I noted in the story that cancer was only one of the menaces to health and longevity that afflict the urban poor more than others: there were also infant mortality, hypertension, diabetes, obesity, cirrhosis, schizophrenia, accidents, and murders. From low birth weight to high blood pressure, being poor was hazardous to one's health. The health of blacks was also far worse than the health of whites, and the evidence indicted poverty more than race for this disparity—blacks' health was inferior because they more often were poor.
"It could be the struggle that causes these things—the struggle and strain of trying to get by," the woman who was dying told me from her bed. "People who don't have this struggle, they might become ill, but it doesn't seem to be as many of them, or as hard for them to get better. Because there's something to fall back on, and when you're poor, there's nothin'—there's just nothin.'" She'd been thinking more about death as hers approached, and wondering whether there might be such a thing as reincarnation. "Maybe next time I come back I won't be poor," she said with a laugh. She died soon after the story was published.
How much progress have we made in closing the racial gap in health in the 26 years since? According to a new study in the journal Social Science & Medicine, in spite of significant reductions in mortality and morbidity rates generally, "racial disparities in the U.S. remain broad and persistent. Blacks continue to suffer the most severe and broadest range of health disadvantages," with much higher rates of asthma and diabetes, and of cardiovascular, cancer, and infant mortality. While some recent research has focused on genetic racial differences, the authors of the new study—D. Phuong Do of the University of South Carolina, Reanne Frank of Ohio State University, and Brian Karl Finch of San Diego State University—found socioeconomic status to be a more significant cause of the gap. Blacks are still sicker mainly because they're still poorer.
And as the authors noted, since racial discrimination and segregation worsen socioeconomic status for blacks, they are key contributors to the health gap between blacks and whites.
Other studies have shown that the gap isn't mainly a function of inadequate health care, but of differences in health status, a more stubborn problem. Bringing better primary care to hypersegregated black neighborhoods helps, but is far from sufficient. The recent focus on food deserts is laudable but deals with the fringes of the problem. Segregation concentrates and intensifies the ill effects of poverty, the main cause of health disparities between blacks and whites.
Twenty-six years ago, the typical escape from a poor black neighborhood was premature death, and that hasn't changed. Poverty remains a carcinogen, and segregation a cancer.