Economics Study Shows the Racial Health Gap Is Closing

In the nearly three decades from 1990 to 2018, the life-expectancy gap between Black and white Americans narrowed by nearly 50 percent, according to a study conducted by researchers at Princeton’s Center for Health and Wellbeing and published in the fall in the Proceedings of the National Academy of Sciences. The news is encouraging, but a more recent falloff in improving mortality trends for all Americans also raises new questions for researchers. 

The closing of the gap came primarily from improvements in mortality rates among Black Americans, particularly in the poorest counties. In 1990, Black Americans lived seven fewer years than white Americans; by 2018, that number dropped to 3.6 years. Deaths caused by cancer declined especially steeply. Reductions in death from homicide, HIV, and fetal and neonatal conditions also played a large role.

“A lot of that reflects improvements in access to Medicaid and other attempts to make medical care more accessible to people,” says Janet Currie *88, the Henry Putnam Professor of Economics and Public Affairs and co-director of the Center for Health and Wellbeing.

There have also been recent decreases in white life expectancy, especially due to drug overdoses, though this accounts for only a small part of the declining gap between Black and white life expectancies. (Since about 2014, opioids — once a problem predominantly for white Americans — have become equally devastating for Black Americans.)

Perhaps the biggest issue raised by the study is that, despite the long-term improvement, life expectancy has stalled and declined for Black and white Americans alike since 2012. (If it had continued improving at the same rate, the racial gap was on pace to disappear altogether by 2036.) The numbers leave researchers wondering “how we can get back on track, if we went off track,” Currie says. 

The researchers analyzed mortality, age, and place data from 1990, 2005, and 2018, and compared it against similar data for Europeans as a benchmark. Notably, life expectancy in Europe has also flattened (though not declined), “so there seems to be some overall issue that is causing the gains we have seen pretty constantly over the last century” to fall off, says Currie. She speculates that improvements from lower smoking rates, or from innovations in drugs for cardiovascular conditions, may have reached their limit or be at a pause.

Obesity and the rise of youth vaping, which has almost entirely reversed past declines in smoking among younger people, are also enormous concerns. And the opioid crisis remains a scourge that has worsened during the COVID pandemic. “As an urgent public policy matter, if we wanted to get back on track, doing something about the opioid epidemic would probably be the single greatest thing that could be done in the short term,” Currie says. 

The pandemic has impacted communities of color more strongly than white Americans, and poorer areas more than richer. Once official mortality data from 2020 is known, more setbacks to an otherwise positive trend could emerge. Nonetheless, Currie believes that many of the study’s findings remain something to celebrate. “You see that, over time, you do make improvements and things do get better if you take the right policy actions,” she says. “Hopefully that will give people more heart and hope to go on saying, yes, we need to make more policy changes to keep improving on how things are.”