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Prevention is the best medicine.
While not all chronic diseases can be prevented, one of the best ways to stay healthy is to take preventive health care measures, and so doctors recommend that most Americans get several screenings from childhood into adulthood.
But for many Black Americans, accessing preventive health care isn’t just about making an appointment. It requires navigating a health care system rooted in racism, mistrust, and inequity — all of which make health care outcomes worse for Black folks compared to their white peers. Medical racism, experiments on Black bodies, and medical mistreatment have all contributed to a deep fear about health care settings — so much so that some Black Americans report feeling apprehension about going to the doctor.
Children and adolescents typically receive developmental screenings, routine vaccinations, and lead screenings. Adults are screened for different types of cancers, sexually transmitted infections, and diabetes, according to the U.S. Department of Health and Human Services.
Even when Black Americans do seek preventive health care, there is still a level of advocacy and education needed. So, we asked three experts how Black individuals and families can navigate the American health care system and get the preventive care they need — particularly around three health issues that impact Black folks most: sickle cell disease, adolescent mental health, and maternal and child health.
Sickle Cell Trait Screening
Sickle cell disease is a blood disorder that affects the shape and function of red blood cells. In the United States, it commonly affects people of African descent, Hispanic people from Central and South America, as well as people of Mediterranean descent, says Yvette Miller, executive medical officer at the American Red Cross. In the U.S., about 100,000 people live with sickle cell disease, and 90% are African American.
The blood disorder causes red blood cells to become rigid and shaped like the letter C. As a consequence, the sickled cells get stuck and block flow, which causes pain and infections. When a patient presents to the health care system with a pain crisis, Miller says, health care providers are not always fully aware of how to properly treat them.
“This lack of access to adequate health care is rooted in long-standing health disparities,” she says. “It can be related to having no insurance or being uninsured. And many health care facilities are not located in convenient locations for people in the Black community.”
The most common way to get screened for sickle cell trait is at a primary care physician’s office. Since 2006, all 50 states and the District of Columbia have mandatory sickle cell trait screening for newborns. And in 2021, the American Red Cross began offering screening to all blood donors who self-identify as multiracial and/or Black or African American.
Whether you know your sickle cell status or not, Miller offers some sobering advice.
“Have a list of trusted contacts that can support you when seeking health care and if you are incapacitated when admitted to hospital,” she says. “Be familiar with your care plan. At all times, carry information regarding your condition, including primary health care provider information.”
Adolescent Mental Health Screening
The American Academy of Pediatrics recommends pediatricians and family physicians screen children and youth for mental health conditions. About half of mental health conditions begin by age 14, and three-fourths begin by age 24. Mental health screenings allow for early identification and intervention, according to the National Alliance on Mental Illness.
The suicide rate among Black adolescents is increasing faster than that of other racial and ethnic groups. From 2007 to 2020, the suicide rate rose 144% among 10- to 17-year-olds who are Black, according to The Pew Charitable Trusts. And Black adolescents are less likely than their non-Black peers to receive mental health care.
Khadijah Booth Watkins, program director for the child and adolescent psychiatry residency program at Massachusetts General Hospital, says a lack of culturally competent mental health care is a barrier Black youth face.
“A challenge for a lot of people of color is wanting to see someone that looks like them, who can better understand their experience,” Booth Watkins says. “We often feel like we’re gonna have to go through all the explanations to catch them up to speed — that’s a barrier.”
In a National Survey of Children’s Health, within a five-year period, the rate of Black adolescent preventive health care visits dropped by 15%. In 2016, Black adolescents were on track to meet the country’s target of 82.6%. By 2021, the rate of preventive health care visits for Black adolescents, which includes mental health screenings, had the most significant drop compared to other racial and ethnic groups.
“The mental health system is really tough to navigate,” Booth Watkins says. Between low mental health literacy across the nation, the cost of health care, and insurance, Black folks face increased barriers to access.
But she says there are solutions.
More opportunities to access mental health education, Booth Watkins says, can help mitigate some of these literacy challenges. This can look like offering mental health education in schools, community centers, and places of worship. And primary care appointments are a gateway to mental health. It’s important to meet people where they already are.
“It’s also so important that we share our narratives and lived experience,” she says. “It will resonate and be more meaningful. That kind of advocacy through lived experience can be really powerful and empowering.”
Maternal and Child Health Screenings
“The maternal and child health population is the foundation of our society,” says Shokufeh Ramirez, associate director of the Tulane Center of Excellence in Maternal and Child Health at Tulane University. “It’s critically important to invest in the health of that population for the future of our society as a whole.”
The most common form of preventive maternal health care is regular prenatal care visits to check for gestational diabetes, hypertension, and birth defects. But Ramirez says it’s about so much more than birthing people getting access to prenatal care. Providers must consider the whole person and evaluate the health of a woman prior to pregnancy.
Some of the barriers Black women face when seeking maternal health care are access to quality care, structural racism, and individual biases that affect patient treatment. “That could include the misconception that Black people do not feel pain in the same way that other people do, so that treatment is withheld,” Ramirez says. And Black women are more likely to experience dismissal of their health care concerns.
A 2020 report found that when Black newborn babies are looked after by white doctors, they’re nearly three times more likely to die than when cared for by Black doctors. And a 2022 report by the U.S. Department of Health and Human Services revealed the infant mortality rate for Black Americans was 2.4 times the rate for white infants.
It’s clear that the ongoing infant and maternal mortality rates continue to harm Black birthing people. Ramirez says addressing preventive care access throughout pregnancy can lessen the harm. Medicaid expansion has also been associated with lower maternal mortality rates for Black mothers.
“We should not have to be in a health crisis before we can have our needs met,” she says. “We need to train our physicians and health care providers in a way that sets them up to treat people in an equitable way.”
