Death has been poetically referred to as the “great equalizer,” yet epidemiologic data tell a different story. The age at which one dies varies dramatically by race and gender, with women maintaining a clear advantage over men, and whites and Hispanics enjoying longer life spans than their black counterparts. One of the most persistent disparities in life expectancy at birth, the black-white gap, has narrowed over the past century—reaching an all-time low in 2010. Throughout the 20^th century, life expectancies have increased for all subgroups in the United States, as shown in the first figure below.

Increases in the early 20^th century are due mainly to improvements in sanitation, nutrition, effective public health initiatives, and the development of vaccines for some infectious diseases. Since the mid 20^th century, life expectancy increases mostly reflect advances in medical technologies that have lowered death rates due to heart disease, cancer, stroke, and chronic lower respiratory diseases. In the last two decades, gains have been steepest for black men, due largely to improved treatment of heart disease and AIDS among this group.

 

Despite the gradual (though incomplete) convergence shown above, stark race gaps in life expectancy at birth persist today. The figure below reveals that a non-Hispanic black baby boy born in 2010 can expect to live just 71.4 years, compared to 76.4 and 78.5 years for non-Hispanic white and Hispanic men, respectively. Although women live considerably longer than men, a black baby girl born in 2010 is expected to live 3.5 fewer years than her white counterpart, and roughly 6 years less than her Hispanic counterpart (77.7 versus 81.1 and 83.8 years, respectively).

 

What accounts for these persistent (albeit declining) disparities? Part of the answer lies in how life expectancy at birth is calculated. This snapshot of a population’s longevity refers to the average number of years a new baby can expect to live. As such, it is highly sensitive to premature death; estimates can be depressed considerably by deaths in infancy, childhood, or young adulthood. For blacks, and black men in particular, premature death is all too common. Infant mortality rates are roughly twice as high among blacks as whites, and homicide rates are roughly five times higher, with an even more pronounced gap among men ages 15–24. These disparities in early mortality risk contribute to the disparities in life expectancy at birth.

Persistent inequalities over the life course also account for the black disadvantage. Blacks are less likely than whites to have health insurance, regular medical care, and early screening for health problems. They also have less access to nutritious food in their communities and are less likely than other ethno-racial groups to live in exercise-friendly, safe neighborhoods. Blacks are more likely to experience neighborhood poverty, racism, poor quality employment, and other stressors that may increase their risk of illness and death.

Latinos face many of these structural obstacles as well, yet some experts have argued that their health advantage reflects two main factors: selective migration and high levels of health-buffering social support. First, those Latinos who moved to the United States may be particularly healthy and robust, to have withstood and survived the rigors of the migration process (the “healthy migrant” thesis). Others argue that high levels of social support, especially for pregnant women, infants, and older adults, contribute to the overall Latino longevity advantage.Through the process of “selective survival,” the steep life expectancy gaps evidenced earlier in life fade.

Interestingly, blacks’ relative disadvantage in longevity diminishes in old age. If black men and women withstand the challenges of neonatal, childhood, and young adulthood health threats and survive until age 65, their future time horizons start to approximate their white and Hispanic counterparts. At age 65, a black man can expect to live another 16 years, compared to 18- and 19-year horizons for white and Hispanic men, respectively. Similarly, a 65-year-old black woman can expect to live to about age 85, whereas her white and Hispanic peers can expect to live just one or two years beyond that. Through the process of “selective survival,” the steep life expectancy gaps evidenced earlier in life fade.

From a policy perspective, the most effective way to ensure that blacks, whites, and Latinos survive until their later years is to eliminate economic disparities that impede access to timely high-quality care and encourage social environments that foster healthy living.