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In 1985, with the release of the Heckler report, America was put on notice that the health status of African Americans was significantly worse than that of their White counterparts (Heckler 1985). Unfortunately, since then, racial disparities in health have worsened in many ways. In 1990, for example, McCord and Freeman shocked the world by reporting that a Black male in Harlem had less of a chance of reaching the age of 65 than did the average male resident of Bangladesh—one of the poorest countries in the world. At the time of McCord & Freeman’s study, African American men fell behind men from Bangladesh in survival rates starting at age 40 (McCord & Freeman 1990Sen 1993). In the United States, life expectancy for African American males experienced an unprecedented drop every year from 1984 to 1989, while all other combinations of Black/White male/female comparisons either remained the same or increased (NVSS 2004).

Today, African Americans still bear a disproportionate burden in disease morbidity, mortality, disability, and injury (MMWR 2005Williams 1995). This continuing health disadvantage is seen particularly in the age-adjusted mortality rates: African Americans remain significantly and consistently more at risk for early death than do similar White Americans (Geronimus et al. 1996Kochanek et al. 2004Levine et al. 2001MMWR 2005Smith et al. 1998Williams & Jackson 2005). Indeed, the overall death rate of African Americans in the United States today is equivalent to that of Whites in America 30 years ago (Levine et al. 2001Williams & Jackson 2005).

These premature deaths arise from a broad spectrum of disorders. Diabetes, cardiovascular heart disease, hypertension, and obesity disproportionately affect African Americans (Davis et al. 2003Krieger 1990Mensah et al. 2005USDHHS 199020002005). For example, in deaths due to heart disease, the rate per 100,000 persons for African Americans (321.3) is higher than for any other racial/ethnic group, including Asian/Pacific Islanders (137.4), American Indian/Alaska Natives (178.9), Hispanics (188.4), and Whites (245.6) (NCCDPHP 2004). This same pattern for African Americans in comparison with Asian/Pacific Islanders, American Indians/Alaska Natives, Hispanics, and Whites is repeated in deaths due to diabetes (49.9 versus 16.9, 45.3, 36.3, and 22.1, respectively) and strokes (80.0 versus 51.2, 46.1, 44.0, and 55.9, respectively). Even prevalence of hypertension per 100,000 is far greater among African Americans (34.2) than among the other major racial/ethnic groups (16.2, 25.8, 18.9, 25.8, respectively) (NCCDPHP 2004).

Furthermore, these health disadvantages occur in the context of increasing disparities in rates of disease. For example, Williams & Jackson (2005) examined Black/White health disparities using data from the National Center for Health Statistics for the years 1950 to 2000, and found that although rates of heart disease were similar for Blacks and Whites in 1950, by the year 2000, African Americans had a rate of heart disease 30% higher than that of Whites. Similarly, in 1950, African Americans had a lower cancer rate than Whites, but by the year 2000, their rate was 30% higher.

Poverty alone cannot fully explain these differences; even when socioeconomic status (SES) is controlled for, there is still an excess of 38,000 deaths per year or 1.1 million years of life lost among African Americans in the United States (Franks et al. 2005). Simple differences in skin color that might be the basis for the occurrence of discrimination also appear to be an inadequate explanation. For example, in the recent National Survey of American Life (Jackson et al. 2004), comparisons of 6000 Americans who reported being either Black of Caribbean ancestry, African American, or White revealed that of the three groups, African Americans evidenced the worst self-reported physical health status, including higher rates of hypertension, diabetes, and stroke).


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