## Stark Health Disparities in America: A Geographic and Racial Divide
A recent study by the Institute for Health Metrics and Evaluation at the University of Washington reveals stark disparities in life expectancy across the United States, highlighting the urgent need for equitable healthcare and social policies. The study, published in November 2024, found significant differences in life expectancy not only based on race but also on geographic location. American Indians in the Western and Midwestern states had the lowest life expectancy in 2021, averaging just 63.6 years – a staggering 20-year difference compared to the 84-year life expectancy of Asian Americans nationwide. White residents in Appalachia and parts of the South, along with Black residents in highly segregated cities and rural Southern areas, also experienced significantly shorter lifespans. This underscores the complex interplay of race and geography in determining health outcomes.
Dr. Ali Mokdad, a study author and chief strategy officer for population health at the University of Washington, emphasizes that these disparities exist even within racial groups, demonstrating the crucial role of geographic location in shaping health outcomes. The report concludes that addressing these inequalities requires substantial investment in equitable healthcare, education, and employment opportunities, while simultaneously confronting systemic racism.
Paradoxically, the beginning of the Trump administration in 2025 witnessed a dramatic rollback of public health initiatives designed to address these very disparities. Within the first two weeks, the administration removed race and ethnicity health data from public websites, halted communication from federal health agencies, suspended research and grant funding, and banned diversity, equity, and inclusion (DEI) programs. These actions, critics argue, directly undermine efforts to identify and address the specific needs of vulnerable communities. The removal of clinical trial diversity information from the FDA website and the halting of public health advisories on communicable diseases further exemplify this concerning trend.
Dr. Donald Warne, physician and co-director of the Johns Hopkins Center for Indigenous Health, strongly condemns these policies, stating that they will exacerbate existing health inequalities. He points to the inextricable link between the health challenges faced by Indigenous populations and toxic stress, as well as systemic racism, limited access to healthy food, and the lasting effects of historical trauma. His own Oglala Lakota community in South Dakota, for example, experiences one of the nation’s lowest life expectancies – a mere 60.1 years in 2024.
The study’s categorization of the country into “10 Americas,” each with its distinct life expectancy, further illustrates these disparities. Black Americans, for instance, were divided into three subgroups, with those in the rural and low-income South exhibiting the shortest life expectancy (68 years). While Asian Americans boast the highest average life expectancy (84 years), Lan Ðoàn, an assistant professor at NYU’s Grossman School of Medicine, cautions against considering them a monolithic group. She highlights the need for research into specific subgroups, emphasizing how overlooking internal diversity perpetuates the harmful “model minority” myth.
Dr. Mary Fleming, director of Harvard T.H. Chan School of Public Health’s Leadership Development program, adds that the attack on DEI programs hinders the ability to even acknowledge and address the root causes of health inequities. Racism, she stresses, remains a major factor, and ignoring it makes it harder to eradicate the problem. Significant regional variations in life expectancy exist even within white and Hispanic populations, with Latinos in the Southwest experiencing shorter lives than those elsewhere, and white individuals in Appalachia and the lower Mississippi Valley facing significantly shorter lifespans than their counterparts in other regions.
A previous Stateline report highlights the widening gap in life expectancy between states like West Virginia and New York, attributing the difference to policy, poverty, rural isolation, and unhealthy lifestyles. While both states had similar life expectancies in 1990, West Virginia is projected to fall to the bottom of the rankings by 2050, while New York rises to the top.
Dr. Mokdad advocates for more localized research to identify specific policies and practices capable of bridging these longevity gaps. He suggests that examining areas where lifespans have increased despite persistent poverty, such as the Bronx and Monongalia County, could provide valuable insights. In contrast, areas like Clark County, Indiana, and Henry County, Georgia, show declining life expectancies despite higher incomes. Dr. Eric Yazel, Clark County’s health officer, attributes this to a complex mix of urban and rural health issues, including the opioid and methamphetamine epidemics plaguing the Ohio River Valley.
Nationally, while overdose deaths have begun to decline among white individuals, they continue to rise among Black and Native populations. Indigenous communities were particularly hard hit by the COVID-19 pandemic, experiencing a near seven-year drop in life expectancy between 2019 and 2021. Calvin Gorman, a resident of the Navajo Nation, shares heartbreaking accounts of friends lost during the pandemic, attributing many deaths to alcohol use and isolation. Dr. Warne concludes that addressing these health disparities requires a multifaceted approach, including economic development as a crucial public health intervention. He emphasizes the importance of creating opportunities within these communities, acknowledging the challenges faced by those who choose to leave their homelands due to lack of opportunity.
This story originally appeared in Stateline.