Black Death, White Death

Abstract

fall 2005 contexts 43 black death, white death trends deborah carr During the 20th century, scientists, physicians, and the public health community drastically reduced mortality rates, with an accompanying increase in life expectancy. Most men and women today can expect to live well into their 70s and 80s, whereas the 50th birthday celebration was a cherished and rare milestone at the turn of the 20th century. These dramatic gains are largely due to improved sanitation, better medical care, and increased use of preventive health services. Yet not all Americans reap these rewards. Blacks die younger than whites, and the racial gap in mortality has barely budged over the past half-century. According to the National Center for Health Statistics, white women outlive black women by roughly five years, with life expectancies at birth of 80.3 and 75.6 years. For men, the gap is even more pronounced; in 2002, white men's life expectancy at birth was 75.1, compared to just 68.8 years for black men (see figure). An even bleaker picture emerges from standardized mortality ratios rather than life-expectancy statistics. A recent study by former U.S. Surgeon General David Satcher found that the racial gap in mortality had actually increased during the last four decades for infants and for men ages 35 and older. Experts fear that health disparities may be more difficult to change than other inequalities. While African-American earnings , assets, and educational attainment increased steadily over the last half of the 20th century (see "Just the Numbers," this issue), the racial gap in health and mortality remains. The widening gap for adult men may be partly due to a spike in gun-related homicides among black men starting in the mid-1980s and peaking in the mid-1990s. A racial gap in HIV infection has also contributed to black mortality. But the main culprit, according to researchers, is unequal access to services and resources. Blacks are less likely to have health insurance, to regularly receive medical care, to be screened early for health problems, to have access to nutritious food in their communities, or to live in exercise-friendly, safe neighborhoods. Some studies suggest that blacks, especially those who are poor, feel that health care providers are condescending and biased, and that the health counseling they receive is incorrect, incomplete, or delivered in language the patient cannot understand. Most African Americans are well aware of the challenges in obtaining quality health care. A recent Gallup Poll that asked Americans how much they worried about twelve different problems facing the country today found that they worry most about "the availability and affordability of health care." Nearly 75 percent of blacks and 56 percent of whites said health care was their top concern. Ultimately, the elimination of economic disparities on the basis of race may be the most effective way to alleviate racial disparities in health and longevity.