Health Issues for Minority AdolescentsBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7059.761 (Published 21 September 1996) Cite this as: BMJ 1996;313:761
- Surya Bhate
Ed Marjorie Kagawa-Singer, Phyllis A Katz, Dalmas A Taylor, Judith H M Vanderryn University of Nebraska Press, £32.95, pp 273 ISBN 0 8032 2732 9
The subject of adolescent health is complex and far reaching, and there is a lack of systematic data. I was therefore not surprised that the contributors to Health Issues for Minority Adolescents had difficulty in obtaining statistics to answer the questions raised by the book—what is health, and how can we design strategies to deal with the problems of adolescent health or ill health?
Poverty is an important factor. The book is based on findings in the United States, where 90% of persistently poor children are black and live in a household headed by a woman. Poverty contributes to whether the adolescent or his or her family have health insurance, leaving 30% of the poor or nearly poor without any insurance.
The history of black Americans in the United States is synonymous with disadvantage that continues to manifest itself in various ways. Black adolescents have high rates of homicide but on the positive side are less likely to commit suicide and also have lower rates of alcohol and drug misuse than their white contemporaries, though infant mortality is twice as likely as in white infants. Black youths have high serum cholesterol concentrations and blood pressure compared with whites. They have a much higher chance of being hospitalised than whites and are likely to receive less psychotherapy and more drug treatment. Another large group, Hispanics with ancestry from Latin America, seems to do as badly. Homicide and HIV infections rank somewhat higher in them than in whites, there is increased incidence of diabetes, and Hispanic youths are often more likely to be involved in fights; in the study reported, 20% of youths had carried a weapon to school during the previous month. The story of native American Indian adolescents' health is equally grim. They have a high incidence of injury or death in accidents, and suicide is the second leading cause of death. High rates of alcohol misuse, drug experimentation, and dropout from school occur in the context of deprivation and historical failure to recognise Indian cultural values.
The message is clear. Poverty affects the majority and minority alike, but minorities fare much worse. Adolescents from minorities fail to have access to existing health facilities and often underuse them. Multiple adversities faced by the family transform into serious risks to the adolescent. Lower social class equates with higher mortality and a higher crime rate. The age structure of immigrant populations is more youthful than the host population's, and the breakdown of traditional community links and support systems, combined with the effects of discrimination and deprivation, has a fundamental and negative influence on behaviour and health.
What should we do, faced with this situation? It is clear from the American experience that focused intervention and reliance on local initiatives constitute an important and successful element in whatever is done. No one strategy will provide an answer to adolescent problems, and a variety of different interventions that contribute to a partial solution might be our best hope yet.—SURYA BHATE, consultant forensic adolescent psychiatrist, Newcastle General Hospital