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Why Are Black Americans Sicker?


Given the title of yesterday’s article, it should be clear that this one is intended as a sequel, hitting on similar themes, but focusing more specifically on black Americans, who I believe didn’t get much focus in the study discussed yesterday.

First things first: black Americans have lower life expectancy than white Americans. This is well borne out by statistics. The most straightforward way to put it is that black men and women today have the same life expectancy as their white counterparts did in 1970. Suffice it to say, white people have made gains since then. Black people have, too, yet still lag behind on these indicators.

According to the CDC, black Americans have higher rates of heart disease, cancer, homicide, diabetes, and perinatal conditions. Black Americans have lower rates of chronic liver disease, Alzheimer’s, chronic lower respiratory disease, unintentional injuries, and suicide. What’s behind these differences?

Some of them are not hard to figure out. When it comes to heart disease, poor healthcare access looks to be the main driver. Heart disease can be prevented or halted but early intervention is critical, and black people simply get less of that due to having less access to healthcare services. The situation is likely the same for cancer: poor access to early screening leads to higher overall incidence and death. Diabetes is strongly correlated with obesity, which has higher incidence (and severity) at lower income levels. The economic gap between black people and white people has remained largely unchanged for the past 50 years, and black Americans have historically been poor for reasons that should be obvious: slavery, Jim Crow, institutional racism, and the list goes on. Food deserts are commonly cited as major contributors to poor eating habits, and thus obesity and poor health overall, but the introduction of fresh produce into neighborhoods that lack such access does not appear to improve health outcomes. Rather, poverty itself seems to be a significant cause of premature deaths. According to Slate:

In fact, researchers who focus on health disparities have suspected for decades that people who live in poverty die early because of the stress of poverty itself rather than the poor health choices low-income people make. That’s not to say that poor people don’t make decisions about diet and exercise, but in general they are preoccupied with very different choices than wealthier people are: Should I pay my electricity or my water bill? Can I pay my rent _and_ buy my kid a pair of school shoes? The immediacy of these pressures may make it more difficult to think about how eating choices today will affect health 10 or 20 years from now.

I reached similar conclusions some time ago. Given the additional economic burdens faced by black Americans, it should come as no surprise that they face worse health outcomes, as well.

Homicide is not a health problem, per se, but the result of various cultural and environmental factors. It is often characterized as a crime of poverty. To some extent, it is, but it’s more complex than that. While the lead poisoning crisis in Flint, Michigan has gained national attention recently, it is far from the only recent instance of black communities being stuck with lead-contaminated water. Freddie Gray, who died at the hands of Baltimore police last year, was also from a neighborhood whose children long suffered the effects of lead poisoning. Though it is rarely brought up during public health debates, lead poisoning is strongly correlated with criminal behavior, especially violence and aggression. Some research has suggested that the decline in violent crime and murder in the US (and other countries) since the ‘90s is not the result of any major cultural shift or even an economic or social policy, but rather the elimination of lead from gasoline. If taking lead out of gasoline broadly reduced violent behavior, then wouldn’t the persistence of lead in the water and housepaint of poor black communities at least be a major contributor to violence and homicide?

And it’s not just lead. Air pollution has caused an upsurge in asthma cases, particularly among children in poor black families who are more likely to live in areas with poor air quality. There is a long history of minority communities being saddled with the pollution, waste, and eyesores that white communities have the money, power, and political organization to stave off. To describe it less charitably: the white majority in America has seen fit to make black people disproportionately bear the external costs of our economy, and those costs result in real illness and real reductions in lifespan. The term “environmental racism” was coined to describe the ways in which existing disparities of power and political organization along racial lines are exploited to inflict disproportionate environmental harm on minority–mostly black–communities. The short version: white people get clean neighborhoods, while black people get toxic waste dumps. The most famous example, and the one commonly credited with starting the environmental justice movement, involved the dumping of PCB (a carcinogen) along roadways in 14 different counties in North Carolina in 1973. The state’s solution was to propose building a landfill to contain the tainted soil–near a majority-black community that had no mayor and no city council. As the landfill was constructed, residents resisted and drew national attention to the issue, and it took 9 years and multiple lawsuits to have expansion of the landfill halted. Local water supplies were found to be contaminated by the PCB dumped in the landfill, and yet it took until 2003 for the state to finally begin destroying the PCB itself to eliminate the problem for good.

Such stories are not unusual, and for it to take years or even decades to reach an equitable solution is not unusual, either. In the meantime, black citizens–likely impoverished by the confines of a racist system to begin with–remain vulnerable and face unnecessary suffering.

It is a common meme, when faced with the facts of black mortality and morbidity, to blame insular, personal factors like a “violent black culture,” or “bad genes,” or “poor eating habits.” These are excuses deployed to absolve white society of our role in the creation of this environment that, in practice, values black lives less and cuts them short. Some of the causes here can be addressed through the same methods as attacking disease and premature death in general: better access to healthcare, better quality of healthcare, and significant reductions in poverty. But black communities face unique challenges due to environmental policies that have placed upon them an unacceptable burden of waste and pollution. This is why justice cannot be found only in the courts or measured only in dollars. The damage done must be repaired and reversed, and the environmental consequences of our way of life must be both minimized and shared equitably, rather than thrust upon the most vulnerable.

Photo by The U.S. National Archives