Editor’s Note: Karen D. Lincoln, PhD, MSW, MA, FGSA, is a professor, sociologist, social worker, and gerontologist who has dedicated much of her career to the study of aging Black Americans.
This interview was edited for length and clarity.
WebMD: What’s the best way to refer to Americans with African roots or identities in a medical context?
Lincoln: Black American is the more accurate and inclusive term to use, as it includes Caribbean Blacks, Africans, and Afro-Latinos who identify as Black. However, it’s important to note that when health statistics are reported, these reports rarely distinguish ethnic groups within the Black American population. I’m glad to see more people acknowledging that Blacks are not all the same. We are an ethnic group of Americans in which health patterns may differ between African Americans and Caribbeans, for example.
WebMD: What are the biggest health challenges for today’s aging Black population?
Lincoln: We know that some chronic health conditions like diabetes, hypertension, stroke, cardiovascular and kidney diseases are more prevalent among Black Americans than in Whites and other groups. The rate of obesity is highest among Black women, compared to any other groups in the U.S. Black women are also more likely to die from breast cancer than other women. We also have a higher risk and prevalence of Alzheimer’s disease and related dementias than White and Latino populations.
Black people tend to get unnecessary procedures such as amputations and hysterectomies when other options aren’t presented. But these conditions are often rooted in structural and systemic inequities that impact Black Americans’ access to healthy environments, health information, resources, and quality care.
WebMD: What is an area of health you’d love more aging Black Americans to think about?
Lincoln: It’s important for Black Americans to know about the vascular system and how it works together. I call it the “vascular choir.” Oftentimes, people (including doctors) will focus just on high blood pressure or stroke, or heart disease without helping patients understand how they all work together. Or, the conversation turns to treatment first instead of education. If you’re not treated for one condition, you are at risk for the others. We must look at conditions as a system of diseases that are connected.
WebMD: Do Black people receive a different standard of medical care because of their race or culture?
Lincoln: The short answer is yes. While there are always exceptions, there is a wealth of empirical evidence – meaning information based on rigorous scientific studies, and anecdotal evidence – meaning information based on personal observations and experiences, that Black Americans receive a different standard of care because of our race. Unequal treatment is based on racially biased beliefs that Black Americans are less deserving, less educated or aware, or are less concerned about our health.
Studies show that White doctors prefer White patients because they falsely believe that they are more intelligent than Black patients and more likely to follow their professional advice. There are also unfounded but widely held assumptions that Black Americans are genetically or biologically different from Whites. Unfortunately, these race-based myths have long influenced medical practice.
WebMD: What can someone do to advocate for themselves or a loved one who is Black?
Lincoln: I say speak up and demand a diagnosis or treatment. If something isn’t working for you, get a second opinion or consider changing doctors. There are reports from many highly credible researchers, including the National Academy of Sciences and the American Medical Association – the largest medical association in the U.S. – that nearly 60% of medical students and residents thought that Black Americans have thicker skin than Whites, and 12% thought that our nerve endings were less sensitive than those of White people. These very same students and residents were more likely to rate the pain of Black patients as less severe than that of otherwise identical White patients, and were less likely to recommend treating Black patients’ pain.
The American Medical Association concluded that the unequal treatment of pain is due to racist beliefs that Black Americans have a higher pain tolerance and the false notion that we are more likely than Whites to abuse drugs. As a consequence, Black patients receive less pain treatment. There are also race-based disparities in treatment for diabetes, heart disease, kidney disease, cancer, and many other health conditions.
WebMD: What can older Black adults do to improve their health?
Lincoln: First, there is work to do for the medical community to address the wide range of factors that could improve health equity. Black Americans have higher rates of chronic health conditions, are more likely to be diagnosed with and die from these conditions at earlier ages than Whites. So, we knew about the severe health vulnerabilities of many Black American children, adults, and older adults, compared to other racial and age groups.
At the individual level, it’s important to prevent the onset of the health conditions that are most prevalent in our communities. If you are diagnosed with a health condition for which there is treatment, it’s important to adhere to that treatment to the extent that you can. Exercise, good nutrition, good sleep hygiene, positive social interactions, and relationships are all important for our health. If you’re already exercising and you’re happy with your diet, great! Keep it up!
If you’d like to make some changes, I recommend that you start small. Change one thing. Walk for 10 minutes per day. Go to bed 15 minutes earlier. Drink one more glass of water. Eat an apple or berries. Carve out 2 minutes and breathe. An easy one is 444 – inhale to a count of four, hold for four, exhale for four. I’d also love older (and younger) Black Americans to think about healthy eating as really returning to our culture. In Africa, the diet is largely plant-based with little meat. Most foods are freshly grown. Our American soul food was based on the leftovers we were allowed to eat as enslaved people. True soul food is really food that’s good for you!
WebMD: There are reports that your ZIP code can impact your health and quality of life. How is this a factor for aging Black residents?
Lincoln: Those “seasoned” Black residents who age in place in communities that are under-resourced are a testament to their resourcefulness, and I applaud them. I also recognize that environmental and social conditions pose barriers to achieving optimal health for some Black Americans because of where we live and work.
But, we can’t allow those barriers to prevent us from taking our health into our own hands. If you don’t have a fitness center in your neighborhood, or it’s unaffordable or undesirable, then exercise at home. If you have access to YouTube, there are a ton of workout videos available – from short 10-minute workouts to longer ones that include low- and high-impact exercises. If you don’t have access to the internet or would rather go outside, go for a walk. If you don’t feel safe walking outside, walk in place inside of your home or at work. Ten minutes of exercise a day is better than no exercise. Small changes lead to bigger ones. Healthy habits develop over time.
WebMD: What are key areas of concern for the aging Black community with mental health?
Lincoln: Access to quality mental health services, proper diagnosis, and treatment have plagued our communities for decades. The COVID-19 pandemic took a huge toll on older Blacks. In addition to the severe losses that many suffered (including loss of a job, stability or a loved one), many have also suffered the loss of social connections.
For many Black older adults, who are less likely to have access to the internet, social distancing requirements impacted their ability to stay connected to family members, friends, neighbors, and their church family. Recently, the surgeon general identified loneliness and isolation as a public health crisis, yet this has been a challenge for older adults for decades. Loneliness and social isolation change our brains and are more harmful for our health than smoking 15 cigarettes per day. Social networks are also very protective against depression in this population.
I see a role for the Black church, as it has been an integral part of the Black community for centuries. It serves as more than an institution and is unique, as it doubles as a social service provider (food pantries, counseling, etc.) as well as an important place for social networks for older adults. The Black church has long existed to serve those on the margins.
WebMD: What’s something about older Black Americans that might surprise others?
Lincoln: First, older Black adults are sexually active. We don’t always want to talk about it, but they are. For this reason, it’s important we talk about HIV and STDs – especially because of how prevalent they are for older Black women. Second is something I’d say about Black people in general, and that is older Black Americans are not all the same. There are different opinions about the health care system. Older Black people from different parts of the country see things differently. There’s a lot to be learned about this diversity within the Black community and how these contribute to health variations.
WebMD: How can health providers better serve this community?
Lincoln: One of the most frequent complaints that I hear from Black Americans is that health care providers do not listen to them. This is also supported by empirical research and anecdotally from famous, affluent people like Serena Williams and previously lesser-known people like Dr. Susan Moore, who died from COVID because of racist treatment. Both claimed that their health providers did not listen to them. Serena Williams was able to save her own life because of her persistence and demand for adequate care. Sadly, Dr. Moore was discharged and died about 2 weeks later, but not before posting her complaints about her hospital treatment on social media. There are so many stories out there that we haven’t heard about.
WebMD: What’s your message to loved ones or caregivers of aging Black Americans?
Lincoln: Whether you identify as a “caregiver” or not, if you are providing unpaid care to someone who relies on you to meet their daily health and personal care needs, you are a caregiver. Please know that it’s very important to take care of your own health. If you are a dementia caregiver, it’s important to know that your health risk is much higher than someone caring for a loved one who does not have dementia.
Caregiving takes a village. Ask for help. If you don’t have family, friends, or neighbors who are available to help, there are caregiver resources available through local senior centers or the Department of Aging. The services can include education and support groups, help with running errands, bathing, and cooking for your loved one, light housework, and simply sitting with your loved one. When we are raising our babies, we need help and breaks. The same is true when we are taking care of our older loved ones. We often see elder abuse because the stress on caregivers is so high. It can also be hard to watch our loved ones age. We sometimes hold onto who they were. Find those moments to embrace whom they are becoming.
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