Race and Mortality

One of the great U.S. national tragedies is the variance in life expectancies between blacks and whites. According to statistics released by the Department of Health and Human Services in April, black men live an average of 7.4 years less than white men (64.9 years to 72.3), black women live an average of 5.5 years less than white women (73.4 years to 78.9) and the black infant mortality rate is double that of whites.

These shocking statistics have been vastly underreported by the media, which devoted more attention to a study claiming that left-handed people die at a younger age than right-handers.

Among those who have commented on the phenomenal difference between black and white mortality and infant mortality rates, many argue that closing the differential will depend primarily not on expanding government programs to provide prenatal care and child immunization, but on reforming personal behavioral decisions relating to such issues as alcohol consumption, tobacco use and violent resolution of problems. Despite the importance of government programs, says Louis Sullivan, secretary of Health and Human Services, "the government can only do so much. As a nation, we often pay for a failure of personal responsibility." Similarly, syndicated columnist William Raspberry argues, "it seems clear that many of black America's problems, from high incarceration rates to youthful deaths to high infant mortality, are behavior induced."

This approach skirts issues of access to health care and the disproportionate effect of workplace-related illnesses on African-Americans who are more highly concentrated in blue collar jobs than whites, but it does raise important questions about behavioral-related health issues which cannot be ignored.

In categorizing behavioral choices as individual decisions, however, Sullivan and Raspberry tend to overlook the social roots of behavioral choices and the public and institutional responsibility to address those causes.

For example, over 400,000 people die in the United States each year from smoking-related illness. Secretary Sullivan says that 10 percent of infant mortality can be traced to tobacco use by pregnant mothers. Blacks, who smoke at a higher rate than whites, suffer the ill effects disproportionately. But the decision to smoke is not a personal decision made in a vacuum; it reflects social and corporate influences, most notably cigarette advertising.

Tobacco companies bombard the African-American community with a vast array of advertisements and promote more dangerous brands to blacks than they do to whites. Black magazines such as Jet and Essence receive proportionately more revenues from cigarette advertising than do other consumer magazines. Billboards promoting tobacco products are four to five times more prevalent in black communities than in predominantly white communities. And many of these ads push "mentholated" cigarettes, which are higher in nicotine and tar. A 1987 study in Public Health Reports showed that 65 percent of cigarette ads in black magazines promote mentholated brands, while only 15 percent of the cigarette ads in magazines targeting white readers were for menthol cigarettes.

Sullivan, to his credit, has criticized the tobacco companies, but other societal causes of black mortality have received less of his attention.

Alcohol consumption follows the same pattern as tobacco. The alcohol companies target the black community for sales and push malt liquor brands of beer which have a higher alcohol content, and blacks suffer from alcohol-related diseases at a higher rate than whites.

Violence is another major reason blacks die at a younger age than whites, with homicides responsible for more young black male deaths than all other causes combined. But this too is a social problem and requires social cures. Stringent gun control laws would go a long way to cutting down the murder rate.

Secretary Sullivan, unwilling to buck the Bush administration on this issue, refuses to support gun control, saying it does not address the fundamental source of violence. But the fundamental source is not a failure of personal values. As has been amply documented, violence and crime correlate strongly with unemployment and a sense of economic hopelessness and alienation, issues that the federal government has a responsibility to address.

Initiatives in the African-American community to address self- destructive behavior are important, but those promoting an ethic of individual responsibility must be very careful not to shift attention away from the social causes of, and solutions to, health problems in the African-American community. In a time when government leaders and opinion makers are increasingly seeking to individualize blame for social ills, we must not lose sight of the role that corporate and government policies play in molding behavior.