Why is life expectancy so low in black neighborhoods?
Earlier this year, the National Center for Health Statistics (NCHS) released data showing a one-and-a-half-year drop in national life expectancy in 2020, largely due to the COVID-19 pandemic, which claimed the lives of approximately 375,000 Americans that year. The NCHS reported that the life expectancy of white Americans has declined by 1.2 years; for black Americans, that number was 2.9 years.
This racial disparity in life expectancy is a late indicator of the disparities that have existed throughout the pandemic. According to the most recent data from the Centers for Disease Control and Prevention, blacks are 1.1 times more likely than whites to contract COVID-19; 2.8 times more likely to be hospitalized with the virus; and twice as likely to die from it. These disparities help explain why, after adjusting for age, blacks account for 22.1% of COVID-19 deaths in the country when they represent only 12.8% of the population.
The causes of these racial disparities are hotly debated, and many focus on the role of individual behavior. But while personal behavior matters, local social determinants of health play a disproportionate role. Because de jure and de facto segregation concentrated black Americans in specific locations, racial injustices occurred through discrimination based on location: disproportionate exposure to pollution and hazardous waste, harmful zoning practices and post-disaster displacement, to name a few. Rather than blaming black people for their suffering, the conditions of the place must be examined to understand the mechanisms of racial discrimination that contribute to this suffering.
Two results highlight a hyperlocal variation in life expectancy before the pandemic
Finding 1: Neighborhood life expectancy correlates with neighborhood demographics
We compared life expectancy in neighborhoods where the black resident population ranged from less than 1% to more than 50%. The graph below shows that nationally, life expectancy in neighborhoods is declining as the percentage of the black population increases. Neighborhoods with a black population of 10% or more have an overall life expectancy lower than the national average of 78.7 years. Majority black neighborhoods have a life expectancy of about 4.1 years lower, and neighborhoods with a Black population of less than 1% have a life expectancy about one year higher than the national average.
Throughout the pandemic, most geographic analyzes of different health outcomes have focused on comparing different states, metropolitan areas and counties. Comparisons are important, but these geographic areas are not homogeneous units. There can often be so many glaring differences found in a metropolitan area as we find on the other side metropolitan areas – a fact highlighted in our second conclusion below.
Finding n ° 2: There are disparities in life expectancy in the neighborhoods compared to the surrounding metropolitan region
We found that majority black neighborhoods had a relatively lower life expectancy compared to the aggregate metropolitan area in which these neighborhoods were located. As the map below shows, the difference in life expectancy between a predominantly black neighborhood and its surrounding metropolitan area can be as high as nine years.
Both results highlight the fact that racial differences in life expectancy manifest as location-related issues. But another way to interpret these results is that blacks might take declining life expectancy with them in the neighborhoods they live in, so the crucial variable is the person, not the location. Supporters of this view might point out that there are persistent (albeit narrowing) nationally aggregated racial gaps in life expectancy that stretch backward for many decades.
While there is some credibility to this point of view, we don’t think it tells the whole story. For example, recent research comparing states has found that “the geographic inequality in mortality among mature Americans increased by about 70% between 1992 and 2016,” underscoring the importance of location as a factor. results. Additional research using experimental and quasi-experimental methods highlights the role of neighborhoods as a driver of health and well-being outcomes.
In our recent Social Determinants of Health report, we identified two place-specific factors that help explain disparities in health outcomes: housing insecurity (including foreclosure and eviction rates) and exposure to environmental hazards (especially toxic air), which are both more common in black neighborhoods. Social determinants related to labor markets, including labor force participation, conditions of employment and access to employer-sponsored health care, are additional factors that are often strongly correlated with characteristics and the location of the neighborhood.
Thus, a better interpretation of the differences in life expectancy at the neighborhood level is that whiteness confers a significant social and economic premium on localities, including neighborhoods – where whiteness is understood not as an intrinsic individual characteristic but rather as an intrinsic individual characteristic. a social construction that allows various systems and structural advantages of these neighborhoods compared to black neighborhoods.
As the first example of these structural advantages and disadvantages, previous research by Brookings found a persistent devaluation of homes in predominantly black neighborhoods, even controlling for objective measures such as home size and neighborhood amenities. Contrary to what other researchers have asserted, additional research conducted by our team clearly demonstrates that these disparities are not due to socio-economic factors but rather are the result of racial prejudice, as these neighborhoods are consistently viewed as less safe and inferior on the basis of racial makeup. .
As a result of this bias and devaluation, once prosperous black neighborhoods often undergo cycles of disinvestment and decay, prompting them to gentrify. In addition to undermining black wealth for individuals and the community, this devaluation also erodes tax revenues through property taxes, compromising the ability of localities to adequately finance public goods and services. White neighborhoods benefit from the opposite dynamic, in which housing is overvalued in relation to the assessed value. Our team has also established evidence that these same undervaluation problems are found when it comes to black businesses.
This interpretation of white privilege as a spatial phenomenon rather than an individual characteristic helps explain why life expectancy in white neighborhoods is higher even though there have been persistent declines in life expectancy for whites people during the last years. For example, from 2013 to 2014, life expectancy decreased for whites but increased for blacks, but this does not appear in the analysis at the neighborhood level. And from 2014 to 2015, there was a national drop in overall life expectancy of 0.2%, but when disaggregated by race, blacks experienced a smaller drop (0.1%) than whites. (0.2%).
Thus, we believe that neighborhood-level differences in life expectancy are linked to residential segregation, which is often driven by income and wealth stratification reflecting a legacy of systemic racism.
Residential segregation is highest in decades
Pundits and politicians often speak of racial progress as if it is an inevitable step in the right direction. But at least on certain parameters, we have lost ground compared to previous decades. This is particularly the case when it comes to racial integration in large metropolitan areas.
According to a study by the Othering & Belonging Institute at the University of California at Berkeley, “81% of metropolitan areas with more than 200,000 inhabitants were more segregated in 2019 than they were in 1990”. The report found that these patterns of segregation both reflect and extend the systemic racism encoded in 20th century law: “83% of neighborhoods that received poor ratings (or ‘redlined’) in the 1930s by policy federal mortgages were from 2010 very segregated. communities of color. These models directly shape the financial characteristics of these neighborhoods, with the report concluding that “neighborhood poverty rates are highest in segregated communities of color (21%), which is three times higher than in segregated white neighborhoods. (7%).
In her new book, Georgetown law professor Sheryll Cashin describes these patterns of segregation as “a residential caste system that hurts those who cannot buy their way to the strongholds of wealth.” In the context of our research, we add that this racialized residential caste system affects neighborhoods that can buy their way to better community health outcomes. Since neighborhoods are often the starting point for the social determinants of health we explored in our report, accessing “better” neighborhoods – neighborhoods with cleaner air quality, more green spaces , higher public spending on public goods – can add years of life.
To be clear, we believe there are many social and political benefits to having more racially integrated neighborhoods. And we strongly oppose the many ways that white wealth enclaves use restrictive zoning, property management, and other similar practices to make it harder for blacks to settle in the neighborhood. But black people shouldn’t have to attach themselves to places that enjoy white privilege in order to thrive. Living in a predominantly black neighborhood shouldn’t be a death sentence imposed for lack of public investment and the kinds of models of “border maintenance, opportunity hoarding and stereotypical surveillance” that Cashin describes.
As we slowly recover from the intersecting health and economic crises caused by the COVID-19 pandemic, it is essential to advocate for the kind of public investment that will create greater equity and enable everyone to lead healthy lives, regardless of what. either his race or his place.