- Cincinnati's 10 neighborhoods with highest hypertension rates are all majority Black.
- Neighborhoods such as Bond Hill and College Hill don't have a dedicated grocery store.
- Abundance of fried food options in certain neighborhoods align with health outcomes.
Jacque Edmerson walked through a sea of produce at the Kroger Marketplace on Marburg Avenue in Oakley, astonished at the selection on display in front of her.
"Look at this," she said to friend Andreya Williams, pointing out the number of vegetables available for purchase at the 145,000-square-foot grocery store, which is the nation's largest Kroger. "Look at all these salads."
Edmerson regularly does her grocery shopping in Oakley and she works out just down the street at Crunch Fitness. Her home however is in Bond Hill. Were she to only shop for groceries locally, her produce options would be limited to what's available at a few corner markets, a Walgreen's Pharmacy and a select few gas stations. A Save-A-Lot grocery store is located nearby in Roselawn and local gym options include the Bond Hill Recreation Center.
That, she says, is an issue.
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It's a stark contrast to Oakley, which has grocery options at Kroger, Meijer, and Target all within a mile radius. For workout options, an Esporta Fitness, Orangetheory Fitness, Planet Fitness and Crunch Fitness are all separated by a short walking distance.
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When comparing the two neighborhoods, the difference in health outcomes is even more striking. Bond Hill, a neighborhood that is 86% Black, ranks second among Cincinnati neighborhoods for the highest adult percentage of hypertension, according to an Enquirer analysis of U.S. Centers for Disease Control and Prevention data. Oakley, a neighborhood that is 81% white, meanwhile, ranks near the bottom at 38th.
The racial health gap between the two neighborhoods isn't an outlier either. In Cincinnati, the 10 neighborhoods with the highest percentage of adults who have high blood pressure all have Black-majority populations, the analysis found. Unlike other health disparities that align with poverty, the 10 poorest neighborhoods in Cincinnati don't have the highest blood pressure rates. Conversely, the 10 neighborhoods with the lowest rates of blood pressure all have white-majority populations. The gap between Roselawn, the neighborhood that ranks highest for the percentage of adult high blood pressure in Cincinnati (50.5%) and the neighborhood with the lowest (Clifton Heights, University Heights and Fairview) is more than 32 percentage points.
Those numbers are not a coincidence, Edmerson contends.
"It absolutely has a lot to do with the lack of access to a major food chain like Kroger and Meijer," Edmerson, who is president of the Bond Hill Community Council, said while speaking about food options for Bond Hill residents. "There's a Kroger in Norwood but if you have to catch a bus to go there or have to walk there, that can be a disincentive for our population. We have a number of people who are elderly here in Bond Hill."
The Queen City falls above the national average for hypertension and heart disease, which is the No. 1 cause of death in both the Cincinnati region and in the U.S.
Lifestyle factors such as diet, exercise, sleep and smoking can put an individual at risk for high blood pressure. But other external factors ‒ such as location, access to care and food deserts ‒ can also become major risk factors, according to more than a dozen health experts interviewed by The Enquirer.
Food deserts, environmental factors and racial inequities
Though the disparities surrounding hypertension may seem extreme in Cincinnati, they actually exist nationwide. High blood pressure or hypertension, affects nearly half of adults in the United States, according to the CDC, and the condition is more common in non-Hispanic Black adults than any other demographic. It also affects men more than women.
Hypertension is a blood pressure that rises above what doctors consider to be normal, typically a systolic blood pressure of 130 or higher and a diastolic pressure of 80 or higher. When blood pressure is raised above those numbers, it can cause problems in the body, particularly within the cardiovascular system.
Health experts agree that a major contributor to high blood pressure is the consumption of foods that are high in salt and sodium. That can present challenges to residents of neighborhoods such as Bond Hill where access to produce is limited and options for alcohol, tobacco and fried foods are abundant. Smoking also causes an acute rise in blood pressure according to multiple studies that have traced the association between the two. And in Cincinnati, a racial inequity exists for smoking habits as well.
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"You can go to any corner store, gas station (in Bond Hill), their biggest sellers are cigarettes and alcohol," Edmerson said. "It's almost like they're marketing that to our community. Both of those will cause hypertension."
The community is also still reeling from closure of a Kroger located on Seymour Avenue, where the current Save-A-Lot sits today in a portion of the building.
Though the address is located in Roselawn, the Kroger served both communities and presented a reliable option for healthy foods to locals. When Kroger left in 2010, protesters stood outside of the grocery store with a coffin and a sign that read "injustice must be buried." The protesters claimed the removal of Kroger in a majority Black area was a racial injustice. Kroger, meanwhile, cited massive revenue losses at the Roselawn location as the reason for its closure.
Either way, the community has been harmed ever since, Edmerson said.
"I see it as a racial issue because why would you think that that's OK for a whole community," she said. "With the number of people that we have residing in Bond Hill, why is it OK for us not to have a major food chain?"
Those environmental factors, such as where the nearest grocery store is located, can lead to stress. And stress leads to raised blood pressure, according to Renee Mahaffey Harris, president and chief executive officer of Cincinnati's Center for Closing the Health Gap.
"It's primarily lifestyle," she said. "The prevention of disease has to do with how you're able to manage your lifestyle. If you have limited access to healthy foods, if the environment in which you live isn't as walkable or there are disproportionate levels of economic disparity. It's holistic."
"Your blood pressure is an indicator of both your physical and mental condition," she added. "There's a strong correlation between your stress and your rate of blood pressure."
Though thankful that they do have a Save-A-Lot nearby, Edmerson and the Bond Hill Community Council have been advocating for more healthy food options locally, and Williams, who serves as the youth chair of the council, has been working to educate young kids on healthy food. The council recently started a garden where it hopes to increase the amount of fresh foods available to the public, and a market owned by the Community Economic Advancement Initiative is expected to open soon on California Avenue.
Then there are attempts by health organizations to intervene.
Since moving its headquarters into Bond Hill in 2015, Bon Secours Mercy Health has vocalized a mission to improve health outcomes locally. Dr. Kent Robinson, a primary care doctor with Mercy, has hosted a number of health initiatives aimed at improving awareness about regular screenings. Mercy has partnered with a number churches and recreation centers in an attempt to reach more community members.
But the mission doesn't end at outreach. And that's what can become so challenging sometimes, Robinson said.
"One of the most important things is follow up," the doctor said. "We can do a blood pressure screening, we can check blood sugar, we can check the cholesterol as a one-time shot and we can tell the person what they need to do, but unless you have the consistency of follow up, sometimes those people won't follow up, you miss a great opportunity."
Reaching more people in more of Cincinnati's communities
Kendall Jones had been thinking about his health for a number of years. Then the pandemic happened. Like many others, a period of self-reflection kickstarted him into action.
"I've just been wanting to get back to working out and staying healthy," Jones, a landscaper said. "It was kind of a wake-up call, like 'I need to be healthier.'"
Though he's maintained good health overall, Jones, a 30-year-old Black man, is aware of some of the racial health inequities that exist and has begun to think about the future. Wanting to get out in front of his wellness, Jones and dozens of others, trekked to Walnut Hills in September, where the first local African American Male Wellness Walk took place at Bush Community Center.
At the event, a 5K run and walk, attendees received free health screenings that monitored blood sugar and blood pressure and eye exams. They were also able to coordinate with health organizations about health care options.
"I was just curious," Jones said of the event, adding that he's been running and exercising more as of late. "I'm just trying to stay ahead of the game and be more mindful of it."
The event drew a wide range of people who were interested in screenings for various reasons. Terrance Mason, 50, who has had high blood pressure and high cholesterol for six years, attended the event. He takes medication for both conditions and has regular screenings with his doctor. But the event was an opportunity for one more screening.
"You can never have too many of these," he said of blood pressure check-ups.
That same reason compelled 72-year-old Purcell Davis Jr., who also takes medication for high blood pressure, to add one more screening to his preventative schedule. Davis survived colon cancer and takes many health precautions, such as maintaining a healthy diet, exercising regularly, and staying consistent with his check-ups at the doctor's office.
"It's just a matter of getting up every morning, taking your pill and going about your business, and you'll be OK," Davis said.
Attempts to reach more people, particularly within the Black community, about the risks of high blood pressure and to encourage regular health screenings, have mostly been fruitful around the country. A barbershop initiative in Los Angeles reduced blood pressure in 64% of the more than 300 African American men who were recruited for the study. Similar initiatives in Toledo, Cleveland and nationwide have started in the past few years with success connecting previously unaware individuals to care.
While there's data that shows successes of health initiatives where organizations attempt to meet communities where they are, another issue exists that Dr. Kim Williams, a national renowned cardiologist and health equity expert, says continues to explain some of the mistrust between Black men and the medical community.
"We have a dearth of African American male physicians," said Williams, who is the chair of the medicine department at the University of Louisville. "The research is very clear. It's very unfortunate but very clear. African American men generally do not follow the recommendations of their doctors and dramatically increase adherence to recommendations if it's given to them by an African American male physician. It really is about structural racism and history. When you look at the Tuskegee experiment that everybody remembers, that's a blight that it may take another 50 years to try to remove the impact of that."
While those remnants remain, Edmerson wants to bring attention to all of the lifestyle factors that are contributing to health disparities in the Black community. She hopes to start by reinforcing that they shouldn't be normalized.
"I hear from people that this 'is just the way it is'," she said "but people don't see that that's not appropriate."
