Systemic issues require systemic solutions: Cardiovascular health outcomes disparities for Black men in the United States are because of social determinants of health
US medical research is based on finding solutions through observation methods that are described as objective. These methods do not cater to the nuanced experiences of many marginalized and underserved populations.
According to the United States Department of Health and Human Services, Office of Minority Health, African-American men are 30% more likely to die from heart disease than non-Hispanic white men.1 This difference is striking and a clear example of a racial health disparity harming Black men in the United States.
There have been calls to investigate the social determinants of health of Black men because healthcare researchers have found that when evaluating methods to eliminate health disparities, solutions have been based on corrections to health behavior rather than addressing socio-political and environmental barriers. 2 Compared to non-Hispanic white men, Black males have a worse life expectancy, infant health outcomes, death from disease-specific mortality, health insurance coverage, and access to medical facilities.3 What is the cause of health care outcome disparities for Black men? I argue that social determinants of health are the principal drivers of Black men's outcomes disparities in the US. Because of the lack of subjective view of human health in biomedicine, biomedical practitioners cannot treat socially stratifying factors that prevent Black men from receiving proper care. This is a systemic issue. Public health, health services, and biomedical researchers must all be concerned about this research topic in the future.
Biomedicine lacks a subjective view of health
Early influential medical anthropologist Byron Good argues that the dehumanizing tendencies of biomedicine are derived from the manner that emerging physicians are trained to view patients and define their condition.4 When physicians are trained, they must go to medical school and study tirelessly to ace exams and regurgitate information on a patient's physiology and potential outcomes. In biomedicine, physician burnout was considered to coincide with unprofessionalism,5 revealing how even in how they view themselves and peers, there is a culture of not acknowledging personal stressors and outside factors on health. Early critiques of biomedicine as dehumanizing were on a cultural care system in its earlier stages of success and development. Biomedicine is currently widespread and quantitatively oriented, emphasizing the importance of a view of physiology and outcomes more than the subjective circumstances of care that might influence those outcomes.
The subjective circumstances go beyond the view of disease physiology and course that early medical anthropologist Arthur Kleinman conceptualizes biomedicine analysis as “illness experience”. 6 Illness experience emphasizes what happens in the everyday life of an individual who has a disease from a broader societal perspective and their care networks. For Black men in America, their illness experience across conditions lacks assistance and aid. Biomedical practitioners are taught how to treat diseases through medical techniques, but cardiovascular medicine in nature develops longitudinally. This development is indicative of illness experience.
Black males are systemically oppressed in the United States
Biomedical practitioners view disease from an objective perspective based on physiology and observations, but illness experiences often can lead to the development of conditions like cardiovascular disease. Black men must overcome violence and prejudice that derives from their positioning in the United States. Segregation has a storied history in the United States. The lateness with which voting rights were obtained in this so-called democracy indicates the youth of this democratic system. Despite legal voting for Black men existing, the long-term ramifications of Jim Crown, segregation, slavery, and widespread violence have led to discrimination and poor results in systems such as higher education.7
Systemic oppression goes beyond healthcare, so systemic oppression affects health care outcomes because it impacts illness experience. Illness experiences are incredibly complex and burdensome for Black men in the US. The history of oppression in the US is a driver for a gloomy day-to-day life in education, incarceration, and access to opportunities.
Systemic oppression leads to health outcome disparity
In biomedicine, practitioners focus on individual care. In the current public health research landscape, there has been a focus on individual behavior to correct health disparities. In medical anthropology and other social sciences, many researchers apply for funding through sources like the National Science Foundation and the National Institute of Health. This indicates the attention to issues in biomedicine as an avenue for social science research to expand. However, even though social scientists are thinking of problems that they can investigate through attention to socio-cultural issues, their applications to funding sources often must be framed in methods and terms that biomedical researchers understand and value.
Because biomedicine does not value subjectivity, the solutions they seek out often must be under the confines inherent with biomedicine culturally. For Black men in America, the issues with biomedicine are systemic. Therefore, keys to aid in their ailing outcomes need to be solved through systemic change. Suppose research continues to target changing individual behavior rather than broader public health issues that address systemic racism and cultural barriers to care. In that case, these adverse outcomes will continue to persist for Black men in America.
Social determinants of health are an issue that leads to geographic problems where individuals who can escape environmental and geographically bound barriers to care choose to move. In contrast, many Black males are forced to suffer in a place that can often actively harm them. There should be a priority on implementing interventions that address public works and goods rather than individual behavior and action in public health research. For example, the illness experience of Black males in America involves escaping systemic oppression and systemic barrier that exacerbate cardiovascular disease and lead to worse outcomes. Simply changing individual behavior will not aid a population that must make specific changes in health behavior at far greater levels of adversity than other demographic groups.
One method implemented to understand social determinants of health and areas where they can be eliminated is evaluating opportunity within a region. Although it is challenging to create a measurement tool that is genuinely subjective when evaluating a group like Black men in America, this framework of thinking emphasizing systemic barrier is necessary to change the trajectory of adverse health outcomes.
-Michael D. Green
Population Health Science Department
Duke University School of Medicine
- US Department of Health and Human Services. Heart Disease and African Americans. Published 2021. Accessed June 4, 2021.
- Xanthos C, Treadwell HM, Holden KB. Social determinants of health among African–American men. Journal of Men's Health. 2010;7(1):11-19.
- Bond MJ, Herman AA. Lagging Life Expectancy for Black Men: A Public Health Imperative. Am J Public Health. 2016;106(7):1167-1169.
- Good B. How medicine constructs its objects. In: Medicine, rationality, and experinece.1994.
- Dyrbye LN, Massie FS, Eacker A, et al. Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. JAMA. 2010;304(11):1173-1180.
- Kleinman A. The Meaning of Symptoms and Disorders. In: The Illness Narratives: Suffering, Healing, and the Human Condition.1988.
- Mustaffa JB. Mapping violence, naming life: a history of anti-Black oppression in the higher education system. International Journal of Qualitative Studies in Education. 2017;30(8):711-727.