This book has focused on how race and racism affect sickness and mortality among African Americans. Social conditions and economic inequality are now widely accepted as the major causes of sickness and premature death. Numerous social conditions adversely affect health, including poor living conditions, stressful work environments, and strained family and social relationships. Most of these social conditions are the result of economic inequalities, which have grown dramatically in the US during the past few years. High levels of income inequality within nations predict worse health in the population (Pickett and Wilkinson, 2015), and the US has a higher level of income inequality than other Western nations. Moreover, millions of Americans still lack health insurance, despite recent health care reform policies. These inequalities help account for the fact that the US ranks lower than other advanced nations on basic indicators of population health, such as infant mortality and average life span. A college-educated, white, upper-middle class American who practices good health behaviors is, on average, in worse health than his counterparts in comparable industrialized nations (Gilligan, 2015).

Within the US, racial disparities in health have remained stark: Blacks have higher rates of sickness and infant mortality than other races, and the shortest life spans. Black rates of poverty and joblessness are more than twice that for Whites, and black people often live in poor neighborhoods and occupy low-level jobs in the labor market. These social and economic inequalities, however, often mask the significance of race and racism in shaping health outcomes. Racial stereotypes, exclusion, and discrimination are chronic stressors and take a toll on black health. Institutionalized racism operates in less visible ways to undermine health, such as less spending on public services in black neighborhoods, targeting African Americans for risky housing loans, and racial discrepancies in criminal sentencing. The adverse effects of these policies are compounded in a society that emphasizes social mobility through hard work yet offers limited opportunities for the disadvantaged to achieve that mobility. Failure is often internalized, resulting in what Emirbayer and Desmond (2015) have called symbolic violence, the “misrecognizing oneself as something less than a full individual—as something less than a person entitled to dignities, protections, and rights—and thus resigning oneself to a kind of partial and unfulfilled humanity” (Emirbayer and Desmond, 2015: 264).