There is an urgent health care crisis affecting America’s communities at a distressing rate. As health care providers, we must generate a course of action to address this emergency. No, this is not another article about the nursing shortage. What I am referring to is a health problem that people of color, particularly African Americans, American Indians, Hispanics and others, are developing at alarming rates.
Scientific journals, national reports and research studies all support the evidence that these minority groups have higher incidences of preventable chronic diseases than the majority population. As health care providers, we should ask ourselves why. Is it because of their diet, culture or socioeconomic status? Is it a result of stress, or is it just genetic? While these questions remain difficult to answer, there is one thing we do know for certain: Kidney disease is rampant in our nation’s minority communities.
My own awareness of the growing crisis of kidney disease in communities of color began about five years ago. As I drove about the city of Cleveland where I live, I kept noticing--no matter what side of town I was on--small corner buildings with the letters “CDC” on them. Not being too concerned or paying much attention, I surmised they were local branches of the Centers for Disease Control and Prevention. However, one thing kept puzzling me: The people who were going into and coming out of these buildings were mostly African Americans.
My curiosity got the best of me; as an inquisitive nurse, I decided to investigate. To my surprise, I discovered that these buildings were Community Dialysis Centers. This hit me like a ton of bricks. Till then, I had only really known one person who had suffered from kidney failure; she was a classmate of mine who had become sick as the result of chemotherapy medication, and that was 30 years ago.
I made a point of identifying just where those centers were located and how many were in my neighborhood. It turned out we had six, all less than 15 minutes from the center of town and each the same distance from each other. Now, that says a lot about the health of a community. These dialysis centers had popped up all over the neighborhood like Walgreens stores.
Today approximately 20 million Americans nationwide have kidney disease; of this group, more than 8 million have seriously reduced kidney function and 10 million have protein in their urine but are unaware of it.1 But what’s even more alarming is that kidney disease affects African Americans four times as often as the overall population. African Americans currently make up 12% of the U.S. population but account for 30% of persons with kidney failure. Furthermore, African-American men age 25 to 44 are 20 times more likely to develop kidney failure than Caucasian men in the same age group.2
Why the disparity? Is it due to lack of access to quality health care and screening, or the inability to afford care due to lack of insurance? One reason could very well be that African Americans--and males in particular--are hesitant about seeking health care. A recent study on patients’ trust of the medical establishment, conducted by researchers at the University of North Carolina-Chapel Hill, revealed that almost 80% of African Americans believe they could be used as “guinea pigs” for medical research without their consent, compared with 52% of whites.3
According to this study, African Americans’ “deep reservoir of mistrust” toward the medical system stems from the 1932-1972 Tuskegee syphilis study, in which researchers withheld treatment from nearly 400 African-American men with syphilis to observe the disease’s progression. It’s not surprising, then, that African-American men with kidney failure are more likely than white men (45% vs. 24.5%) to have late evaluation by a nephrologist, and in many cases do not know they have a problem until they need dialysis.4 Here is a population at high risk that can benefit from culturally sensitive providers.
Hypertension and diabetes, both of which affect minority populations disproportionately, are the two most common reasons for kidney failure. Diabetes is the number one cause of chronic kidney failure, accounting for approximately 44% of new cases in the United States each year. Uncontrolled or poorly controlled high blood pressure is a close second, responsible for about 35% of all chronic kidney failure cases.
Still another reason why the kidney disease epidemic is especially devastating in minority communities is that this is one of the costliest illnesses in the U.S. today. The average cost of dialysis can range anywhere between $45,000 to $50,000 per year alone. Medications for kidney transplant recipients who lack insurance coverage can cost about $11,000 per year.1, 2 Kidney and urinary tract diseases continue to be one of the major causes of work loss among employed men and women. Kidney problems result in more than 1 million physician visits and more than 300,000 hospitalizations in America each year.
As advocates of quality health care, minority nurses must be aware of the role we can play in heightening the understanding of kidney disease in our communities. This can best be done through our visible presence in the community, and through collaboration with national, state and local agencies that have launched initiatives that address these health disparities and are working toward producing positive health outcomes while diminishing the development of the disease. Not long ago, the focus of health care was on disease management or care management. Today the emphasis is on prevention.
As minority health providers we are uniquely positioned to affect change in our homes, our families and our communities simply by the very nature of our profession. Our loved ones, friends and community look to us for knowledgeable advice and guidance; they value our opinion and referrals. They consider us experts in our practices as we educate, consult, administer and nurture them back to health. They know that this is what nurses do. Ours is the voice they must hear.
Many of our family members and friends receive health care services from health professionals who are Caucasians. I do not mean to take anything away from them, because there are excellent practitioners in every culture. But when it comes to getting the message across about preventing diseases that disproportionately affect people of color, we as minority nurses are the ones who can be the most effective in producing positive health outcomes among our own communities. We have a responsibility to increase knowledge and awareness about the seriousness of kidney disease and the inherent risk factors to a population that is suffering unnecessarily.
Through strategic and innovative planning, we must deliver community outreach based on aggressive educational methods that will facilitate understanding about the risk factors that threaten people of color with high rates of morbidity and mortality. We can no longer take a back seat to personal involvement in the campaign to eradicate kidney disease, diabetes and hypertension.
The good news is that we don’t have to start from scratch. Many national organizations and government agencies have already developed innovative programs in an attempt to address these health issues--programs that nurses can tap into and implement in their own communities without having to reinvent the wheel.
One collaborative effort now underway is the National Kidney Disease Education Program (NKDEP), an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases (one of the National Institutes of Health). NKDEP has developed a pilot program that is currently being implemented by health professionals in four major cities--Atlanta, Baltimore, Cleveland and Jackson (Miss.)--in an effort to spread the message that preventing kidney failure can indeed be a reality in African-American communities.
Through community programs, public service announcements and education of primary care providers, the NKDEP seeks to raise awareness about the seriousness of kidney disease, the importance of testing those at high risk and the availability of treatment to prevent or slow kidney failure. To learn more about this program, and how you can use it to make a difference in your own community, visit www.nkdep.nih.gov.
As minority nurses, we have a great opportunity to influence our communities, but we must be at the table where decisions are made and policies are discussed. If we are truly to be the front line soldiers in the battle to eradicate preventable kidney diseases, we must develop a passion for the fight, roll up our sleeves and begin the work. Promoting prevention through healthy lifestyles and early detection is the key, and that begins with awareness. Who better to get it done than those in our profession?
1. National Kidney Foundation, 2003.
2. U.S. Renal Data System, 2003.
3. Corbie-Smith, Giselle, et al. “Distrust, Race, and Research.” Annals of Internal Medicine, November 25, 2002.
4. Kinchen, Kraig S., MD, MSc, et al. “The Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality.” Annals of Internal Medicine, September 17, 2002.