Running head: RIsk paper

Population Risk Paper

Kelly DeBolt
Ferris State University

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Population Risk Paper

Saginaw County has many populations that are at risk for bias affects within the health
care system. Biases can affect the way health care professionals deliver quality care to their
patients. Patients from minority groups are often hit with bias opinions in the health care setting.
Minority groups can consist of ethnic groups, racial groups, gender groups or religious groups.
Minority groups within Saginaw, MI that are at the highest risk for health care bias would be
minorities within the racial group.
Racial Groups
Race is known as the racial and national origin of a sociocultural group (United States
Census Bureau, 2016). According to the United States Census Bureau, racial groups are defined
into five different categories: white, black or African American, American Indian or Alaska
Native, Asian, and Native Hawaiian or Other Pacific Islander (2016). African Americans consists
of 20 % of Saginaw County overall population. Whereas, Michigans overall average of African
Americans is only 15% of its total population (Michigan Department of Health and Human
Service, 2016).

Often times, within the health care profession, racial bias impacts the treatment patients
receive. Research suggest there is a higher level of bias impact from clinicians when the clinician
is taking care of an African Americans. This type of bias impacts the quality of patient-physician
communication and lowers how the patient will rate the quality of the medical encounter
(Willians, Wyatt, 2015, p. 555). Clinician who have these types of bias can put themselves at
risk for potential lawsuits and misdiagnosiss.

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Bias, Attitudes, and Stereotypes of African Americans

There are many different stereotypes, bias, and attitudes regarding African American that
have developed over many centuries. Racial groups have a unique challenge when it comes to
stereotypes, bias, and attitudes within the United States (US) due to the fact that the US culture
has ingrained negative believe about race. African Americans are often thought of as poor,
violent, religious, lazy, cheerful or dangerous (Willians, Wyatt, 2015, p. 555). You can see these
types of bias, attitudes, and stereotypes on television daily. Saginaw also reflect these types of
bias, attitudes, and stereotypes which results in poor health care treatment for this at risk
population. The health care setting in Saginaw, African Americans are often thought of as drug
seekers, gang members, and non-compliant patients. Scientific evidence indicates that conscious
and unconscious bias can contribute to social racial bias to create a pattern of racial/ethical
discrimination towards patients (Willians, Wyatt, 2015, p. 555).
Health care bias places African Americans at risk because this population has an earlier
onset of multiple illnesses, greater severity and increase risk for rapid progression of diseases,
higher level of comorbidity and impairment throughout life, and an increased risk for mortality
(Willians, Wyatt, 2015, p. 555). African Americans and racial biases contribute to lower quality
and intensity of care, therefore resulting in, increase racial disparities and increase in the severity
and course of the disease. Society racial bias also place African Americans at risk for mortality.
With these types of believes, health care for these patients is often hindered.

Demographics of African Americans

Racial bias among the African American population place them at risk because they are
usually lower income or live in poverty. The median household income for African American

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residents in Saginaw County is significantly lower than the median County household income. A
household income for African Americans is $25,259.00; where whites, Asians, and Hispanics
average $36,858.00 - $57,457.00 for a median household income (Saginaw County Department
of Public Health, 2014-2016, p. 9). Mean household income for African Americans within the
United States is estimated at $35,902.00 (DeNavas-Walt, Proctor, 2016, p. 6). This low mean
household income places African American at risk for a second bias due to their low income
status as well. Both of these factors place this population at greater risk for health care bias.
Some of concerns regarding lower income can relate back to times of segregation. Even though
segregation is illegal African American tend to reside in integrated neighborhoods. Often time
this leaves African Americans in geographical areas that are considered poverty. This type of
segregation can affect health care because of low-income housing or high crime neighborhoods.
This concept is can be seen with the Saginaw community.
Health Concerns with African Americans
African Americans in Saginaw are at an increased risk for chronic diseases. Heart Disease
and Cancer are to the leading causes of death related to African American in Saginaw (Saginaw
County Department of Public Health, 2014-2016). Infant mortality is also high health concern
among African Americans. In 2013 the state of Michigan had 13.4% infant deaths while Saginaw
had 14.3% in 2013. Saginaw has on been significantly above average, in relation to infant deaths,
since 1995 (Saginaw County Department of Public Health, 2014-2016, p. 8). This could be due
to the increased African American population within the community.
All of these diseases are affected by biases. Heart disease can be affected by biases
because often times peoples perception is that African Americans are eating fried chicken and
are lazy. A healthcare professional may think this bias is true and feel the patient will be non-

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compliant with diet changes or an exercise routine. Which could result in poor communication
between the patient and the health care professional. If an African American was diagnosed with
cancer a health care professionals bias opinion could be that his cancer was caused from poor
living condition when in fact it could be many different reasons. One study showed that African
Americans who were diagosised with non-small-cell lung cancer where only offered surgery as
an option 64.0 percent of the time, whereas white patients who were offered surgery 76.7 percent
of the time (Bach, P.B., Cramer, L.D., Warren, J.L., Begg, C.B. , 1999). This data proves that
health care professions can hinder that care of their patients when bias opinions are used when
health care professionals are developing treatment plans for patients.
Heart Disease in African Americans
Coronary heart disease (CHD) continues to be one of the leading causes of death among
African American. In 2007 at ages 35-84, US age-adjusted CHD death rates per 100,000 (95%
CI) were as follows: women European American (EA) 111 (110112), African American (AA)
171 (168174); men EA 238 (237239), AA 312 (307316) (Gillum, R.F., Mehari, A., Curry, B.,
Obisesan, T.O., 2012, p. 2). As you can see from this data African American have the higher
mortality rate for CHD when compared with European Americans. This increase could be
contributed to African Americans socioeconomic status. African American socioeconomic status
(SES) contributes to their increase in CHD because of their psychosocial, behavioral and
biological risk factor for coronary vascular disease (Subramanyam, M.A., Diez-Roux, A.V.,
Hickson, D.A., Sarpong, D.F., Sims, M. Taylor, H.A. Willias, D.R., Wyatt, S.B., 2012, p. 1146).
African American population is at risk for CHD due to risk factors such as obesity,
depression, hypertension, poorly controlled hypertension, increased heart rates, abdominal fat,
increased morning cortisol level, and metabolic syndrome (Subramanyam, M.A., Diez-Roux,

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A.V., Hickson, D.A., Sarpong, D.F., Sims, M. Taylor, H.A. Willias, D.R., Wyatt, S.B., 2012, p.
1147). An example of a situation where bias opinion could affect the care of a patient who has
CHD could be an African American patient who has poorly controlled hypertension.
Hypertension for most patients is fairly easy to control with diet and exercises. However, African
Americans are more likely to have uncontrolled hypertension due to their genetics. Health care
professionals who have a bias opinion towards African Americans may think this patient is noncompliant with their medication or diet. This assumption can cause frustration for the patient the
health care provider. The health care provider ultimately may not investigate further why the
patient is having uncontrolled hypertension which may result in increased health risk for this
patient.
Improving Health Care Delivery for African Americans
Nurses can add in improving health care for the African American population in two
major ways. First, by providing improved communication and being aware of any biases the
nurse or health care professional may have and secondly, by advocating for the patient.
Communication between patients and health care professional is vital to the patients health.
Nurses can assist with improved communication with African American patient by listening to
the concern the patient has and appropriately addressing them with the physician. Nurses need to
be aware of not only their own biases but also physician and patient biases. When nurses are
aware of these factors they can assist patients and physician in communication.
Secondly nurses can improve care amongst African American by advocating for them. If
a nurse is concerned about a physician bias opinion towards an African American, they should
address it with the physician. If the physician continues to not listen to the nurses concern she
should feel comfortable following the chain of command to advocate for what that patient may

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need. Often African Americans are not given options for testing that a white patient may be
given. If a nurse sees this type of behavior, they should again advocate for what that patient need
and question why a physician isnt order a test that may be need to help diagnosis something.
Conclusion
The African American population, as a prominent racial group within the Saginaw
community, is at risk for bias health care treatment. Clinicians and health care professions need
to be aware of how bias opinion can affect treatment for their patients. Also, being aware of way
to address and evaluate situation when they feel a bias opinion may be affecting a patients care.
All patients have a right to have appropriate, unbiased, and effective healthcare, including the
African American population.

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References

Bach, P.B., Cramer, L.D., Warren, J.L., Begg, C.B. . (1999). Racial differences in the treatment
of early-stage lung cancer. New England Journal of Medicine , 1198-1205.
DeNavas-Walt, Proctor. (2016, July 12). United Status Census. Retrieved from Income and
poverty in the United States:
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60252.pdf
Gillum, R.F., Mehari, A., Curry, B., Obisesan, T.O. (2012). Racial and geographic variation in
coronary heart disease mortality treads. BMC Public Health, 1-7. doi:10.1186/1471-245812-410
Michigan Department of Health and Human Service. (2016, July 11). Retrieved from Michigan
Population: http://www.mdch.state.mi.us/pha/osr/CHI/POP/PO14CO7.htm
Saginaw County Department of Public Health. (2014-2016, July 12). Retrieved from Saginaw
County Health Improvement Plan:
http://www.saginawpublichealth.org/pictures/file/Publications/CHIP/2014_CHIP_Final_4
.pdf
Subramanyam, M.A., Diez-Roux, A.V., Hickson, D.A., Sarpong, D.F., Sims, M. Taylor, H.A.
Willias, D.R., Wyatt, S.B. (2012). Subjective social status and psychosocial and
metabolic risk factors for cardiovasculat disease amond African Americans in the Jackson
Heart Study. Social Science & Medicine , 1146-1154.
United States Census Bureau. (2016, July 1). Retrieved from Race :
http://www.census.gov/topics/population/race/about.html

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Willians, Wyatt. (2015, August 11). Racial Bias in Health Care And Helaht Challenges and
Opportunities. Journal of American Medical Association, 555-556.