Memorize the phrase "excess deaths." The chances are you'll be hearing it a good deal in the years ahead. The term refers to the number of deaths among black Americans that (theoretically) would not occur if blacks lived under the same health conditions as whites. According to American Health magazine, the number of "excess deaths" in 1987 -- the last year for which the statistics are available -- was 75,000.
That's a lot of deaths: three times the number of AIDS deaths reported last year, for instance, and almost a third of all black deaths recorded in 1987. As Harold Freeman, director of surgery at Harlem Hospital, put it, "About one-third of the deaths that occur in black Americans would not occur if black Americans had the same health status as white Americans. And that's on top of the fact that some of the white deaths shouldn't occur, because there are a lot of poor white people dying as well."
Can it be true that blacks are dying in such numbers simply for want of adequate health care? As a matter of fact, American Health casts some doubt on its own November cover story, in which it says the "excess death" figure is computed by taking "the number of black Americans who die each year, minus the number you'd expect to die in a group of whites of the same age distribution."
That is, the computation includes not just the victims of poor health care but also of behavior-induced causes: drug overdoses, AIDS among intravenous drug abusers and their sexual partners (the leading cause of death among black women aged 15 to 44 in New York and New Jersey) and -- the major cause of death among young black men nationwide -- homicide. But, says American Health, "these killers are more than matched by the fact that cancer, cardiovascular disease, diabetes and just about every other disease you can think of hits blacks much harder than whites."
Why? The magazine, citing a report by the Journal of the American Medical Association, attributes roughly a third of the difference to such factors as high blood pressure, high cholesterol levels, obesity, diabetes, smoking and drinking -- a combination of behavior and genetics. (Blacks appear to have a hereditary predisposition to diabetes and hypertension). Another third, according to JAMA, can be traced to poverty-related causes.
The rest are attributed to "unexplained" factors. "One of those factors," says American Health's editors, "may simply be racism. Some psychologists have suggested that the epidemic of black hypertension is partly due to the stress of living in a society where race is still a major barrier, although the role of genetics is also clear.
"Then there's the striking finding, reported by two Chicago researchers, that even middle-class, college-educated black women are twice as likely to have low-birthweight babies as comparable white women. The problem may stem from the cumulative effect of 'generations of poverty,' the researchers speculate. It may reflect poor nutrition during adolescence. Or these women may have smaller babies because they are under chronic stress -- a possibility supported by recent UCLA research."
A careful reading of the American Health article suggests that its authors may be guilty of a combination of purposeful alarmism (imputing to discriminatory health care "excess deaths" resulting from deadly behavior) and questionable speculation (racism-induced stress).
But there remains an unarguable and shameful kernel of truth in the report: "At every socioeconomic level, black Americans get medical care inferior to that available to whites. In the poorest areas (such as the Mississippi Delta and the sprawling big-city ghettos) just getting to a doctor may be all but impossible."
Nor is there reason to doubt the magazine's conclusion that racially discriminatory health care ultimately raises the cost of medical care for all Americans. "A man with untreated hypertension who ends up on dialysis; a low-birthweight baby placed in the neonatal intensive care unit; a woman with poorly controlled diabetes who becomes blind -- all represent a great cost, not only in human suffering but in health care dollars."
It's true. I wish the editors of American Health had taken greater pains to separate the effects of inadequate health care availability from the effects of underutilization of available facilities -- to examine, for instance, some of the reasons why so few pregnant black women (and girls) avail themselves of free prenatal care at neighborhood clinics.
But to question the magazine's calculation of "excess deaths" is not to dispute its major contentions: that blacks are dying needlessly, that it isn't wholly their fault and that in the interest of both justice and economics, we'd better do something about it.