82 million years — that’s the amount of lifespans black Americans lost to premature death between 1999 and 2020, new research shows.
Experts on racial health disparities say the numbers aren’t entirely surprising, as they are a reminder of worrying issues related to health disparities. The study’s authors say their findings should serve as a “call to action” for policy makers. “There is no intrinsic biological reason why darker-skinned people live shorter lives,” said study co-author Harlan Krumholtz, a cardiologist at Yale University. But because of the systemic racism that pervades American society, “families born in this country can have devastating consequences.”
The data used in this study included people categorized as male and female, and included both children and adults. For clarity, all individuals are referred to as “male” and “female” in the diagram below.
fragile improvement
Researchers often talk about racial health disparities simply as differences, but the vague language fails to convey that such disparities shouldn’t exist, Krumholtz said. Instead, he and his colleagues discuss excess mortality. Excess deaths are black deaths that exceed white deaths, taking into account the differences in age distribution and size of each community. Death certificate data, published last month in a journal, showed that 1.63 million more blacks died than whites over the 22-year study period. Journal of the American Medical Association.
Many of these deaths were due to several diseases, including heart disease. There are multiple reasons for this, says Lisa Cooper, an epidemiologist and physician at the Johns Hopkins Center for Health Equity, who was not involved in the new study. For example, economic barriers often cause Black people to live in places where it is difficult to access healthy food, space to exercise, and adequate medical care. And living in a racist society puts an additional strain on your mental health. Cooper says this is “near a cascading effect” on overall health.
In the early 2000s, heart disease in the black population began to decline, reducing the overall health disparity between blacks and whites. “It was an amazing time,” says Kathleen Mullan Harris, a demographer at the University of North Carolina at Chapel Hill who was not involved in the study. She ties this decline to the fact that cholesterol drugs that reduce the risk of heart disease and drugs for hypertension began to become more widely available in the black community. Improvements in cancer treatment have also contributed to the reduction in mortality.
However, progress did not last long. Around 2011, the difference in excess deaths between blacks and whites stabilized. “I think it really has something to do with obesity,” says Harris. In the 1970s and his 1980s, highly processed foods became cheap and plentiful in the United States. Decades later, the impact was reflected in mortality. The same socioeconomic disadvantages that have caused high rates of heart disease have made the black population particularly vulnerable.
And in 2020, the novel coronavirus hit the United States, undoing all the progress made in reducing health disparities over the past two decades. The disease was a leading cause of death among blacks, as well as other marginalized populations. The indirect effects of the pandemic have exacerbated other health conditions as well. For example, heart disease surged again. Among black men, the number of deaths from assault also soared. Although the recent study did not address the reasons for the increased assault rates in this population, Professor Cooper found that pandemic-related stress increased interpersonal violence and led law enforcement to systematically target black men. I speculate that targeting may have made the violence even worse. “I dare say they all contributed,” she says.
Early and late risks
Krumholtz et al. found that relatively high health risks among blacks start at an early age. For every 100,000 children born, about 700 more black children die in their first year of life than white children. The new findings are consistent with previous studies showing that black babies tend to have lower birth weights than white babies, but researchers still don’t understand why. Harris says.
Between the ages of 1 and 14, black children are only slightly more likely to die than white children. However, excess mortality begins to rise when black children reach their mid-teens, and the number continues to rise into adulthood.
Cooper cites epidemiologist Arline Jeronimus’ observation of “weathering”, which explains that blacks tend to age faster than whites. Over time, the combined effects of many chronic stresses (both physical and mental) leave many people exhausted. “By the time you’re a teenager, you’re already obese. You’ve already developed high blood pressure,” says Cooper. These stresses can lead to premature death.
Weathering can shorten a person’s lifespan by decades, and even five or ten years is a big loss. “Grandparents aren’t at the table, or older parents aren’t nearby,” says Krumholtz. “It’s tragic.”
how to help
The magnitude of these inequalities can make them feel “insurmountable and utterly impossible,” says Cooper. Nevertheless, she and other researchers have some ideas on how to close the health gap.
Proposed solutions often focus solely on increasing access to health care for blacks, but some of the causes of health disparities lie outside clinics, says the nonprofit policy group Kaiser Family. LaToya Hill, a senior policy analyst at the foundation, points out. To create lasting change, she wants policies that improve black people’s ability to find high-paying jobs, access to education, and housing in areas with low pollution levels. She said, “The housing sector, the economic sector, the employment sector, education…the health care sector also plays a role, but we really need to target these,” Hill says.
Cooper says three types of interventions can be particularly helpful. The first is improving opportunities for black communities, such as raising the minimum wage and providing early childhood education. Second, health care providers invest more energy in mitigating health problems before they become long-term (for example, programs aimed at reducing childhood obesity rates can prevent problems later in life). there is a possibility). A third intervention would encourage key decision makers to reduce the health burden placed on the black community. A possible step towards this goal is for employers to take steps to better support their employees when they find that their health is preventing them from reaching their full potential. You can. “when [Black] Communities have been hit hard and all of us are worse off,” Cooper said.
At this rate, many years of black lives will continue to be lost. “People had no friends, no family, no loved ones,” says Krumholtz.
