Black Male Life Expectancy in the United States: A Multi-Level Exploration of Causes

Article excerpt

As one of the richest nations in the world, the United States enjoys many comforts, including a stable government and economy, a robust education system, and access to technology and health care. Not surprisingly, a nation's wealth is positively correlated with the life expectancy of its residents. Demographers project that a baby born today in the US can expect to live 77.85 years. Predictably, our ranking falls behind that of Luxemburg (78.9 years) and Norway (79.5 years), the two countries with a gross domestic product higher than ours. 1^2 However, life expectancy estimations in the United States exemplify the "ecologie fallacy"-the belief that an association observed at the aggregate level applies to individuals.

Disparities in life expectancy along racial and socioeconomic lines are the result of complex social factors in our otherwise low mortality country. By highlighting the relatively shorter life expectancy of black men in our country, I advance the hypothesis that our social environment is a component, though not the sole cause, of shortened life expectancy in black men. In this essay, I describe the life expectancy of black men relative to white men, present data on disease-specific causes of the life expectancy disparity, and place the causes of these diseases on their broader social context

WHICH U.S. RESIDENTS EXPERIENCE LONG LIVES?

Unfortunately, that question can easily be answered-not black men. Black men born in 2004 are projected to die six years sooner than their white counterparts, and seven years sooner than black women (Figure 1). In an analysis comparing years of potential life lost by black and white men with low (0 to 8 years) and high (13+ years) levels of education to that of black women with high levels of education, highly educated black men lost 8.1 years of life and white men lost an estimated 5.2 years of life. By comparison, black men with low levels of education lost 19.9 years of life, while white men lost 11.9 potential years of life.3

Black men have higher mortality rates than white men at every age (Table 1). It is only among adults older than age 65, where this disparity begins to decline. This "survivor effect", demonstrates that if one can survive to old age, the mortality rate is roughly equivalent. According to estimates generated in 2004, white and black men who live to age 65 can be expected to live 17.1 and 15.3 years longer, respectively.4 While this observation is encouraging for a segment of our society, by definition this phenomenon only applies to that relatively small proportion of black men who exceed their life expectancy projections and live into older age.

Over time, life expectancy has increased for all persons living in the U.S. (Figure 2). Despite life expectancy gains in the aggregate, the gap in life expectancy between blacks and whites has not narrowed with time. Between 1940 and 1998 excess mortality in blacks (men and women combined) as compared with whites has ranged between 50,000 and 103,900. The greatest discrepancies of 103,900 and 96,800 were in 1990 and 1998, respectively.5 Shifting the course of this public health crisis requires that we understand the causes of the disparity.

CAUSES OF THE LIFE EXPECTANCY DIFFERENTIAL

In 1991, Time magazine featured an article titled, "Why do blacks die young?"6 Sixteen years later that question generates identical answers. On the macro level, our society is still plagued by subtle and overt discrimination that leads to unequal access to education, economic opportunity, housing, and health care. On a micro- or individual level, black men still engage in adverse health behaviors and have lifestyle characteristics associated with higher mortality. However, some proportion of the adverse health behaviors and lifestyle characteristics is influenced by socioeconomic opportunity and other macrolevel correlates. Despite knowing that the causes and consequences of the black male life expectancy gap "then" and "now" have not changed, a renewed exploration is warranted, if only to call attention to the persistent disparity. …