The impact of ethnicity on health stands out vividly when we look at infant mortality. Not only is infant mortality twice as common among African Americans than among whites, but also as, it is also more common among African Americans than among citizens of countries such as Turkey, Romania, and Costa Rica.
As we have seen, poverty is a major cause of infant mortality. Around two- thirds of African American children are either poor or near poor, which definitely helps explain high rates of African American infant mortality. However, even African American infants born to middle- and upper-class families are more likely to die than are white infants. The same holds true for other health problems: At all income levels, African Americans have higher mortality and morbidity rates than do whites . One explanation for this is racism. First, research consistently shows that the experience of racial discrimination is highly stressful and affects both physical and mental health. If, for example, pregnant women experience these stresses, they may be more likely to give birth prematurely. Second, racial discrimina- tion by landlords, realtors, or mortgage bankers can leave even middle-class African Americans unable to obtain decent housing in neighborhoods free from pollution and violence. Other middle-class African Americans choose to live in poorer, segregated neighborhoods rather than face the daily hostility—or simply social discomfort—of white neighbors. Conse- quently, more-affluent African Americans sometimes live in conditions similar to those experienced by poorer African Americans, thus placing themselves and their families at risk. Finally, racial bias clearly helps explain why Hispanics are twice as likely and African Americans are three times as likely as whites to die during encounters with police, prison guards, and other legal authorities.
Health disparities between African Americans and whites don’t end in in- fancy. Although ethnic gaps in life expectancy have declined, white, non-Hispanic women still live an average of 3 years longer than do their African American coun- terparts, and white, non-Hispanic men live 4.3 years longer
cancer are the top two causes for each group. For the remaining causes of death, however, the impact of social conditions is obvious. As noted previously, African Americans are disproportionately likely to be killed by police and other legal author- ities. Many other homicides among African Americans are linked to poverty and the despair that it brings . Poverty is also an underlying cause of diabetes. In turn, diabetes can lead to deaths from kidney disease.
Yet kidney disease need not kill if individuals can receive transplanted kidneys. However, African Americans are significantly less likely than whites to receive transplants. Doctors less often refer African Americans to transplant programs, less often put African Americans on wait lists for donated kidneys, and more often reject African Americans as transplant patients because they lack transportation to hospitals and aftercare facilities. In late 2014, however, U.S. organ transplantation centers adopted a new system in which people receive transplants based in part on how long they have been on dialysis rather than how long they have been on a waiting list. Early data suggest that the new system has increased African Americans’ access to transplants.
Recently, attention has been brought to one other factor that helps explain high rates of disease and death among African Americans: mass incarceration. That issue is addressed in “Contemporary Issues: Mass Incarceration and Public Health,”