Nurse-Researcher Guided by Principle: “If It’s Important, Then Something Should Be Happening”

Left to right): Henry N. Young,PhD, Merta Maaneb de Macedo, MPH, Diane C. Gooding, PhD, and Linda Denise Oakley, PhD, are co investigators on the African American Health & Education Research Project, funded by the Wisconsin Cardiovascular Health Program, the Southwest Health Education Center, and the UW-Madison School of Nursing and School of Pharmacy.

Linda Denise Oakley, PhD, RN, professor at UW-Madison School of Nursing, stood before listeners of the Bascom Hill Society and offered them a provocative perspective: “Two truisms have informed my thinking about African American health disparities,” spoke Oakley. “Number one: In the United States, health is wealth. Number two: When white America gets a cold, black America gets pneumonia.”

Using effectiveness of care received by the white population as the standard, Oakley presented a sobering incongruence in health care among racial ethnic groups: In the African American population, she posited, there are more lower extremity amputations associated with diabetes, more deaths per 100,000 for breast cancer, more hemodialysis complications with end-stage renal disease, more dialysis patients waiting for transplantation, less hospital care for heart attack, fewer children receiving recommended vaccines or dental care, higher rates of new AIDS cases, and fewer women receiving prenatal care.

As a nurse-researcher, Oakley confronts issues on health care disparities from the viewpoint of the social scientist. “The social scientist asks a different question,” Oakley states. “‘Why are health disparities persistent?’ and uses biological data to find potential sources of health disparities.”

Oakley, like other social scientists, focuses on biopsychosocial factors that determine one’s health. These factors include one’s genes; relatives, friends, and relationships; diet and physical activity; beliefs; patterns of work, play, rest, and sleep; home, neighbors, and community; and social competition using race.

Oakley points to research findings that reveal the existence of health disparities regardless of income or education level. The data suggest that social competition among races on issues of health care has spawned a new kind of group dominance. One potential outcome of social competition by race is racial stress.

A research theory supporting racial stress is explained in the concept of allostasis and allostatic load. The body perceives (e.g., helplessness, vigilance) and responds (e.g., flight, smoking, exercise) to challenges, via stress response. Stress response—the body’s capacity to respond to stress by adapting, that is, maintaining physiological stability in the midst of change—is allostatis. This wear and tear, or jousting of restless and active states in the body, over time can have adverse effects on the body’s various organ systems. This overexposure to stressors is allostatic load.

“African Americans experience persistent health disparities related to diabetes, the heart, and depression,” says Oakley. “Our study, the African American Health & Education Research Project, examines the impact of racial stress on diabetes and heart disease risk factors in the south Madison African American community.”

Oakley and project colleagues Diane Gooding, PhD, from the School of Psychology; Henry Young, PhD, from the School of Pharmacy; and Merta Maaneb de Macedo, MPH, began their study earlier this year, going into the south Madison African American community. Assisted by twenty-five UW-Madison students, Oakley and colleagues began gathering information from members of the South Madison Health and Family Center-Harambee, which provides community-based, culturally sensitive health and educational services for families and individuals.

The project began with a series of focus group interviews in January 2006. Health screenings were held in February and March; and health education classes were presented in March and May. Summer 2006 will be spent completing analyses of data and getting reports published. Contingent on findings, the study could support a more targeted project examining links between health disparities and racial stress. This, in turn, could produce a stress-coping tool built on health education.

“We remain convinced,” Oakley states, “that until we are willing to do something about health disparities other than count them, the only solution to African American health disparities is to reduce the health burden they create on communities so that communities can better withstand their circumstances as they must live them today.”