LOW INCOME LEVELS AND INEQUALITY OF OPPORTUNITY FOR SOME AFRICAN-AMERICANS CONTRIBUTE TO CONTINUING HIGHER INCIDENCE OF HEALTH PROBLEMS CHARLOTTESVILLE, Va., Feb. 1 -- While the health of black and white Virginians has steadily improved over the last three decades, many lower-income African-Americans still face a much higher incidence of health problems than the state population as a whole, research by a University of Virginia policy analyst shows. Gains in life expectancy for African-Americans have been dramatic, coinciding with gains in social equality and income opportunities. But in some cases the rate of chronic disease among black Virginians disturbingly remains more than twice that for the overall state population, said Paul L. Puryear, professor at the Weldon Cooper Center for Public Service. Income levels have risen strongly for many African-Americans, but low incomes for many others are closely related to poor health, Puryear said in a Cooper Center report that is the first in a series on the socioeconomic status of minorities in Virginia. Health care officials and the medical community need to mount stronger health-education efforts aimed at African-Americans, Puryear said. Proposed cuts in government services to low-income populations at both the state and federal levels could threaten gains in health, he said. And because the health gap is "directly linked to disparities in employment, income, education and housing," Puryear said, efforts to improve those areas -- "coupled with greater diligence in ending racial discrimination in the workplace" -- will improve health. Among Puryear's findings: ¥ The infant mortality rate, probably the most widely used indicator of health of a population, has remained consistently higher for nonwhite Virginians. And in addition to that disparity, since 1987 there has been an actual increase in the infant mortality rate for minorities. In 1960 the nonwhite infant mortality rate was 1.8 times greater than the white rate; by 1990 the nonwhite rate was 2.3 times greater. The mortality rate was 17.5 per 1,000 infants for nonwhites and 7.4 for white infants in 1990. The figures present one of the starkest examples of the quality of health among many poorer African-Americans in Virginia, Puryear said. ¥ In 1989, some 84 per cent of white mothers received prenatal care during the first trimester of pregnancy, but only 65 percent of nonwhite mothers received prenatal care this early. "Not only are nonwhite babies generally more prone to die, but they are more greatly affected by the delay in prenatal care," Puryear said. ¥ Mirroring national figures, nonwhite Virginians are twice as likely to have low birthweight babies as whites. In Virginia in 1990 about 12 percent of minority babies had a low birthweight. ¥ Although the rate at which life expectancy increased between 1960 and 1990 was greater for minorities, white Virginians on the whole can still expect to live about five years longer than nonwhites. The life-expectancy increase for nonwhite females has been especially striking, growing by 16.3 percent over the three-decade period, compared with a 7.8 percent increase for whites of both sexes. Minority males' rate of increase was 11.7 percent, also better than the rate for white males. Still, the consistently lower life-expectancy rates for nonwhites is a reflection of higher incidence of life-threatening illness among blacks, including heart disease, stroke, cancer, diabetes, hypertension, homicide and AIDS. ¥ The homicide rate for nonwhites has averaged 24.6 deaths per 100,000 population during the past 30 years, compared to an average of 4.8 for whites. Homicide rates have risen tragically for young African-American males. The homicide rate for 15-to-19 year-old minority males was 182 percent higher in 1990 than in 1960. Deaths from violent behavior are more than a problem for the criminal justice system; they are "a preventable health disorder" affected by psychological, environmental and lifestyle factors, Puryear said. ¥ African-Americans account for 19 percent of Virginia's population but 38 percent of all AIDS cases in the state. Further, over half of all cases known to have been transmitted by intravenous drug users were African-American. This suggests that the disproportionately high number of AIDs cases among blacks and Hispanics is more closely linked to drug usage than to homosexual relations, Puryear said. "The rapid upward trend of these cases among blacks suggests that the disease will continue to be a health problem of major proportions in Virginia and elsewhere," he said. "The income status of minority groups appears to be closely linked to disparities in health status," Puryear said. "The death rate for individuals below the poverty line is twice as high as it is for the general population. The incidence of diseases such as lung cancer increases as income levels decrease. Similarly the number of days spent in bed because of illness increases as income decreases." "The improvement of minority health can be viewed as part of a continuing effort to erase the stigma of racial inequality from American society." Examining population trends in Virginia, Puryear also pointed out that migration of African-Americans into Virginia has been increasing since 1970, reversing the historic pattern of the segregation era. Younger blacks, aged 15 to 44, have been particularly attracted to the state, as well as significant numbers of older blacks, many of whom may be returning to the South to retire after having lived elsewhere, he said. By 1990 the black population in Virginia was growing at a slightly faster rate than the white population. But in 1990 the black proportion of the total population, 18.8 percent, still had not reached its 1960 level of 20.5 percent. The proportion of both blacks and whites in Virginia has also been significantly affected by increases in other groups, Puryear noted. Asians represented about 2.5 percent of the total Virginia population in 1990, and a similar percentage identified themselves as being of Hispanic origin. During the next century, following national trends, minority groups will become an increasingly larger portion of the population in Virginia, Puryear said. ### January 31, 1995 For additional information or interviews Paul Puryear may be reached at (804) 982-5575 or 982-5522.