A Conversation With Herman TaylorMississippi's 'Heart Man'
Examines Links Between
Race and Disease
JACKSON, Miss. — When Dr. Herman A. Taylor Jr. goes for breakfast in this city of 180,000, he orders carefully: granola, fresh fruit. "People look at what I put on my tray," he said on a recent morning at the Broad Street Bakery, a local cafe. "They wonder if I practice what I preach."
Around Jackson, where a common breakfast can be eggs fried in lard, Dr. Taylor, a University of Mississippi cardiologist, is known as "heart man." He is the director of the Jackson Heart Study, the largest epidemiological investigation ever undertaken to discover the links between cardiovascular disease and race.
From now until 2014, Dr. Taylor and his team will be following 5,302 black residents of three Mississippi counties — Hinds, Rankin and Madison — observing their lives and how their heart health is related to their environment.
For the study's participants, there will be periodic medical examinations and referrals for care when problems are detected. The ultimate aim of the $54 million investigation, Dr. Taylor said, "is to gain the information we need to stop an epidemic of cardiovascular diseases within the African-American community."
Q. The Framingham Heart Study, which tracked cardiovascular disease in three generations of New Englanders, is thought to be the most productive investigation in public health history. With Framingham's research continuing, why do something similar here in Jackson?
A. Framingham can't tell us everything. You can probably count the number of blacks in the original study on one hand. Well, maybe two. It's no one's fault. When that study was first begun in 1948, the town of Framingham was mostly populated by second-generation immigrants and Yankees. That's just what it was.
But if there are unique risks and environmental agents triggering cardiovascular disease in African-Americans, Framingham's data can't be that helpful.
Q. Is there a special problem with heart disease in African-Americans?
A. For the nation as a whole, death from cardiovascular disease has declined since 1963. Yet, if you look at African-Americans in regions like Mississippi, mortality from heart disease is flat, or trending upward. This is particularly true for women. A middle-aged black woman in Mississippi will have four times the risk of death from cardiovascular disease than a white woman elsewhere in the country.
We have reasonable guesses why this is so. We think obesity is hugely important. We also think that smoking, inactivity, high blood pressure and access to health care figure into the problem, too. But we have to pin it down. We need more information on things like social support, anger, hostility, optimism. There may also be some unique buffers against stress within our community — like religion and extended family.
When you do a study like this, you want to figure out what's killing people. You enroll a large number and follow them. Over the years, some people will get sick; others won't. So the job is to try to determine the difference between those who got sick and those who didn't.
That's how Framingham worked.
Q. Why do a health study in Jackson?
A. What did the bank robber Willie Sutton answer when asked why he robbed banks? "Because that's where the money is!" Mississippi is where the heart disease is. We have the highest rates of it in the country.
Q. You've just finished collecting your base line data. Have you found anything interesting? A. Very high levels of obesity, higher than the national average. African- American women lead the way in obesity nationally, and our numbers here are significantly higher than that. The rates of diabetes and hypertension are quite high.
Interestingly, alcohol consumption among the women is much lower than average. There are some other findings, but we'll have to hold off on announcing them until they are published in professional journals.
Q. Are you looking at the unique stresses that African-Americans experience — racial discrimination, for instance?
A. We have questionnaires that zero in on discrimination. But we also look at the response, how you cope with it.
Also, a lot of the areas where blacks live are economically depressed. One of the things we're looking at is, What kind of access do you have to a healthy lifestyle?
Can you get out of there to walk, do exercise — or is the level of violence in your immediate surroundings so high that this would be a risky proposition? We look at how many grocery stores are in a certain area. Do you have to rely on the corner market with its jars of pickled eggs and pigs' feet on the counter?
Q. Is the traditional diet of Mississippi a problem related to heart disease?
A. Yes. In the traditional diet, the fat and calories are astronomical. They add up to our being the fattest state in the union. The soul food diet needs a lot of tweaking if it's ever to be remotely healthy.
There was a study of blacks and whites in a Georgia county in the 1960's. It showed that even given the traditional diet, blacks had a surprisingly low rate of coronary heart disease. The big difference: they were sharecroppers, people who did physical work. They didn't have nearly the access to bad things all day long that people have now.
The problem today for people living under stressful conditions is that harmful stuff is sometimes a cheap way to take a load off their lives and feel less stressed. I think that drives a lot of eating and smoking.
Q. Do you think that some people are going to hate your message of heart health?
A. Some will think we're further stigmatizing a group with a lot of problems already. But if you have conversations with African-Americans from the South, they already suspect that a lot of things they love are no good for them.
Q. Do you try to intervene in the lives of the people you're studying?
A. We're an observational study. But we have to be careful. If you don't share helpful information because you don't want to interfere with the natural history of their disease, then you're on a slippery slope. That was the rationale behind keeping information from the sick in the Tuskegee study.
People around here remember that. So, of course, we take an active role in spreading the word about prevention.
Also, when one of our medical exams shows something of clinical importance in a participant, we contact their physician. If they don't have one, we have a group of local doctors who've volunteered to take them on.
Q. Did you grow up in the South?
A. Near Birmingham. My mother was a teacher; my father a steelworker, active in his union.
During my childhood, I think there were two big influences, beyond my family: the incredibly heroic acts you saw from individuals like Martin Luther King, and the space program. I wanted to grow up and help my people. I also dreamed about science. For me personally, the wonderful thing about working on this study is that it's a way for me to do both.