American Apartheid: Racial Segregation is bad medicine, UM study suggests

Social factors—particularly residential segregation and neighborhood quality—contribute to racial disparities in the death rates of white and Black Americans, according to an analysis by researchers at the University of Michigan and Indiana University. Large disparities persist for deaths due to homicide, heart disease and cancer, according to U-M researcher David R. Williams and IU researcher Pamela Braboy Jackson, who tracked changes in Black and white deaths from five conditions over a 50-year period. But the gap has narrowed for deaths from the flu-pneumonia and suicide. The analysis appears in the March/April 2005 issue of Health Affairs. "We need to rethink what constitutes health policy in this country," said Williams, a sociologist at the U-M Institute for Social Research (ISR). "Given the broad social determinants of health and mortality, policies far removed from traditional health policy can have decisive consequences." Among the major findings:

• Heart Disease & Cancer The racial gap in homicide death rates narrowed between 1950 and 2000, but the homicide rate (the 15th leading cause of death in the U.S.) was still almost six times greater for Blacks than for whites.
• Homocide The racial gap in homicide death rates narrowed between 1950 and 2000, but the homicide rate (the 15th leading cause of death in the U.S.) was still almost six times greater for Blacks than for whites.
• For flu and pneumonia, the seventh-leading cause of death, large racial differences in death rates existed in 1950, with Black mortality 70 higher than that of whites. Over the last half-century, striking declines in death rates occurred for both races, with larger declines for Blacks than for whites. "The virtual elimination of a racial disparity in death rates from flu and pneumonia is a result of the ready availability of treatment facilitated by Medicare and Medicaid," noted Jackson. "Social variations in motivation, knowledge and resources played a small role in eliminating a large disparity in health."
• For suicide, the 11th leading cause of death, Black death rates have consistently been less than white death rates. "High levels of self-esteem and religious involvement in the Black community are potential contributors to the better suicide and mental health profile of Blacks," noted Williams.
  

Williams and Jackson maintain that racial differences in socioeconomic status, neighborhood residential conditions and medical care are important contributors to continuing racial differences in death rates from heart disease, cancer and homicide. Education, income and health practices, including diet, physical activity, tobacco use and alcohol abuse, all play a role in racial differences in disease and mortality, they point out. But other factors also come into play. For example, the homicide death rate for African-American men with at least some college education is 11 times that of similarly educated whites. "Strikingly, the homicide rate of black males in the highest education category exceeds that of white males in the lowest education group," the authors write. [more]