Black Americans are all too familiar with the impact of health disparities in America. Generational inequities, racism, and social injustice have led to barriers to care within health care system, placing many Black Americans at a disadvantage.
Injustice within the health care system can be traced back to the early 20th century. Black communities were the targets of nonconsensual studies and medical mistreatment – with noteworthy examples including the story of Henrietta Lacks, whose cancer cells were unknowingly biopsied for cervical cancer treatment by Johns Hopkins Hospital in the 1950s and are currently being used today to continue to advance medical research. This history has reverberated through generations and affected the perception of clinical health care for many Black communities.
This, combined with other implicit and explicit biases, as well as a lack of cultural competencies in health care, has compounded the barriers and challenges for Black Americans. According to one study by Pew Research, 56% of Black Americans said they’ve had at least one negative experience in their health care journey, including having to speak up to get the proper care and feeling as if they are being treated with less respect than other patients.
Additionally, due to structural and systemic economic barriers, Black Americans face a wide range of inequities that affect their Social Determinants of Health. This includes inequity in pay and generational wealth, home ownership, access to education, healthy food, and health insurance – all of which can negatively impact mental and physical health outcomes.
Health Disparities Black Americans Face
Let’s examine the specific health disparities faced by the Black community in more detail. Black Americans are at higher risk for a wide range of physical and mental illness compared to their White counterparts. According to the U.S. Office of Minority Health, Black Americans are at higher risk for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS.
Consider the following statistics. Black American adults are 60% more likely than non-Hispanic White adults to be diagnosed with diabetes by a physician. Heart disease is also a risk for the Black community, with twice as many Black Americans ages 18-49 suffering from heart disease than Whites in this age group. Additionally, 50% Black Americans ages 35-64 are 50% more likely to have high blood pressure than White Americans.
Black Americans also have a higher incidence rate of colorectal cancer, are more likely to be diagnosed at a later stage, and have lower survival rates than their White counterparts. And, when it comes to mental health, access and stigma are major issues.
The COVID-19 pandemic only magnified these disparities. Data from Johns Hopkins found that Black Americans are disproportionately affected by COVID-19, experiencing 2.6 times higher cases, 4.7 times higher hospitalization rates, and 2.1 times more deaths from coronavirus compared with White Americans – which researchers attribute to inconsistent access to health care and other factors related to social determinates of health.
Building Cultural Competency and Addressing Social Determinants of Health
Despite the challenges and inequities mentioned above, it is crucial to note the importance and history of resilience of the Black community – one study suggests substantial physical, mental, and collective resilience among Black Americans, concluding that understanding this resilience may help chart new pathways to understanding health in the face of adversity. And when it comes to social determinants of health, there are a wide range of positive trends which demonstrate this resilience. For example, a new study shows that Black women are now among the most educated group in the United States, and have been receiving degrees and enrolling in college at a higher rate for years compared to their white counterparts.
Cigna is committed to help build upon these positive trends and address social determinants of health at the root of negative health outcomes – in 2020, Cigna launched the Building Equity and Equality Program, a five-year initiative to expand and accelerate our efforts to support diversity, equity and inclusion for historically underrepresented communities. Through the program, Cigna invests in initiatives and partnerships to improve health outcomes, including access to education, job opportunities, and health care for the Black community.
Building cultural competency in health care is another key way Cigna is working to improve health outcomes for Black Americans. Cultural competency in health care is the ability to recognize and understand cultural distinctions, address biases, and adapt care delivery and services to meet unique social, cultural, and language needs. Cigna improves cultural competency by increasing awareness, outreach, and training for health care clinicians in areas of inequity.
For example, when it comes to diabetes care, health coaches and health care providers who offer a culturally appropriate treatment plan can help make long-term management of the disease easier for Black patients, which can improve treatment adherence and lead to better health outcomes. Black patients with diabetes are more likely to be trusting and receptive of treatment advice from a provider who understands and considers their culture and beliefs, lifestyle and circumstances, and issues and challenges they face.
Cigna created a specialized training course designed to help raise awareness of these needs among staff clinicians through cultural insights and potential solutions to help them address social barriers and improve diabetes management. These trainings can help increase providers’ level of confidence and help them feel more comfortable discussing a patient’s culture, background, dietary customs, and beliefs as they relate to diabetes management. Cigna also adapted the training course into an educational module and video series for network providers who want to enhance the cultural competency of their practice.
To further drive health equity in diabetes care, Cigna is also collaborating with Methodist Le Bonheur Healthcare in Memphis to help our most vulnerable customers living with diabetes. The program connects customers with diabetes directly with community health workers to build trust, as well as identify and address social and economic barriers.
Supporting Maternal Health in the Black Community
For Black women in particular, many experience devastating disparities in maternal and child health care. For example, according to the U.S. Centers for Disease Control and Prevention, Black women are three times more likely to die of pregnancy-related causes than White women, and the Black infant mortality rate is twice the rate for White infants. Disparities are also illustrated by the rate of preterm birth. In 2020, the rate of preterm births among Black women was nearly 50% higher than the rate for White or Hispanic women.
To support healthy pregnancies, Cigna launched a Maternity Health pilot in partnership with its pharmacy benefits management arm, Express Scripts, where all Cigna health plan customers receive free prenatal vitamins and aspirin to prevent preeclampsia, as determined by their doctor. Through this program, Cigna also works directly with expectant mothers to assess the risk for preterm birth and identify any challenges related to social determinants of health. For example, if mothers lack access to healthy foods, the program connects them with appropriate services.
“The U.S. has the highest maternal mortality rate among developed nations, and despite all that we spend on health care and all the advancements in medicine, our rates in maternal morbidity and mortality are actually going up,” said Dr. Neema Stephens, national medical director for health equity, in a previous interview with our Newsroom staff. “Cigna is committed to addressing the significant racial disparities in maternal care by implementing targeted interventions to individuals at highest risk and providing an additional layer of support by screening for social needs.”
Health Disparaties in the Black Community
Black Americans experience significant disparities with chronic conditions, access to care, and more.