The Toll of Inequality

Abstract To take stock of the human toll resulting from racial inequality in the United States, we estimate the number of excess deaths that accumulated among African Americans over the twentieth century as a result of the enduring racial gap in mortality rates. We assemble a wide array of demographic and vital statistics data for all years since 1900 to calculate the number of Black deaths in each half-decade that occurred in excess of what would be projected if Blacks had experienced the same gender- and age-specific mortality rates as Whites. We estimate that there were almost 7.7 million excess deaths among African Americans from 1900 through 1999. Those deaths comprised over 40% of all African American deaths over the century. Excess deaths were highest in the early decades (peaking in 1925–1934), but the only period of sustained decline was 1935–1949. Subsequent reductions in excess deaths were relatively modest and unstable, and in the last decade of the century the percentage of Blacks’ deaths that were excess returned to levels as high as in the first decade. That trajectory is less positive than the trajectory for the racial gap in life expectancy over the century. Excess deaths fell disproportionately among the young in the early twentieth century, but in the succeeding decades they progressively hit harder among older African Americans, many of them in the prime of life when their economic and social pursuits were vital to their families and communities. Excess deaths were also especially heavy among Black women for most of the century. We conclude by discussing the social and policy implications of the excess deaths. We assess trends in the early twenty-first century as we consider the political challenges involved in tackling the continuing excess death toll.