Patterns and Causes
of Disparities in Health
DAVID R. WILLIAMS
The health of the U.S. population has improved markedly over time. Average life expectancy at birth increased by 30 years in the last century, from 47 in 1900 to 77 in 2000 (National Center for Health Statistics 2003). Yet different social groups in the United States continue to experience dramatically varying levels of health. For example, the life expectancy of Asian American women in Bergen County, New Jersey, is 97.7 years, while that of American Indian men in a cluster of counties in South Dakota is 56.6 years (Murray et al. 1998). This 41-year difference in life expectancy indicates that some social groups have health experiences reminiscent of the nineteenth century while others enjoy twenty-first-century health status. Sentiment is growing in many quarters that such large disparities in health are unacceptable.
This chapter provides an overview of social disparities in health in the United States. It begins by outlining the complex social forces that combine to produce variations in health. It then considers the patterns of racial/ethnic differences in health and shows how these must be understood in the context of the heterogeneity of those groups, and the even larger disparities by socioeconomic status (SES) and gender. The chapter concludes by focusing on the opportunities and challenges for reducing social disparities in health in the United States.
Analysts estimate that behavioral patterns account for 40 percent of U.S. deaths, with social circumstances and environmental exposures accounting for 20 percent, genetics 30 percent, and inadequacies in medical care 10 percent (McGinnis, Williams-Russo, and Knickman 2002). Differential exposure to a broad range of social and behavioral factors can importantly affect the distribution of disease, disability, and death. Race, SES, and gender are social categories that are linked to varying exposures to health-enhancing or health-damaging factors in multiple social contexts, including family, neighborhood, and work environments.
The types of stressors to which individuals are exposed, the availability of resources to cope with stress, and the patterned nature of responses to environ-