NYAPRS Note: Yesterday’s Times looked at improved health and life expectancy among black Americans due in part to lower rates of suicide, homicide, smoking, AIDS and access to healthcare. It did, however, underscore the devastating rates of incarceration and addiction and emphasized what so many of said recently: it’s taken the shocking rise in opioid use in white communities to draw long needed attention to an issue that has devastated minority communities for decades.
Black Americans See Gains in Life Expectancy
By Sabrina Tavernise MAY 8, 2016
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.”