An expert discusses why.

Story by Steven Petrow

Black men face many more health hurdles.

Social epidemiologist Roland Thorpe Jr. is on a double mission: to improve the health and extend the life expectancy of Black men, and to do the same for himself since both of his grandfathers died prematurely from heart disease.

An expert in minority aging and men’s health, Thorpe is the principal investigator of the Black Men’s Health Project — a partnership of Johns Hopkins Bloomberg School of Public Health, Tulane School of Public Health and Tropical Medicine, and Michigan State University — created to call attention to the health crisis of Black men.

“Black men are hidden in plain sight,” Thorpe says. “I mean, we have the worst health profile. We have premature mortality, which means we die before the overwhelming majority of men do. We’re often in the media either being attacked by the police, or enduring other experiences from structural racism. There’s very little support that’s been given. The evidence is all in front of us, but there seems to be no particular people calling it out or moving to drive toward solutions.”

“Black men are hidden in plain sight,” social epidemiologist Roland Thorpe Jr. says. “I mean, we have the worst health profile. We have premature mortality, which means we die before the overwhelming majority of men do.”© Johns Hopkins Bloomberg School of Public Health

For instance, he says, when it comes to heart disease, Black men are 30 percent more likely to die than White men; for stroke, it’s 60 percent. And they are 75 percent less likely to have health insurance than White men. But numbers don’t tell the full story. Thorpe recently sat down with The Washington Post for an interview. The conversation has been edited for length and clarity.

Q: You’ve spoken openly and personally about the fact that both of your grandfathers died of heart disease in their 60s. What’s the message embedded there?

A: A majority of Black men don’t get preventive care. They should establish a [relationship with] a primary care physician. Neither of my grandfathers were engaged in the health-care system. At the time they were coming through, they were pretty familiar with the public health service syphilis study at Tuskegee, and so I could probably understand why they didn’t go to doctors.

[That notorious study was conducted by the U.S. Public Health Service starting in the 1930s and involved hundreds of Black men who were not informed about their disease and never offered any treatment, even after penicillin had become the drug of choice for syphilis in the early 1940s. After revelations about it, the study was canceled in 1972.]

Q: That study is infamous. Are things better now?

A: I think we’ve come a long way since then because there’s been some improvement within the health-care system in engaging Black men, like listening to them when they say they have concerns, and then engaging them in some shared decision-making about their health and health care. But we still have a ways to go.

Q: Are you referring to the still significant discrepancy between the average life expectancy for a Black man versus a White man?

A: Do I think we’ve gotten better and improved? I don’t think so. Prior to covid, we’ve extended life for Black men, absolutely. But on the flip side, [life expectancy for] everybody else is extended also. That means the gap hasn’t narrowed. Since covid, life expectancy for everyone has decreased, with Black people experiencing a reduction twice as large as Whites.

Q: What other challenges do Black men face when it comes to their health?

A: A large part of that discrepancy is based on structural racism that Black men experience across all levels of socioeconomic status. Stress is one of the prominent pathways by which structural racism affects health. These accumulations of stress impact different physiologic systems that then lead to earlier onset of chronic conditions like hypertension and heart disease, which then contribute to our life expectancy being much shorter than White men.

Q: Police violence is also considered an aspect of structural racism. You’ve suggested previously that the police killings of Black men impact the health and well-being of other Black men.

A: Police brutality also contributes to the problem, and that’s linked to structural racism. I’m thinking about Rodney King, and the most prominent one recently was George Floyd. There have been others, as well. Just to see another Black man die on TV, that’s very traumatic, and many [White] people don’t think of the trauma that Black men have endured, to have to even watch that. Black men have one of the most horrific health profiles, and we have few resources available to us to improve that, like dealing with that trauma.

Q: Do you mean witnessing these murders on TV increases Black men’s stress, leading to other health issues? Or that it increases Black people’s distrust of institutions in general, including medical institutions?

A: Both.

Q: How do you hope that the Black Men’s Health Project will help?

A: Our goal is to create awareness of Black men’s health, and the social and historical issues that Black men have faced that could possibly impact their health. One of the key things for us is to create a Black men’s health survey, to create a cohort to better understand their health trajectory. There is currently no study that focuses uniquely on the specific needs of Black men.

Q: When it comes to mental health issues, what disparities exist by race?

A: There are disparities by race, as it relates to mental health. But the disparity is a little trickier because Black men still fare worse because there’s [more of] a stigma associated with Black men saying they have mental problems. Typically, when Black men do go to the health-care system, and they try to express themselves, they feel like they’re not heard by their health-care providers.

Q: What can Black men, and those who love them, do now to try to improve their health?

A: If they don’t have a primary care physician, go establish one. That’s my number one thing, and then to understand what your basic numbers are. What is your blood pressure? What is your weight? And what is your height? What is your hemoglobin A1C? What are your cholesterol levels? Understanding these numbers is very important.

Then engage in preventive care practices. Get your PSA checked [a marker for prostate cancer]. When Black men do get diagnosed with prostate cancer, they are at more progressed stages than White men. That limits our treatment options. If we’d been in the preventive care system, some of this would’ve been picked up earlier, and we would have had an opportunity to have additional treatment options. As you might imagine, the chances of survival are higher.

And know your family history. Is there a family history of diabetes, prostate cancer, breast cancer or hypertension? Knowing that information is very helpful and sharing it with your physician helps them, too.

Q: Let me get personal for a moment. How has your family history — again, both of your grandfathers died of heart disease — impacted how you take care of yourself?

A: My father also passed six years ago of uncontrolled hypertension that led to a stroke. I don’t want to be in that same situation. I have a primary care physician and I go to my appointments. Also I have a dentist, podiatrist, audiologist and optometrist. I share my family history with all of them. Those three men dying has really had an impression on me and me engaging in the health-care system. If my fingernail hurts a lot, I’ll go to the doctor.

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