The Black Papers: A Blueprint For Addressing Health Inequities

At a time when technological advances have allowed many people to enjoy longer lifespans, Black people live 5 years less – on average –  than their white counterparts, according to the National Academy of Medicine (2024). Only American Indian/Alaska Native people experience a lower life expectancy than Black people, according to the U.S. Centers for Disease Control and Prevention (CDC, 2023). In some states, the Black/white disparity is even greater.

This isn’t happenstance. It’s a result of policies promulgated and reinforced by structural racism. To get something different, we must hold elected officials accountable for doing something different. Fortunately, the soon-to-be-released Black Papers: A Policy Agenda for Black Liberation in the 21st Century outline several recommendations for addressing inequities and health disparities.

Data consistently show that overall, across the healthcare system and throughout their lifespan, Black people, when compared to white and sometimes other population groups, have and have had less access to affordable, high-quality healthcare services and treatments. Black people are more likely to live in poorer states of health and experience worse health outcomes, including dying prematurely from preventable causes (CDC, 2023). This is likely compounded by higher levels of stress influenced by unemployment or underemployment, untreated mental health illnesses, substandard housing, and living in a persistent state of fight-or-flight due to racism.

These indices are across the board.

·       Black women are three to four times more likely to die from pregnancy-related causes than white women, regardless of income or education levels (American Journal of Public Health, 2023).

·       Black babies are more than twice as likely to die before their first birthday compared to white babies (March of Dimes, 2024).

·       Black men are nearly two times more likely than white men to be diagnosed with prostate cancer, disproportionately more likely to be diagnosed late with advanced stages of the disease, and are two times more likely to die from the disease (ACSCAN, 2023).

·       Black people with mental health illnesses are nearly 2 times less likely than whites to receive mental health treatments and services, and across certain mental health conditions and illnesses and age cohorts, that disparity is even greater (Administration for Children and Families [ACF], 2023; National Institute of Mental Health, 2023).

If current trends continue, the United States will drop from 80th globally in healthy life expectancy in 2022 to 108th by 2050—a dramatic decline in just over 25 years (Institute for Health Metrics and Evaluation, 2024). These projections are even worse for U.S. women, whose ranking is expected to fall from 19th (in 1990) to 74th by 2050. For men in the U.S., the ranking will likely drop from 35th to 65th during that same timeframe. These drops in healthy life expectancy will likely be even worse for Black people and American Indian/Alaska Native people who already experience the lowest life expectancies in the United States.

This should concern us all. Health disparities and inequities cost lives and money. For instance, according to the Joint Economic Committee of the U.S. Congress (2023), these health disparities cost the U.S. economy an estimated $1.24 trillion annually through:

• Premature deaths
• Excessive medical costs
• Lost economic productivity

Furthermore, mental health inequities cost the U.S. economy an estimated $477.5 billion every year. Without immediate action, the cost could rise to over $14 trillion by 2040 (Dawes et al., 2024). These economic impacts result in increased healthcare costs, reduced workforce productivity, and increased strain on public resources. And no one is immune. Addressing these grave disparities and inequities benefits not only the healthcare system, but the entire U.S. economy (Brookings Institution, 2024).

The central message for us all to hear and embrace is that health inequities are a collective issue. Health inequities and disparities cost the nation $1.24 trillion every year. Eliminating health disparities and advancing health equity will not only save millions of lives, a disproportionate number of which are Black, but also will strengthen the overall national economy.

While it is true is that overall, Black people experience higher rates of chronic and acute health conditions, uninsurance, poor healthcare quality and worse health outcomes when compared to white individuals, it is important to recognize that these disparities are not mainly because of genetics, personal lifestyle decisions or biological reasons. These disparities are largely driven by political, social, economic, educational, and geographic conditions that have profound impacts on health. Therefore, it is impossible to discuss Black health and wellness without focusing on the differences and relationship between health disparities and health inequities. 

Fortunately, we know what to do. We have a blueprint, an architectural rendering, if you will, of a plan to make our communities healthier while eradicating inequities and disparities. If we focus on the political and social determinants of health and the factors that arise from them, we can meaningfully advance health equity. Genetics and biology play a part, but research shows they play a minor role compared to the impact and influence of the political and subsequent social determinants of health. So let’s focus there.

 This essay, an edited excerpt from Chapter 10, is pulled from The Black Papers. Chapter 10 was penned by Britt Weinstock, Dr. Linda Elam, Dr. and Dr. David J. Johns.

Dr. Weinstock is an Associate Professor in the Department of Political Determinants of Health, the School of Global Health, Meharry Medical College, and Principal and Chief Strategist at The Health Equity Strategies Group. Dr. Elam is an independent consultant and health policy and management leader with deep expertise in the financing and delivery of health care to vulnerable populations.

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