Why My Fight for Global Health Equity Hits Home: Understanding the Pervasiveness of Kidney Disease in the African-American Community
“She’s going to be fine, Jaimee.”
I remember my grandmother telling me those words as I watched my mother being rushed off into the emergency room. Just like with any hospital, chaos consumed the atmosphere. My brother, sister, grandmother, a few church members and I were running alongside my Mom while she lay on the stretcher. She looked so small. I saw the pain in her eyes as the nurses told us we could not go any further with her. I watched as they took her away from me, and I thought that was last time that I would see her again.
And when my grandmother whispered those words to me, I had already broke down, weeping, inconsolable on the hospital floor.
In 2010, my mother was diagnosed with kidney renal failure or end stage renal disease (ESRD). I was in my sophomore year at Temple University, and everything came to a screeching halt when I found out about my mother’s condition. Reflecting on the situation, it seemed as if it came out of nowhere and my family and I were completely ignorant of what was happening to her. Lo and behold, my family and I would learn about the various stages of kidney disease and failure and how it is one of the silent health epidemics in the African-American community.
According to the National Kidney Foundation, chronic kidney disease (CKD) or chronic renal disease (CRD) is a conditioned characterized by a gradual loss of kidney function over time. The kidneys are organs that are located in the upper abdominal area against the back muscles on both the left and right side of the body. The essential purpose of the kidneys are to remove excess fluid and waste from the body. When one has chronic kidney disease, the outcomes of the diagnosis include damages to the kidneys and the prevention of the elimination of wastes and toxins, which can build up in one’s bloodstream and make one feel very sick.
However, when kidney disease progresses it may eventually lead to end stage renal disease (ESRD), which requires dialysis — a life-support treatment that aids in removing toxins from the blood — or a kidney transplant to maintain life. There are two types of kidney dialysis, including hemodialysis, in which the blood is filtered using a dialyzer and dialysis machine; and peritoneal dialysis, which allows the blood to be filtered inside the body after the abdomen is filled with a special cleaning solution.
Though my mother is much better than she was five years ago, she still maintains a three-day a week hemodialysis regimen to survive; for other dialysis patients, it can be more. Reflecting on those days I used to drive my mom to and from dialysis, I remember noticing a significant trend in the patients at the treatment center and that they were disproportionately African-American.
According to the National Kidney Foundation, due to high rates of diabetes, high blood pressure and heart disease, Blacks and African-Americans have an increased risk of developing kidney failure. African-Americans suffer from kidney failure at a significantly higher rate than Caucasians — more than 3 times higher. Although African-Americans only represent 13% of the overall United States population, Blacks constitute more than 32% of all patients in the U.S. Diabetes is the leading cause of kidney failure in African-Americans; in fact, they are twice as likely to be diagnosed with diabetes as Caucasians. Approximately 4.9 million African Americans over 20 years of age are living with either diagnosed or undiagnosed diabetes and the most common diabetes in African-Americans is type 2 diabetes. Risk factors for type 2 diabetes include family history, impaired glucose tolerance, diabetes during pregnancy, hyper insulin and insulin resistance, obesity and physical inactivity.
With these staggering statistics, one can see that kidney disease is truly a health dilemma in the Black community (and when I say Black community, I am being inclusive of both African-Americans and Africans from the Diaspora who are in America). Although these outcomes are preventable, one must also dig deeper into the historical and contemporary racial disparities; the systematic implications of racial, social, economic and health inequities in the Black community; and the social and physical determinants of health that serve as catalysts to the pervasiveness of health issues within the Black community.
If social and physical determinants of health represent the social, economic, and physical conditions in which people are born, it is imperative that global and public health practitioners understand that the conditions in which people are reared and developed affect an array of health, functioning, and quality-of-life outcomes and risks. Examples of social and physical determinants of health include availability of resources to meet daily needs (e.g., safe housing and local food markets; access to educational, economic, and job opportunities; access to health care services; social norms and attitudes (e.g., discrimination, racism, and distrust of government); aesthetic elements (e.g., good lighting, trees and benches) and residential segregation/gentrification.
For the African-American community, the historical and contemporary social and physical health determinants have played a significant role in the disenfranchisement of African-Americans to access to healthcare and health equity. Although, yes, diabetes and kidney disease are preventable, it is important that global and public health specialists look at the full scope of social issues that affect the African-American community, in regards to the notions of health equity and also outside of it. In order for there to be a substantive paradigm shift for health equity in the African-American and African Diasporic communities, it is important that global and public health specialists educate themselves and others on these salient matters and address these issues head-on, or the health impact that we are trying to make will be futile.