They were captured, marched to the coast, kept in pens, then chained in the holds of slave ships, often deprived of life’s basics: salt and water.
Many of them died.
Those who survived – the genetic ancestors of today’s African Americans – may have been the ones most able to conserve salt in their bodies, speculates Dr. Clarence Grim, a high blood pressure specialist at the Medical College of Wisconsin.
Today, in salt-rich America, the one-time advantage of what Grim calls this “unnatural selection” process has become a major disadvantage: a salt sensitivity that may partly account for American blacks’ dramatic tendency to develop high blood pressure.
Diet, as well as the stress of racism and poverty, may contribute as much, or more, than any controversial genetic factor. But the unarguable fact is that black men in America today are five times more likely to die from high blood pressure, or hypertension, than white men.
Among other things, this means they have more heart failure, more strokes and more severe kidney disease, says Dr. Rodman Starke, senior vice president for science and medicine at the American Heart Association.
But cardiovascular troubles are just one card in a deck that seems stubbornly stacked against black men’s survival. There is a lot that an individual can do to beat these unhealthy odds – but without that extra effort, they can be formidable indeed.
Black men, for instance, have more than their share of diabetes. They have a higher incidence of cancer than any other racial or ethnic group in America. Their risk of prostate cancer is particularly sobering: White men have a 1-in-11 lifetime risk; for black men, it’s 1-in-7, according to the American Cancer Society. That is the highest rate in the world, and nobody can explain why.
Violence and HIV infection, too, rob many black men of their shot at long life. Homicide is the leading cause of death for black men between 15 and 24 years old and the fourth leading cause for black men of all ages, according to the National Center for Health Statistics.
Murder isn’t even among the top 10 causes of death for white men, though suicide is. For black men of all ages, HIV infection is the third leading killer; for white men, it’s seventh.
But perhaps most telling is this: A male black born in 1995 had a life expectancy of only 65.2 years. A white male born that same year could expect to live 73.4 years.
“Black men have the lowest life expectancy,” laments Dr. Kenneth Edelin, who runs the Roxbury Comprehensive Community Health Center in Boston and is associate dean for student and minority affairs at the Boston University School of Medicine.
“Staying healthy is a lifelong endeavor,” he adds, and a lot of it “has to do with diet and exercise.”
But many of the better health habits that have benefitted other Americans have not yet caught on among black men, says Dr. Louis Sullivan, former US secretary of health and human services and now head of Morehouse School of Medicine in Atlanta.
“The fitness movement is really middle class,” says Sullivan. “It has not been as successful in reaching low-income people.” Nor has the message to eat a lower fat diet, quit smoking and drink less alcohol.
“Black men smoke more than white men,” says Sullivan, and they get “more lung cancer, more emphysema, more bronchitis.”
And men of all colors still shy away from doctors more than they probably should – and more than women do.
“Women are in general much more tuned in to their bodies and more willing to admit vulnerabilities,” says Dr. Harvey B. Simon, editor of Harvard Men’s Health Watch, a consumer newsletter.
“In my practice, men come in with lists made out by their wives,” says Simon, adding that in health matters, the similarities between black and white men are greater than the differences.
That was partially borne out in a survey released last week by Men’s Health magazine and CNN. About a third of all men, black and white, had not seen a doctor in the preceding 12 months.
But by oversampling black men, the pollsters from Opinion Research Group in Princeton, N.J. did discover differences between black and white men’s attitudes toward health.
Blacks, for instance, were far more likely than whites to cite cost and lack of trust as reasons for not seeing doctors.
“There’s a hesitancy on the part of African American males to establish an ongoing relationship with a health care provider,” notes Dr. Warren Jones, an active duty military physician who is also an official of the American Academy of Family Physicians who deals with issues affecting minorities.
Beyond that, he says, many black men have jobs that make it hard to take time off from work to get to a doctor’s office.
Granted, many doctors no longer think an annual physical exam is a must. But certain things – like checking your blood pressure and discussing with a doctor whether to be screened for prostate cancer – are important, says Dr. Harold Sox, chairman of the department of medicine at Dartmouth Medical School and president-elect of the American College of Physicians.
Prostate screening is dicey for all men, because screening can lead to more testing, which is often followed by surgery and radiation that can lead to impotence and incontinence.
But doctors who treat black men, like Dr. Mark Drews, medical director of the Whittier Street Neighborhood Health Center in Roxbury, often recommend screening because prostate cancer is such a huge risk. Drews takes “the view that if we’re saving some people’s lives, it’s worth it.”
So is trying to get young black men into the habit of taking care of their health – and seeing health care providers regularly, says Dr. John Rich, an internist at Boston Medical Center who started a clinic there for young men.
Many young men “don’t recognize to what extent stress can make their lives unpleasant,” he says. “The reasons for stress are legitimate and real – safety and economic issues. But one of the benefits of connecting with a primary care doctor is that there are ways of dealing with stress that can improve your life.”
Unlike much of the rest of the population, Rich says, young men often want to gain weight “to get bigger.” So he uses that urge to teach them about good diet, safe ways to lift weights and how to take care of their bodies.
One who has taken Rich’s philosophy to heart is Christopher Pierce, 26, who works with a group called Boston Health Crew at Boston Medical Center to teach young men about health.
“With young black men, there’s a tough guy attitude,” says Pierce, who hopes to go to medical school and follow Rich’s example. “We try to help before they . . .get shot.” Young black men, he adds, “don’t realize health is everything.”
For all black men, health advocates say, there is an important message that doesn’t always get through: Health counts, and there are clear ways to enhance it.
For older black men, this may mean getting regular blood pressure checks, and taking medications to keep high blood pressure under control. For younger men, it may be learning about safe sex and conflict resolution skills to avoid violence.
Whatever your age, says military physician Jones, the key is “to get together with people that love you – your spouse, your kids, your significant other – to put together a list of health care concerns and take that list to a doctor.”
How you can help yourself
Health advocates offer the following health tips for black men who want to take charge of their own health:
- For young men, consider a visit to the Young Men’s Health Clinic at Boston Medical Center, or call 617-534-5951. You can get free medical care if you need it, as well as advice on safe sex and substance abuse. Clinic workers also offer help on how to deal with violence, and tips on weight lifting, body building and healthy diets.
- For older men, get your blood pressure checked regularly. Many neighborhood health centers offer free or low-cost testing. You can also be checked at some workplaces or your doctor’s office.
- If you have high blood pressure, get it treated. There are lots of medications available; if one does not work for you or causes side effects, there are often other choices.
- If you’re over 40, talk with your doctor about prostate cancer screening.
- Limit salt intake to less than 2,000 milligrams a day, about three quarters of a teaspoon, especially if you have high blood pressure. Because 80 percent of salt intake is from prepared foods, read food labels carefully. A “Lunchables” snack, marketed for kids, is one of the most salt-rich products on the market, with almost 2,000 milligrams of salt.
- Exercise regularly – at least 30 minutes per session, three to five times a week.
- Limit intake of fats to less than 30 percent of calories.
- Eat five servings a day of fruits and vegetables. (Orange juice counts.)
- Find a doctor you like – whether you have insurance or are getting free care – and use that relationship to help deal with stresses in your life. Doctors can help you find ways – like meditation and counseling – to reduce stress.