19.3.1 Health by Race and Ethnicity

When looking at the social epidemiology of the United States, it is hard to miss the disparities among races. The discrepancy between Black and White Americans shows the gap clearly; in 2018, the average life expectancy for White males was approximately five years longer than for Black males: 78.8 compared to 74.7 (Wamsley 2021). (Note that in 2020 life expectancies of all races declined further, though the unprecedented COVID-19 pandemic was a significant cause.) Other indicates show a similar disparity. The 2018 infant mortality rates for different races and ethnicities are as follows:

• Non-Hispanic Black people: 10.8
• Native Hawaiian people or other Pacific Islanders: 9.4
• Native American/Alaska Native people: 8.2
• Hispanic people: 4.9
• Non-Hispanic White people: 4.6
• Asian and Asian American people: 3.6 (Centers for Disease Control 2021)

According to a report from the Henry J. Kaiser Foundation (2007), African Americans also have higher incidence of several diseases and causes of mortality, from cancer to heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican Americans and Native Americans, also have higher rates of these diseases and causes of mortality than White people.

Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s, but it began widening again in the early 1980s. What accounts for these perpetual disparities in health among different ethnic groups? Much of the answer lies in the level of healthcare that these groups receive. The National Healthcare Disparities Report shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups. The Report identified these racial inequalities in care:

• Black people, Native Americans, and Alaska Native people received worse care than Whites for about 40 percent of quality measures.
• Hispanic people, Native Hawaiian people, and Pacific Islanders received worse care than White people for more than 30 percent of quality measures.
• Asian people received worse care than White people for nearly 30 percent of quality measures but better care for nearly 30 percent of quality measures (Agency for Healthcare Research and Quality 2020).