II. Disparities in Black Health in the American Context
Racial disparities in health are not a recent phenomenon. The historical record of disparity is alarmingly longitudinal:
For as long as records have been kept, studies have reported racial differences in health care access and health status in the United States.
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Disparities in Black health have been studied to death, while the patients continue to die. Still more studies and reports are in the pipeline. The Tragedy of American health care is that while disparities in Black health are not new, they remain newsworthy, persisting for centuries right up to the present day. *937 The statistics are grim. Black health disparities are both physical and philosophical. They are clearly dangerous to human life:
Black mortality rates are significantly higher than white rates in seven of the ten leading causes of death, resulting in more than 73,000 excess Black deaths per year. If being Black was a separate cause of death, it would rank sixth in the United States. . . . Black infant mortality in the United States is more than triple the European rate, and significantly higher than infant mortality in countries like Bulgaria, Costa Rica, Estonia, Greece, South Korea, Lithuania, and Oman, among many others. Black men's life expectancy at birth (LEAB) is currently 5.7 years less than white men's; the female disparity is 4.3 years. If a white male student were to agree to become Black, almost six years of life would be forfeited. . . . Even as general population health improves, most Black health disparities remain, especially for men. While gaps in health care access narrowed in the period 1968-1978, during the expansion of Medicare and Medicaid, the gaps in [LEAB] have not narrowed appreciably over the last century. . . . For Black men, the disparity in LEAB is even greater . . . much of the gains in Black health have been among women. At current rates of change, these disparities may persist for many generations, even as absolute health improves for most groups. Nor is the situation likely to improve in the near term. For American children born in 2100, the US Census Bureau projects female LEAB to exceed 91 years for women and 87 years for men. The US Census Bureau blatantly assumes that Black LEAB will improve by 2100, converging almost entirely with white LEAB. This assumption is made without any externally validating data. But even under this wildly optimistic and ahistorical assumption, Black health disparities will outlast every law professor teaching today.
Each year, the federal government collects the latest research and publishes it in the National Healthcare Disparities Report (NHDR). Each NHDR sounds some optimistic notes, but when one has read the similar reports stretching back decades, something more substantial is required for well-founded optimism. The 2007 NHDR searched in vain for evidence of consistent progress: “[t]he 2007 NHDR finds that, across all core measures and for all priority groups, the number of measures of quality and access where disparities exist grew larger between 2000-2001 and 2004-2005.”
Some scholars approach disparities in Black health as if the problem was novel, or recently discovered. Nothing could be further from the *938 truth. Disparities in Black health are rooted in historical tragedy: the American experience of slavery, racism, Jim Crow segregation, and their legacies. These events were not superficial wounds to the body politic. Discrimination against Blacks has been a prominent and persistent feature of American life from the earliest days of English settlement until our present era. Slavery may be gone, but racism and legal segregation is not a phantom from the dim mists of history. We are not talking about a handful of frail veterans who faintly remember the Great War. Legal segregation was laid to rest during my lifetime and the lifetimes of more than one hundred million of my fellow citizens. This tragedy is deep and fresh, ancient and ongoing.
