Dr. Andre Churchwell, MD

Dr. Andre Churchwell, MD, speaks with patient Dennie Marshall at the Heart Institute on Thursday

February is Black History Month and American Heart Month. It’s a month dedicated to recognizing the impact of African Americans on America’s story and the importance of a healthy lifestyle that includes taking care of one’s heart.

Heart disease is the No. 1 cause of death nationally for black and white male and female adults and is a major national issue according to the Centers for Disease Control. 

According to Dr. Andre Churchwell, a Vanderbilt University Medical Center cardiologist who lives in Brentwood, it’s only been in the past 35 years that the medical profession has had evidence-based research concluding that African Americans have the same heart attack mortality figures as whites. In the past, the numbers were heavily skewed in favor of whites.

This progress is largely a result of the Heckler Report, a comprehensive, landmark paper that shed light on the health status of racial and ethnic minorities and disparities. 

The report, advanced by Margaret Heckler, secretary of the Department of Health and Human Services under President Ronald Reagan, laid the foundation for building health equity.

The first level was the creation of HHS’s Office of Minority Health in 1986, which became the “driving force for change” throughout HHS agencies and the health-care system by putting a focus on community initiatives to improve health equity and the drivers that affect the disparities.

“Margaret Heckler created the first body of (disparity) data,” Churchwell said. “It fueled a whole generation’s focus on health disparities. ... There was a thrust of disparity research.” 

According to the Office of Minority Health and Disparities Elimination, drivers of good health are varied and diverse. Physical activity, social and economic environments, access to quality health care, personal behavior, genetics, access to quality education and job opportunities and access to healthy food and safe recreational opportunities are key factors. Some drivers are based on choices, such as choosing to smoke, engaging in physical activity or in risky behavior, but choices are often influenced by other drivers, such as economics and accessibility to education and opportunity. 

Churchwell says that Heckler’s report highlighted the importance of quality of life and led to a deeper understanding of disparity for both poor white and urban blacks.

“A lot of things determine a person’s health before they get to the clinic,” he said, citing access to grocery stores with healthy food, proximity to health providers, access to safe parks and playgrounds, low crime rates, quality educational opportunities, well-paying job opportunities and support systems.

Williamson County is consistently “the healthiest county in the state of Tennessee,” according to VUMC’s Community Health Needs Assessment. It also consistently ranks among the top 10% of the nation’s healthiest counties. 

However, not all county residents enjoy the same prosperity and health advantages.

In 2017, Williamson County’s population was about 226,250, which is about 23.5% more than what it was in 2010. Within that population, 4.6% live below the federal poverty level and the rate of uninsured residents is 6%, According to the Census Bureau, in 2018 the population was 89.1% white, 4.8% Hispanic or Latino, 4.5% black, 4.4% Asian and 2% “other.”

According to the needs assessment, the top health concerns in the county are air pollution, drug and substance abuse, alcohol consumption, affordable housing and food insecurity. Other concerns include suicide, health education, obesity, mental health and access to transportation sectors of the population. 

 

General Health

 

Early in the past century, top causes of death were infectious diseases such as influenza, pneumonia and tuberculosis. Much has changed. In 2020, heart disease and cancer account for 45% of all deaths in Williamson County. The national average is 44.3%. 

Today, cancer is the leading cause of death in Williamson County for black and white populations. According to the report, deaths associated with prostate, breast and skin cancer are occurring at a much higher rate in Williamson County compared with the rest of Tennessee. More black women die from breast cancer than white women and lung cancer kills more blacks than whites.

According to Briana Gochett, who was working as a community health coordinator with the Office of Health Equity at Vanderbilt University Medical Center, heart disease, the second leading cause of death in the county, is generally declining, but as with many indicators, some racial and ethnic groups experience this condition at higher rates than others.

In Williamson County, African American populations have, by far, the highest rates of mortality from cardiovascular disease. And the heart disease death rate for blacks and whites is higher in Williamson County than that of the rest of Tennessee.

Other leading causes of adult deaths in Williamson County are Alzheimer’s disease, accidents, stroke, chronic lower respiratory disease, suicide, diabetes, influenza/pneumonia and kidney disease.

The infant mortality rate has dropped 95% in the past 100 years. In Williamson County, the infant mortality rate in 2017 was four per 1,000 births, which is significantly lower than the state and national rates. 

Birth defects and very low birth weights are the top causes of infant death. A disparity exists between black babies, who make up 20% of all births, and white babies. Black babies account for 33% of total infant deaths.

Nationally, teen birth rates have declined substantially since the 1990s. The largest rate decline is with black and Hispanic teens, however their rate is still higher than white teens. In Williamson County, the difference is pronounced. The birth rate for black teens in 2017 was 13.3 per 1,000. It was 1.1 per 1,000 for white teens.  

One driver in which the county doesn’t rank well is alcohol consumption. 

It’s well known that this county’s very social residents enjoy their wine and cocktails. Unfortunately, 17.2% drink excessively compared with 14.4% statewide and 18% nationally.

While we like our alcohol, Williamson Countians no longer enjoy the proverbial cigarette with their drink. Only 15.5% of the population smokes, which is lower than state and national rates.

However, according to the National African American Tobacco Prevention Network, while blacks tend to start smoking at an older age and smoke fewer cigarettes per day compared with white smokers, tobacco use is a major contributor to the three leading causes of death — heart disease, cancer and stroke — among the black population. The risk of diabetes, the fourth leading cause of death among African Americans, is 30-40% higher for black cigarette smokers than nonsmokers. 

Second-hand smoke results in greater cases of asthma and chronic breathing problems and other health issues for those exposed than in any other racial or ethnic group.

Also, compared with any other ethnic group, a higher percentage of African American smokers either want to quit and or are attempting to quit but have less success than the other groups.

Suicide is a leading cause of death in Williamson County, according to the CDCP. Suicide ideation and planning has decreased nationally for all races except black males and females, according to the Youth Risk Behavior Survey released in 2017. Attempts increased among black males and females and injury from suicide attempts increased among black males. 

According to the report Trends of Suicidal Behavior among High School Students in the United States, black teens may not be getting the mental health treatment they need or they may be dealing with racial discrimination or adverse childhood experiences.

Williamson County is in the top 10 percent of counties in the United States when it comes to access to primary care physicians, but when it comes to mental health care providers, the county falls short, with a 700:1 ratio.

It’s often said that where we are born, grow, live, work and play can determine future successes in many aspects, including health. According to the World Health Organization, these social determinants of health are mostly responsible for health inequities. In Williamson County, efforts continue to address inequities throughout the community. 

Carole Robinson may be contacted at crobinson@williamsonherald.com.

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