The difference in rates of premature death between racial groups can be completely explained by socioeconomic factors, a new study from Tulane University found. Researchers found tight connections between early death and material deprivation. Lifespan gaps by race were driven by differences in employment, family income, food insecurity, education, access to healthcare, health insurance, housing instability and relationship status, the study found.
The findings suggest that policy shifts to address and close gaps in those eight socio-economic factors could entirely close the lifespan gap.
The factors that the study focused on are known in research and policy circles as the social determinants of health (SDoH). SDoH are the “non-medical” social, environmental and behavioral factors which drive up to 80% of health outcomes. The Tulane study stands out from previous research concerning SDoH in that it expands the indicators to include metrics on community connection and personal networks – aspects of so-called “human capital” that economists have already shown are linked to financial wellbeing. Recent publications have already identified a health impact for marriage and cohabitation, social networks and housing security, but haven’t weighted their effects within the SDoH.
Average life expectancy for White people is over 76 years, but under 71 for Black people and barely 65 for Indigenous people.
In the Tulane study, Black adults were more likely to have unfavorable levels of all SDoH compared to White adults and thus were at higher risk of dying younger. But when researchers adjusted the data for these SDoH, there was no difference between Black and White premature mortality. This disproves the old notion that genetic differences between races determine lifespan and that an individual’s choices about healthy behaviors are made separate from that person’s socioeconomic reality.
If genetics were entirely to blame, we could let ourselves off the hook. Instead, for society at large – and policymakers specifically – we have to face the reality that the systems and structures we have been part of making may increase the standard of living for some, but at the expense of the mortality and quality of life of others.
The social determinant in this study most likely to lead to negative health outcomes was unemployment. Black and Brown individuals are more likely to be unemployed, a disparity only widened by inequitable college access and hiring and employment bias. The effect of unemployment goes beyond personal finances, Tulane’s researchers found: There is a direct connection between unemployment and long-term health.
The more negative SDoH a person experiences, the more at-risk they are for negative health outcomes. For instance, a person lacking education who is also experiencing housing instability is more likely to have a premature death than an educated person who is only experiencing housing instability. The study showed that people with six or more unfavorable SDoH are significantly more likely to die younger than people with no unfavorable SDoH.
Luckily, there are interventions proven to positively affect SDoHs which would then reduce health disparities between Black adults and other racial groups. Successful workforce development programs which result in meaningful employment would not only produce more economic security but also fewer heart attacks and longer lifespans. Investments in small business development have long been shown to increase wealth creation – but they can also extend people’s lives. Food insurance plans can address food security and other SDoH including education attainment – again making lives not just happier but longer.
Interventions and policies that target individual needs will not be enough to address the SDoHs which affect the racial disparities in premature mortality rates. We also have to find ways to improve community conditions. Negative SDoHs which affect Black and Brown adults more dramatically across the board are systemic and embedded in the current socioeconomic and political landscape. Community-wide and place-based interventions are a powerful method of changing that, and ensuring longer-lasting positive outcomes which span decades and generations. Racial equity should be a goal of these health-focused community solutions, as this study highlights the changes along racial lines in premature mortality.
The Tulane research offers a clear road map to better health and longer lives for more people: eight social and structural indicators that shape mortality, each of which can be addressed with material investment and attention. The next step is for health equity specialists, health systems, policymakers and community members to identify and implement programmatic and policy interventions along those eight vectors, and work toward eradicating the racial mortality gap.
Magdalena Mysliewic was NCRC’s Health Equity Specialist.
Devin Thompson is NCRC’s Director of Health Equity and Impact.