Early Death Racial Disparity - Ages 65-74

Early Death Racial Disparity - Ages 65-74 in United States

United States

Certain historically marginalized racial and ethnic groups are more likely to have earlier onset and more severe disease, as well as higher disease-specific mortality. According to the Centers for Disease Control and Prevention (CDC), inequities in the social determinants of health are driven by the negative effects of interpersonal and structural racism, placing communities of color at risk for poor health outcomes. Additionally, chronic stress due to racial discrimination or interpersonal racism may result in psychological distress, as well as increases in adverse health behaviors.

Structural racism — the interaction of institutions, social forces and ideologies that may determine the resources available to communities based on their racial and ethnic composition — contributes to racial inequities in health and premature death. Aspects of life impacted by structural racism include the social determinants of health, such as housing, transportation and neighborhoods; education, job opportunities and income; language and literacy skills; and violence and other forms of discrimination. While not the direct cause of death, these social factors often play a large role in how and why a person dies.

The largest disparities in premature death by race and ethnicity are among:

• Older Black adults, who have the highest early death rate. Older multiracial adults have the lowest rate. The death rate among older Black adults is 2.9 times higher than that of older multiracial adults and 1.5 times higher than that of older white adults. 
• Older Hawaiian/Pacific Islander adults, who have an early death rate 2.5 times higher than that of older multiracial adults and 1.3 times higher than that of older white adults. 

To address racism and its effect on health, comprehensive and upstream solutions are needed at the system and institutional levels. Interventions that improve the quality and accessibility of social factors such as housing, income, employment and education can potentially improve health. To address health disparities, the CDC supports programs that target aspects of the social determinants of health, address barriers to accessing care or focus on populations facing disparities. Examples of these programs implemented across the United States include:

• The National Center for Chronic Disease Prevention and Health Promotion works with American Indian/Alaskan Native communities to develop culturally competent and community-supported public health services and surveillance. Their programs include implementing Tribal Epidemiology Centers and helping tribal communities gain access to traditional fresh produce.
• The National Breast and Cervical Cancer Early Detection Program helps to increase cancer screening, diagnostic, and treatment services among those who are uninsured by providing community navigators and partnering with local agencies for outreach.
• The National Diabetes Prevention Program provides structured lifestyle change programs both in person and online to prevent Type 2 diabetes among high-risk groups.
• The Community Health Workers for COVID Response and Resilient Communities initiative provides financial support and assistance to community health workers, who are established and trusted in their communities and can liaise effectively with health and social services institutions. These relationships can better support the communities impacted most by COVID-19 to stop the spread and move toward health equity. 

According to Healthy People 2030, promoting healthy choices is not enough to eliminate health disparities. They suggest that public health organizations collaborate with partners in other sectors like education, transportation and housing in order to take action to improve the conditions in people's social, economic and physical environments.

One of the founding principles of Healthy People 2030 is that “achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy.” Two of their national overarching goals are to “attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death” and to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.”

Henning-Smith, Carrie, Ashley M. Hernandez, Marizen Ramirez, Rachel Hardeman, and Katy Kozhimannil. 2019. “Dying Too Soon: County-Level Disparities in Premature Death by Rurality, Race, and Ethnicity.” Policy Brief. Minneapolis, MN: University of Minnesota Rural Health Research Center. http://rhrc.umn.edu/wp-content/files_mf/1552267547UMNpolicybriefPrematureDeath.pdf.

Krieger, Nancy. 2014. “Discrimination and Health Inequities.” In Social Epidemiology, 2nd ed., 17–62. Oxford, New York: Oxford University Press. https://doi.org/10.1093/med/9780195377903.003.0003.

Williams, David R. 2012. “Miles to Go before We Sleep: Racial Inequities in Health.” Journal of Health and Social Behavior 53 (3): 279–95. https://doi.org/10.1177/0022146512455804.

Williams, David R., Jourdyn A. Lawrence, and Brigette A. Davis. 2019. “Racism and Health: Evidence and Needed Research.” Annual Review of Public Health 40 (1): 105–25. https://doi.org/10.1146/annurev-publhealth-040218-043750.

Williams, David R., and Selina A. Mohammed. 2013. “Racism and Health II: A Needed Research Agenda for Effective Interventions.” The American Behavioral Scientist 57 (8). https://doi.org/10.1177/0002764213487341.

Williams, David R., and Valerie Purdie-Vaughns. 2016. “Needed Interventions to Reduce Racial/Ethnic Disparities in Health.” Journal of Health Politics, Policy and Law 41 (4): 627–51. https://doi.org/10.1215/03616878-3620857.