Disparity Among African Americans

What can you do in four years? Get a bachelor’s degree, learn to play the piano, have a child, write a book—the potential is enormous. Four years. In the US, the average life expectancy at birth for African Americans is nearly four years less than that of Whites (Kochanek, Arias, & Anderson, 2015). A large contributor to this disparity is difference in health outcomes between Whites and Blacks in the US. For example, African Americans have higher rates of a myriad of diseases than Whites, including cardiovascular disease, diabetes, and hypercholesterolemia, which leads to a shorter life expectancy and poorer quality of life (Sullivan, 2013; Kuzawa & Sweet, 2009). A major mechanism causing this disparity is epigenetic modifications due to psychosocial effects of racism as well as environmental racism, which prevents African Americans’ access to healthy foods while increasing exposure to harmful environmental toxins. The poor health outcomes associated with being Black in America are only exacerbated by institutions that systematically prevent access to quality health care.

One of the most alarming measures of racial health disparities is the aforementioned difference in life expectancy.

In 2013, the average life expectancy at birth for Black Americans was 3.6 years shorter than that of White Americans (Kochanek, Aria, & Anderson, 2015). This difference is even greater between Black and White males (Kochanek, Aria, & Anderson, 2015). Fortunately, this disparity has been decreasing, largely due to decreased mortality in African Americans from heart disease, cancer, HIV, and perinatal conditions. However, this decrease has been attenuated by an increase in mortality due to maternal conditions and Alzheimer’s disease, among other conditions (Kochanek, Aria, & Anderson,

2015).
Despite these decreases in mortality, African Americans are still disproportionately affected by chronic health conditions, including asthma, diabetes, heart disease, and obesity (Artiga, Foutz, Cornachione, & Garfield, 2016). African Americans also experience “earlier onset of disease, greater severity and progression of disease, and higher levels of comorbidity and impairment” (Williams & Mohammed, 2013). Some of these disparities are illustrated in Figure 1.

Figure 1: Black/White Disparities in Chronic Conditions. Data from Artiga, Foutz, Cornachione, & Garfield, 2016. All Black/White disparities are significant at the p<.05 level.
Even for the same diseases, African Americans often have higher age-adjusted mortality rates. Figure 2, taken from Artiga, Foutz, Cornachione, & Garfield, shows this disparity for diabetes, heart disease, and cancer.

Figure 2: Age-Adjusted Death Rates per 100,000 for Selected Diseases by Race/Ethnicity, 2014. Taken from Artiga, Foutz, Cornachione, & Garfield, 2016.
Moreover, poor birth outcomes are much more prevalent for African American infants than their White counterparts. 13% of Black infants are born prematurely, while only 9% of White infants are. Similarly, 13% of Black infants are born with a low birth weight, compared to only 7% of White infants (Artiga, Foutz, Cornachione, & Garfield, 2016). The differences in infant mortality rates, often caused by preterm birth and low birth weight, are even more stark. More than twice as many Black infants die during infancy than White infants, at 11.1 deaths per 1,000 versus only 5.1 per 1,000 (Artiga, Foutz, Cornachione, & Garfield, 2016). Although all of the racial health disparities presented thus far are concerning, the poor birth outcomes for Black babies are most worrying due to the lasting effects of preterm birth and low birth weight on future health outcomes. Low birth weight and premature birth allow less time for fetal organs to develop in structure and functionality. With less functionality, these smaller organs are more prone to disease, thereby predisposing an individual to diseases such as hypertension, diabetes, hypercholesterolemia, obesity, and cardiovascular disease (Kuzawa & Sweet, 2009). Moreover, the deleterious effects of poor birth outcomes persist across generations, as the gestational parent’s fetal growth strongly predicts offspring fetal growth through both genetic mechanisms and environmental consistency (Kuzawa & Sweet, 2009; Sullivan, 2013). That is, epigenetic changes associated with poor birth outcomes can be passed down directly during reproduction, but can also be similarly programmed if offspring are raised in similar environments as their gestational parent. Therefore, poor birth outcomes are a primary avenue through which racial health disparities emerge and persist.