By RICHARD SKOLNIK
Los Alamos
The death of George Floyd in Minneapolis last week reminds us of the extent to which racial injustice remains a central feature of American life. Closely related to this are America’s remarkable racial disparities in health.
Life expectancy at birth in the US varies with race, with African Americans, American Indians, and Alaska Natives having the shortest lives. In 2017, life expectancy was 4.5 years greater for a white male than for an African American male. It was 2.7 years greater for a white female than for an African American female. American Indians and Alaska Natives have a life expectancy about the same as African Americans.
These numbers, however, mask as much as they reveal. A closer look reveals even larger disparities by race as we move from one location to another. There is a more than 20-year gap in life expectancy between the best off, mostly white neighborhood, and the worst off, mostly African America neighborhood, in Baltimore. In New Mexico, there is an almost 11-year gap in life expectancy between Los Alamos County and McKinley County, with its large American Indian population.
The racial disparities in maternal mortality is a national disgrace. The maternal mortality ratio (the number of pregnancy-related deaths for every 100,000 live births) for African American women is 2.5 times that of white women. American Indian and Alaskan Native women have a maternal mortality ratio more than twice as high as white women. In fact, on average, an African American woman has a risk of dying of maternal causes that is 50% greater than that of a woman in Mexico, a middle-income country. An Alaska Native or American Indian has about a 15% greater risk of dying of maternal causes than a Mexican woman.
The share of children who will die before their first birthday in the US is also closely correlated with race. A non-Hispanic black child in Wisconsin is more than twice as likely to die in her first year of life than a non-Hispanic white child. A non-Hispanic black child in Massachusetts is three times as likely to die in her first year of life as a non-Hispanic white child. The black child in Wisconsin, in fact, has about a 30% greater likelihood of dying in her first year of life than a child in the middle-income countries of Brazil and Colombia. An American Indian or Alaska Native child is about twice as likely to die in her first year of life as a non-Hispanic white. Their risk of dying would also be less in many middle-income countries.
COVID-19 further reflects many of the fundamental racial disparities in health. Recent studies suggest that African Americans are hospitalized and dying from COVID-19 at about twice the rates of white Americans. We in New Mexico are confronted daily with the terrible and disproportionate impact of COVID-19 on American Indian communities.
One’s health depends on a number of factors. Some are genetic. Some have to do with income and education. Others relate to behaviors, such as smoking, drinking alcohol, and eating too many calories, while getting too little physical exercise. Government policies also have a major bearing on health. People are more likely to be healthy in a society that promotes gender equality, high quality education, and universal health coverage. Societies that have lower levels of income inequality are also healthier than those with high levels of income inequality. There is also good evidence that discrimination takes a toll on the health of those with less social and political power.
The US has shown itself capable of achieving remarkable feats. Facing an existential threat from Germany, the US built a nuclear bomb. Facing a rising Soviet Union, the US sent astronauts to the moon. Yet, despite progress in reducing some of the worst forms of institutional racism, racial disparities persist in the US in dramatic ways. Within the high-income US, in fact, many of our African American, American Indian, and Alaska Native populations have shorter and less healthy lives than the average person in many middle-income countries.
Perhaps the conjunction of COVID-19 and the death of George Floyd will help more of us to understand the importance of health equity, that many aspects of health are a public good, and that health disparities like those discussed above weaken us as a society. Only if this happens will a broader array of Americans demand that the US make reducing racial disparities in health a central feature of American life.
Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.
