By SABRINA TAVERNISE MAY 8, 2016, New York Times [original article containst links and a chart, poorly shown below]
WASHINGTON — It is a bitter but basic fact in health research: Black
Americans die at higher rates than whites from most causes, including AIDS,
heart disease, cancer and homicide.
But a recent trove of federal data offered some good news. The suicide
rate for black men declined from 1999 to 2014, making them the only racial
group to experience a drop. Infant mortality is down by more than a fifth
among blacks since the late 1990s, double the decline for whites. Births to
teenage mothers, which tend to have higher infant mortality rates, have
dropped by 64 percent among blacks since 1995, faster than for whites.
Blacks are still at a major health disadvantage compared with whites. But
evidence of black gains has been building and has helped push up the ultimate
measure — life expectancy. The gap between blacks and whites was seven
years in 1990. By 2014, the most recent year on record, it had shrunk to 3.4
years, the smallest in history, with life expectancy at 75.6 years for blacks and
79 years for whites.
Part of the reason has been bad news for whites, namely the opioid crisis.
The crisis, which has dominated headlines — some say unfairly, given racial
disparities — has hit harder in white communities, bringing down white life
expectancy and narrowing the gap.
But there also has been real progress for blacks. The rate of deaths by
homicide for blacks decreased by 40 percent from 1995 to 2013, according to
Andrew Fenelon, a researcher with the National Center for Health Statistics,
compared with a 28 percent drop for whites. The death rate from cancer fell by
29 percent for blacks over that period, compared with 20 percent for whites.
“Blacks are catching up,” said Samuel Preston, a demographer at the
University of Pennsylvania. “The gap is now the narrowest it has been since
the beginning of the 20th century, and that’s really good news.”
The history of health for black Americans has been one of deep inequity.
At the start of the 1900s, life expectancy for blacks was nearly 15 years less
than for whites, according to federal data. This was partly because infant
mortality was so much higher for blacks. But it was also because blacks, who
were subjected to discrimination and segregation, faced worse living
conditions and had almost no access to medical care.
Well into the 1950s, cancer was known among researchers as a “white
disease,” in part because fewer blacks lived long enough to die from it, said
Keith Wailoo, author of “How Cancer Crossed the Color Line.”
Life expectancy for blacks improved in the 1970s as Medicare and Medicaid
increased access to health care and helped integrate hospitals after the
abolition of Jim Crow laws. Smoking had started to decline and new
treatments for heart disease, including blood-pressure medications, drastically
improved health for everyone.
Then came a lost decade. From 1982 to about 1995, blacks’ progress in life
expectancy stalled, dragged down by homicides, AIDS and fallout from the
crack epidemic. Life expectancy in 1993 stood at 69.2, down from 69.4 in
1982. There were five years of outright declines during the period,
unprecedented in modern times, said Sam Harper, an epidemiologist at McGill
University.
Since then, blacks have experienced health improvements on a number of
fronts.
One profound change has been the decline in violence over the past two
decades. The cause is still a matter of intense debate. The decline came after
the institution of contentious tough-on-crime policies, but some researchers
point out that similar declines happened in Canada, where no such policies
were enacted.
Homicides have decreased for everyone since the early 1990s, but have
gone down faster for blacks. As a result, the black-white gap in deaths from
homicides fell by 40 percent from 1990 to 2010 in the largest metropolitan
areas across the country, according to Michael Light, a sociologist at Purdue
University.
“The decline in violence is a major social fact that is really reshaping
society and the lived experience of kids growing up — particularly blacks,” said
Robert J. Sampson, a sociology professor at Harvard University who has been
studying youth in Chicago since the 1990s.
“There are all kinds of negative consequences that flow from violence, in
emotional responses, cognitive development, and links to future violent
behavior,” Dr. Sampson continued. “This change has provided an advantage
that wasn’t expected. It’s almost like a reset of the expectations and experience
of urban life.”
But he noted that the improvement has been complicated by the explosive
rise in incarceration rates, which has taken a heavy toll on black families.
Dr. Harper, who has written extensively on the racial mortality gap, said it
was difficult to tell whether any of the improvements were because of specific
policies aimed at lifting blacks’ health. But he said the gains were clear.
And while for some causes, like AIDS, the percentage drop in the death
rate may have been similar for blacks and whites, Dr. Harper said, the absolute
decline in the number of deaths per 100,000 was larger for blacks over the
past 15 years, because they had started at far higher rates. (The decline in
black deaths from AIDS accounted for about a fifth of the narrowing of the
mortality gap with whites from 1995 to 2013, Dr. Fenelon said.)
“There has been true progress for blacks,” Dr. Harper said.
Dr. Otis W. Brawley, the chief medical officer of the American Cancer
Society, said faster declines in cancer mortality for blacks were driven largely
by substantial drops in deaths from lung cancer. Smoking has declined faster
for blacks than whites, and in most of the past 15 years, blacks have had lower
smoking rates than whites.
“I think it’s something to be celebrated. It’s a very good thing,” Dr.
Brawley said. “But we need to be very cautious,” he added, pointing out that
over all, black death rates from cancer were still higher than those of whites,
and that for some cancers, like colon, a disparity has sprung up since the
1980s, possibly a result of screenings and new treatments that were less
accessible to blacks.
David R. Williams, a professor of African-American studies and public
health at Harvard, cautioned that the country still has a long way to go to
address the health disadvantages of blacks. He said the excess in premature
deaths among blacks is the equivalent of a jumbo jet crashing every day.
“We have had this peculiar indifference to this unprecedented loss of
black lives on a massive scale for a very long time,” he said, in a reference to
W.E.B. DuBois. “That to me is the big story.”
He added: “When something happens to whites, it’s news and it’s a crisis
that we have to attend to.”
Researchers do not fully understand why drug overdoses have hit whites
harder than blacks. (Dr. Fenelon said white rates overtook those of blacks in
2003.)
But it is clear that the difference is helping to close the life-expectancy
divide. Dr. Harper calculated that faster increases in white overdose deaths
accounted for about 15 percent of the narrowing of the black-white gap in life
expectancy for men from 2003 to 2008.
Whatever the case, the national hand-wringing can leave a bad taste.
Indiana State Representative Charlie Brown, who represents Gary, a
majority-black city, said it took a surge in infections in mostly white counties
last year for his state to approve a needle-exchange program.
“We’ve had this issue all along about people coming up with H.I.V. and
hepatitis C because of needles, and it has not been a concern,” Mr. Brown said.
“But now it’s a problem in the white communities, and it becomes almost a
hysteria.”
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