Excess Death Creates a Vicious Cycle in Black Communities

A new study published in the Journal of the American Medical Association shows the extent to which racial disparities in the prevention and treatment of serious health conditions has created a dramatic gap in mortality between Black and white Americans. In the last 22 years alone, roughly 1.6 million Black Americans died prematurely. While progress had been made in reducing the gap between Blacks and whites in the early 2000s, it stalled after 2011 and was all but erased with the onslaught of Covid-19 in early 2020 (Szabo, 2023). 

Excessive death is deeply troubling in its own right, but the magnitude of its effects becomes even clearer when the impacts on families and communities are considered. Buckley et al. (2012) highlight the crippling physiological impacts of grief, including increased inflammation, poor sleep, higher levels of stress hormones, and poor immune function. Likewise, Umberson et al. (2017) note the overwhelming harm the death of a loved one brings to families and communities and adds that the stress can act as a gateway to further exposure to stressors like financial burden, familial conflict, substance abuse issues, and more. In this way, excess death creates a vicious cycle in Black communities, where racial disadvantages drive preventable death, and that preventable death drives further racial disadvantages.

Of course, 21st-century inequities in health outcomes are only the tip of the iceberg in the larger context of racial health disparities in the United States. The root of the problem extends back to slavery, when enslaved people were regular victims of violence, abuse, neglect, and overwork. In slavery’s wake, Black communities in the South sought self-sufficiency but were weighed down by persisting racism that manifested in denial of care, continued inhumane working schemes, segregation, and later, mass incarceration (Hammonds & Reverby, 2019). 

In concert with history’s powerful social and economic factors noted above, unethical treatment of Black Americans by medical professionals further exacerbated the severity of the problem by sowing doubt and fear in Black communities. The infamous Tuskegee Syphilis experiment serves as one of the most well-known breaches of ethics and trust perpetrated by the American medical system in modern history, and other similar instances of grave unethicality have deeply undermined many Black Americans’ trust in the medical system. Scharff et al. (2010) calls out some disturbing examples, including a study in which researchers deceptively recruited Black boys to investigate what they hypothesized was a genetic factor in aggressive behavior. Even now, Black patients are often treated with less empathy, taken less seriously, and treated less effectively (check out our May 4th LinkedIn post to learn more). 

Just as history is important to acknowledge, so too are the social and economic contexts in which people live today. Recently, Equity Commons Chief Medical Officer, Dr. Aubrey J. Grant, has been spreading the word about the social determinants of health and their role in inequity. Among these many important factors is income, a strong driver of access to quality healthcare, an often hefty expense in the United States. Similarly, access to healthy food plays an important role in determining health outcomes, as it is widely known that malnutrition contributes to chronic disease and cognitive dysfunction. Taylor (2019) cites several statistics to corroborate this, pointing out that Black households made almost $39,000 less than white households in 2018 and that the rate of hunger among Black Americans is almost twice that of white Americans. 

The alarming extent of excess deaths among Black Americans is not a foregone conclusion, but in order to make real progress, it is paramount that we acknowledge both the historical transgressions against Black people as well as the way those hardships manifest as determinants of health today.

References

Buckley, T., Sunari, D., Marshall, A., Bartrop, R., McKinley, S., & Tofler, G. (2012). Physiological correlates of bereavement and the impact of bereavement interventions. Dialogues in clinical neuroscience, 14(2), 129–139. https://doi.org/10.31887/DCNS.2012.14.2/tbuckley

Hammonds, E., & Reverby, S. (2019). Toward a historically informed analysis of racial health disparities since 1619. AM J Public Health, 109(10), 1348-1349. https://doi.org/10.2105%2FAJPH.2019.305262

Mortality and years of potential life lost in the US Black population. (2023, May 16). JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association. https://jamanetwork.com/journals/jama/article-abstract/2804822

Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved, 21(3), 879–897. https://doi.org/10.1353/hpu.0.0323

Szabo, L. (2023, May 16). Study reveals staggering toll of being black in the America: 1.6 million excess deaths over 22 years. NBC News. https://www.nbcnews.com/health/health-news/study-reveals-staggering-toll-black-america-16-million-excess-deaths-2-rcna84627

Umberson, D., Olson, J., & Crosnoe, R. (2017). Death of family members as an overlooked source of racial disadvantage in the United States. PNAS, 114(5), 915-920. https://doi.org/10.1073/pnas.1605599114