Disparities in excess deaths: How systemic racism decreases life expectancy

1.63 million excess deaths over two decades – that’s the estimated toll of the racial inequities embedded in modern America, according to a new study in JAMA. How does this play out on the city level, and what can we do about it?

2 Miles, 23 Year Life Expectancy Difference

In Boston, the two-mile difference between the Roxbury area and the Back Bay area could make the difference of 23 years in terms of life expectancy. This stat comes from a recent analysis by the Boston Public Health Commission, which also identified stark differences in income, education, race, and rates of homeownership between the two neighborhoods. The combination of these social determinants likely plays a major role in the life expectancy gap.

Boston is not the only city with significant differences in neighborhood life expectancy. Chicago, Los Angeles, Houston, and many other cities have documented persistent life expectancy disparities by neighborhood, also closely tied to the social determinants of each neighborhood. 

Our data at the Lown Institute shows that many hospital markets are racially segregated, further contributing to the varying health outcomes between one group of residents vs another. In some cities, prestigious academic medical centers underserving patients from low-income communities and communities of color, while safety nets disproportionately serve these patients. In New York City, for example, a New York Times investigation found that wealth undeniably affords faster, better treatment. VIPs at NYU Langone were given priority access and special treatment, while poorer patients were directed to go to the public safety net hospital.

The accumulation of a lifetime of disparities

The fact that these social determinants are cutting years off residents’ lives is not new. In 2012, a similar study by the Center on Human Needs at Virgina Commonwealth University identified a 33-year life expectancy gap in Boston. The gap has decreased by 10 years over the past decade–but why does this gap persist at all?

The Associated Press published a series of articles investigating the lifetime of disparities faced by Black Americans, covering the impacts of racism from pregnancy to childhood through old age. Every step along the way, Black Americans faced worse health outcomes. The accumulation of a lifetime of disparities results in “weathering,” a term used to describe the physical impacts of chronic stress. Over years and years, “weathering” diminishes health outcomes, increases the rate of chronic health conditions, and ultimately cuts lives short. According to a recent JAMA study, racial inequities are related to an excess of 1.63 million deaths over two decades.

There are numerous ways in which social determinants impact life expectancy, and just as many potential solutions. From eliminating toxic environmental exposures and expanding healthcare access to making neighborhoods greener and investing in education, we have plenty of options to mitigate the negative impacts of social determinants of health. Hospitals can play their part by focusing on their community members in need, rather than on recruiting wealthy patients for elective, albeit profitable, procedures. Our data shows some hospitals are already prioritizing inclusivity, but we need more to follow their lead. The slow pandemic of weathering is ongoing, but it doesn’t have to be this way.