Why Is Life Expectancy So Low in Black Neighborhoods?

Earlier this year, the National Center for Health Statistics (NCHS) published data showing a 1.5-year decline in national life expectancy in 2020, largely due to the COVID-19 pandemic, which took the lives of approximately 375,000 Americans that year. The NCHS reported that white Americans’ life expectancy declined by 1.2 years; for Black Americans, that number was 2.9 years.

This racial disparity in life expectancy is a lagging indicator of disparities that have existed throughout the pandemic. According to the most recent Centers for Disease Control and Prevention data, Black people are 1.1 times more likely than white people to contract COVID-19; 2.8 times more likely to be hospitalized with the virus; and two times more likely to die from it. These disparities help to explain why, when adjusting for age, Black people account for 22.1% of the nation’s COVID-19 deaths despite only comprising 12.8% of the population.

The causes of these racial disparities are hotly debated, and many fixate on the role of individual behavior—for example, a recent Brookings analysis cited vaccine hesitancy as a key driver of disparate death rates. But while personal behavior matters, social determinants of health at the local level play an outsized role. Because de jure and de facto segregation concentrated Black Americans in specific locales, racial injustices have occurred through place-based discrimination: disproportionate exposure to pollution and hazardous waste, harmful zoning practices, and post-disaster displacement, to name a few. Rather than blaming Black people for their suffering, the conditions of place must be examined to understand the mechanics of racial discrimination that contribute to that suffering.

TWO FINDINGS HIGHLIGHT HYPERLOCAL VARIATION IN LIFE EXPECTANCY PRIOR TO THE PANDEMIC

Finding #1: Neighborhood life expectancy correlates with neighborhood demographics

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Finding #2: Neighborhood life expectancy disparities exist relative to the surrounding metro area

We found that Black-majority neighborhoods had relatively lower life expectancy when compared to the aggregate metro area in which those neighborhoods were located. {snip}

Both findings illuminate the fact that racial gaps in life expectancy manifest as place-based problems. But one alternative way of interpreting these findings is that Black people might carry life expectancy decline with them into the neighborhoods they live in, such that the crucial variable is the people, not the place. Supporters of this view could point to the fact that there are persistent (though narrowing) nationally aggregated racial gaps in life expectancy that extend backward for many decades.

While there is some credence to this view, we don’t think it tells the full story. For example, recent research comparing states found that “geographic inequality in mortality for midlife Americans increased by about 70 percent between 1992 and 2016”—underscoring the significance of place as a driver of outcomes. Additional research using experimental and quasi-experimental methods further highlights the role of neighborhoods as a driver of health and well-being outcomes.

In our recent report on social determinants of health, we identified two place-specific factors that help explain disparities in health outcomes: housing insecurity (including rates of foreclosure and eviction) and exposure to environmental hazards (particularly toxic air), which are both more common in Black neighborhoods. Social determinants related to labor markets—including labor force participation, employment conditions, and access to employer-sponsored health care—are additional factors that are often highly correlated with neighborhood characteristics and location.

Thus, a better interpretation for neighborhood-level differences in life expectancy is that whiteness bestows a noticeable social and economic premium on localities, including neighborhoods—where whiteness is understood not as an intrinsic individual characteristic but rather as a social construct that enables various systemic and structural advantages for these neighborhoods compared to Black neighborhoods.

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This interpretation of white privilege as a spatial phenomenon rather than an individual characteristic helps to explain why life expectancy in white neighborhoods is higher even as there have been persistent declines in life expectancy for white people in recent years. For example, from 2013 to 2014, life expectancy decreased for white people but increased for Black people—yet this does not show up at the neighborhood-level analysis. And from 2014 to 2015, there was a national aggregate life expectancy decline of 0.2%—but when disaggregated by race, Black people had a lower decline (0.1%) than white people (0.2%).

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