For all the talk of worsening economic inequality, here’s something that goes unnoticed: Disparities in health between blacks and whites in the U.S. have never been smaller. In 1970, the gap in life expectancy was 7.6 years. Whites lived 72 years on average and blacks about 64. By 2010 the gap had been cut in half. Whites lived about 79 years and blacks about 75.
This progress reflects concerted efforts in minority communities to improve public health, increase access to medical care, and better manage chronic conditions. In New York City, for example, a multifaceted campaign a decade ago to increase colonoscopies completely eliminated disparities in the rates at which blacks and whites were screened. Between 2005 and 2011, infant mortality fell by 16% in black communities nationwide, possibly due to better prenatal care and education about preventing Sudden Infant Death Syndrome.
Homicide is the No. 1 cause of death for blacks between the ages of 1 and 44. Blacks make up 13% of the U.S. population, but they are half or more of all homicide victims. The high homicide rate lowers the life expectancy of black men by almost a full year. In other words, homicide accounts for almost a quarter of the remaining racial gap in men—more than cancer, and more than stroke and infant mortality combined.
What has shrunk the racial gap in life expectancy is mostly that black women are living longer, primarily because they have become better at managing chronic disease. Heart disease, cancer and stroke now claim fewer years from black Americans than they used to. But the victims of violence and homicide are still disproportionately black.
Few seem to realize that this is a major source of the racial health gap. The prevailing view—at least among researchers and advocates dedicated to closing racial disparities—is that narrowing gaps will require better diabetes management, cancer screening and the like. These are certainly important. But reducing violence in black communities might shrink disparities more effectively than anything else.
This means reframing how the medical community perceives violence. Homicide can no longer be understood only as a criminal-justice problem; it needs to be seen as a first-order health issue, a contributor to early mortality. Doctors need to think of violence as a disease, an epidemic even, that infects communities and destroys lives.
There are precedents for this type of paradigm shift. In 1966, a physician named William Haddon was appointed to be the first director of the National Highway Safety Bureau. Dr. Haddon brought a systematic and epidemiological approach to motor vehicle safety. He led the medical community in promoting speed limits, air bags and seat belts, and stigmatizing drunken driving. The death toll has steadily declined. In 2014 there were 32,675 motor vehicle deaths—less than the 33,186 in 1950, even though there are now hundreds of millions more cars on the roads.
More recently, a spike in opioid overdoses, particularly in white communities, has prompted a robust discussion among doctors about the ethics and safety of prescription drugs. Since 2000, drug overdoses have tripled among whites. In March the Centers for Disease Control and Prevention, which rarely advises doctors on how to prescribe medications, released guidelines urging them to limit the doses, duration and conditions for which the painkillers are prescribed. The Food and Drug Administration similarly announced last month that it will require new, tougher warning labels on opioids.
These actions are important and encouraging. But we have seen no similar moves to address violence in black communities. And without concerted efforts, the data is clear: Racial disparities in health will never close.
There are many benefits to conceptualizing violence as disease, thereby placing it in doctors’ purview. The National Institutes for Health, along with private and nonprofit foundations, could fund research to identify the best strategies to prevent homicide. Clinicians could routinely ask patients about violence in their communities, and help develop programs to deter it. Elected officials could design public-health campaigns to discourage violence.
Eliminating health disparities is an important goal. But American can no longer afford to ignore homicide, which is one of the biggest causes of the racial gap. Failing to treat violence as a disease might kill progress toward health equality.
Dr. Khullar is a resident physician at the Massachusetts General Hospital. Dr. Jena is an associate professor of health-care policy and medicine at Harvard Medical School.
Appeared in the April 28, 2016, print edition.