As an African American pediatrician, I am acutely aware of the health
disparities that exist between populations in the United States.

I personally think that it is a major error to not address the legacies of
slavery and discrimination and their impact on the well being of a group.
The "here and now" is relative (slavery only ended a little over 140 years
ago in the US: the vestiges of institutional racism still exist in this
country).  There is also a legacy of suspicion in many African American
communities about medical advice (perhaps this is related to suspicion about
being guinea pigs a la the Tuskeegee Syphilis Project and several other
infamous medical studies).

Being sensitive is not enough; cultural competence encompasses seeking out
concrete information as well.

I am a breastfeeding advocate.  As important as breastfeeding is to the well
being of an infant, there are other important factors.  African American
infants also do not have the same access to health care as other groups.
Children living in poorer communities also have a disproportionate risk for
accidental injury, environmental related diseases (such as asthma).  The
"back to sleep" campaign to reduce SIDS has not been as well accepted in the
African American community.

I'd take exception to the comment African American moms are not concerned
about money and that formula is upscale (a big generalization).  Perhaps one
could consider how many of these moms have to return to school or work and do
not have the luxury of being stay at home moms.  Also there are many mixed
messages about breasts and their role, use of tobacco, drugs and alcohol in
African American communities as well.

African American communities in the US are not monolithic.  There is a lot of
variation in income, lifestyle, and choices made.  What may work well in one
region may fail miserably in another.

I believe one of the most important factors in making positive health changes
is having role models that look and talk like you.  Nice pamphlets and videos
only go so far.

Hoping that the path is widened with many more of my brothers and sisters,

Pierrette Mimi Poinsett, MD FAAP
Modesto CA

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