Unequal Cities

Black Americans die younger on average than white Americans, a gap tied to structural racism and to wider forces that shape population health. Eliminating racial and ethnic health disparities, meaning those that are avoidable, unnecessary, and unfair, has been a national health goal for decades, yet the differences persist, rooted in structural and social determinants of health. Nationally, a Black infant can expect to live four fewer years than a white infant, but the picture shifts considerably from one city to another. In Washington, DC, average life expectancy for Black residents trails that of white residents by twelve years, while in other cities the gap between races is smaller or absent altogether. That raises a pointed question: if equity is achievable in some cities, what keeps the rest from reaching it?

Maureen R. Benjamins and Fernando G. De Maio assemble a team of specialists to examine these racial disparities and the ten-year difference in life expectancy between the healthiest and least healthy large American cities. Their analyses provide data not previously available on life expectancy, deaths from leading causes, and Black-white disparities across the country's 30 largest cities. The essays look at how features of a city, including income inequality and racial segregation, relate to its overall health and to the gap between Black and white residents.

Presented as the first book to look specifically at racial health disparities within and across American cities, it proposes a social justice framework for confronting the inequities it identifies. It also includes case studies meant to help public health advocates, civic leaders, and other stakeholders picture the steps needed to improve their own city's health outcomes and reach racial equity. Contributors include David Ansell, Darlene Oliver Hightower, and Ruqaiijah Yearby, among others, along with members of the West Side United Metrics Working Group.