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After 250 years of social segregation and discrimination, current health data confirm that African Americans are the least healthy ethnic group in the USA. Although the resources and policies to eliminate disparities exist in the USA, there has been inadequate long-term commitment to successful strategies and to the funding necessary to achieve health equity. African Americans have not been in the fiscal nor political positions to assure the successful implementation of long-term efforts; the health of African Americans has not been a priority for decision makers.

Usually, the black community is not present when strategies and programs addressing their poor health status are designed and prioritized, and planners have limited understanding of the social mores and history of the African American community. The administration of health and social organizations serving black communities is rarely in the hands of those with this knowledge and commitment.

Current mortality disparities are evident in cardiovascular disease, cancer, diabetes, and infant mortality. These causes of death may be the most visible health problems for African Americans, but they do not tell the whole story. Mental illness is the second largest cause of morbidity in African Americans, and violence in the form of homicide is the greatest cause of preventable death. High levels of poverty, lack of education, and excess incarceration further compound the poor health status of African Americans.

The USA is in the midst of a surge in training health professionals, but, for many reasons, the institutions (HBCUs) created to educate African Americans have not made much impact on advancing the health of African Americans. African Americans are under-represented in all of the professions responsible for the provision of intimate physical, mental, and social care.

All health providers should be required to obtain regular training and refreshing in the provision of equitable care; this includes providers of color. Training of young people of color in the health professions should be viewed as an urgent national objective requiring the rebuilding of many of social development and community health programs of the past which have been virtually extinguished by lack of funds. Outreach to young people of color encouraging them to pursue health careers should be given a much higher priority. The role of HBCUs in the preparation of young populations for health careers must be strengthened.

It is evident that focusing on health risks alone is not conducive to redressing health disparities among African Americans, given that structural factors primarily underlie their poorer health outcomes and shorter lifespans. Tackling the social determinants of health, from poverty to the built environment, racial discrimination, violence, and incarceration, is likely to elicit greater effects on black health than risk reduction programs. Even though the ACA has expanded access to African Americans, medical care for people with unhealthy lifestyles and social and cultural barriers to access will have limited effects on reducing health disparities of African Americans in the USA.


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