minorities would have fewer health returns from upward mobility," says study co-author Cynthia Colen, an associate professor at Ohio State University.

Colen also wanted to dispel the prevailing narrative that poverty is at the root of black Americans' experiences, in health care and beyond. "Upward mobility is certainly better than the alternative," she says, "but it doesn't make everything better-particularly health outcomes."

Colen used decades of research focused on the experiences of middle-class black Americans. According to her data, more money isn't enough to rid black Americans of higher rates of chronic disease or shorter life expectancy. Black women with a graduate education are still at higher risk for pre-term birth and infant and maternal mortality than white women with high school educations. Black women with a Ph.D. and high take-home pay are also more likely than white women who have only a high school diploma to die from birth-related complications.

That finding flies in the face of the assumption by many that racial health disparities are rooted in issues of education and wages. "[When] we talk about racial disparities in health our knee-jerk reaction is to say, 'It's due to exposure to poverty, or exposure to poor neighborhoods, or going to underperforming schools, or not having access to healthy food options,'" Colen says. "Much of the research that I've been doing is aimed at picking that apart. Even among these non-poor populations, you still see racial disparities."

A driving factor is that race uniquely affects life experiences. And for upwardly mobile black Americans, those effects can take a heavy toll on their physical and mental health.

Colen has two theories behind the worsened outcomes: First, that there are increased opportunities for exposure to discrimination that come with moving to mostly white schools or neighborhoods; and, second, that there are prolonged effects of stress from tokenism -that is, when an individual is expected to speak for their entire community. As black Americans climb the corporate ladder, they often find themselves more likely to be tokenized.

Kenesha (not her real name) experienced just that when her family moved to a prosperous yet very white neighborhood in a suburb of Atlanta, Georgia. She was often the only black woman anywhere she went. During those years, the family experienced a host of assumptions, unwarranted police stops, and, often, social exile. She says her workplace experiences were no better. Her interaction with co-workers ranged from being called the wrong name to invasions of personal space.

"At work, as one of three black women in the finance department, I was subject to my own micro-aggressions, like being called the name of the other black woman who worked in HR because our names 'sounded alike.' Yet, we looked nothing alike, nor did we work in the same department," she says.

Co-workers have also touched her natural hair, commenting that it didn't feel as they had expected.

Outside of the office, Kenesha was often assumed to be a teenage mother and received shocked reactions when others found she and her husband weren't struggling financially. Other experiences were much scarier-like the time a driver in a car emblazoned with a Confederate flag pulled up next to Kenesha at a red light to wave a smaller mini Confederate flag out the window at her. Kenesha had no choice but to sit there until the light turned green.

It wasn't long before Kenesha and her husband noticed how these experiences were starting to affect their children's social development.

"The thing that hurt the most was that those that were in our same socioeconomic class would be 'nice' on the outside, but we were still not accepted into their social group. Birthday party invites for our children weren't reciprocated, and no one but parents of other minority children would extend playdate invites," she says. "This was a big problem because our children were often the only black children in their class, [and] they weren't getting the same childhood experience as their white peers."

Ultimately, the family decided to leave the neighborhood to move to a location where they could raise their sons and develop social connections without fear.

Kenesha's story isn't a rare one.

Other upwardly mobile black Americans often report similar experiences.

Prolonged exposure to racism reduces comfort and feelings of safety, meaning adverse health outcomes are not solely tied to class. Yes, rising to the middle class or higher as a black person is difficult. But Colen's work invalidates the bootstrapping myth that brings up the harmful rhetoric behind African-American struggle. No amount of hard work and economic mobility can alleviate racism.

This type of data is vital to improving future health initiatives-by examining both the nuances in the disparities between race, and why those disparities exist, researchers can make demonstrable steps in addressing the root of these issues. It also reminds policymakers of the importance of tailoring projects to focus on the often overlooked black middle class.

"Too often what happens when we are designing these prevention programs and policies is we completely ignore the needs of non-poor racial and ethnic minorities," Colen says. "[These disparities] are not going to go away simply by anti-poverty campaigns."

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Even as Black Americans Get Richer, Their Health Outcomes Remain Poor

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One of the prevailing views on the disparities between whites and blacks in terms of medical care and mortality is that people of color suffer from worse health outcomes solely due to a lack of financial resources. It is true that low education and socioeconomic status are often associated with worse health outcomes, and the correlation is quite high.

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Distrust in healthcare.
Religious beliefs.

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by Lawrence Richardson

The Washington Post published an article about the increase in African Americans who now seek mental health treatment. This news is a welcomed and dramatic shift for many African Americans. For centuries, our ancestors were used as medical experiments, which made it impossible for the average Black person to trust that going to a doctor would be beneficial for their overall life.

And even after the advent of Black doctors, there are still the stories that are passed between generations that haunt family lines of grandmothers who were raped, babies who were never returned, and men who didn't have a say over which surgical procedures they received-all at the hands of white medical professionals.

For those who live in poorer or lesser evolved areas around the country, the reality of racism and the inability to access quality education still exists and makes it almost impossible for people to receive, or trust that they will receive, adequate medical care.

As an alternative to seeking professional medical care, many religious members of the Black community utilize the Black Church as a place to cultivate wellness. For these members, the role of the pastor is more than worship leader. Black pastors are trusted more than medical professionals and provide the care that therapists, counselors, life coaches, and spiritual directors would typically provide.
Here is a clip from the show, Black-ish where the elder of the family, Pop, shares his feelings about going to the doctor and how he has been self-medicating for 30 years to avoid going to the doctor.
Growing up in the Midwest, even I was told that going to a doctor was only for white people. I've been told the horror stories of family members who were abused, disrespected, and tortured. And of course these stories were never reported because we are conditioned to know that we won't be believed.

It's a new century, and there are many prominent medical professionals in all fields from all backgrounds who treat people fairly and who provide quality medical care that saves lives and inspires well-being. It's possible to live longer, healthier lives and no one has to suffer in silence or in isolation. How do we ensure that everyone has access to this kind of care?

Our mental and physical health greatly impacts our children and grandchildren; and how we care for ourselves influences future generations. American slaves became free and received no medical treatment for their trauma or the injuries they sustained while being held captive.

How did a life of violence, oppression, and untreated sicknesses shape Black culture and the generations of people who are now alive post slavery? How can we heal the wounds of people whose stories and experiences determine their overall health and their capacity to contribute to a meaningful, productive society?

About Lawrence Richardson

Rev. Lawrence T. Richardson is a United Church of Christ pastor, writer, and digital evangelist. He uses multiple online platforms to advocate for social justice, express relevant content, and communicate inspired information. When he is not blogging and ministering, Lawrence spends his time enjoying nature, practicing yoga, and being an active presence in both the Transgender and Progressive Christian communities. You can find Lawrence online at www.LTRichardson.com and on Twitter @Larry2_0 View all posts by Lawrence Richardson

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Why It's Difficult For Black People To Go To The Doctor | Lawrence Richardson

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by Lawrence Richardson The Washington Post published an article about the increase in African Americans who now seek mental health treatment. This news is a welcomed and dramatic shift for many African Americans. For centuries, our ancestors were used as medical experiments, which made it impossible for the average Black person to trust that going to a doctor would be beneficial for their overall life.

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Statistics

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Statistics

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Minorityhealth.hhs.gov

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Healthcare