To age successfully is a shared aspiration. We all want to live free of disease and disability, maintain optimal physical and cognitive functioning, and actively engage with our communities and families. Recent medical advances, greater access to quality health care, and successful public health initiatives have improved life expectancy at all ages, and people are spending more time free of disease and disability. These trends in health and longevity give us all reasons to be optimistic about life in old age and have made aging successfully seem less elusive and more tangible. Yet, some aspects of this progress are worrisome because some segments of the older population are not experiencing the same improvements in health and longevity. Stark disparities by race and ethnicity exist, where older racial minorities bear a disproportionate disease burden and have a higher risk for death.
Older blacks, for instance, are particularly disadvantaged with regards to their cardiovascular health. They have higher rates of cardiovascular diseases, experience an earlier onset of disease, have greater disease severity, and face premature death due to cardiovascular diseases. My research with Drs. Eileen Crimmins and Jennifer Ailshire at the USC/UCLA Center on Biodemography and Population Health focuses on health disparities among older adults. Our research shows that older blacks have higher cardiometabolic risk scores than whites or Hispanics. This summary measure of risk is a reflection of the amount of dysregulation across the cardiovascular and metabolic systems of the body, and is associated with subsequent disease and mortality. Our research also shows that older blacks not only start off with the worst cardiometabolic risk scores, their scores also worsen over a strikingly short period of time—four years—whereas risk scores among other groups appear to stay the same or improve.
In a country that is more readily considering itself “colorblind,” these findings are paradoxical and prompt difficult but critical questions: Why, if we are a country that believes in social justice and the equity of all people, do racial disparities in health exist and persist? And why is the health of older blacks disproportionally affected? As a minority aging and health disparities researcher, these are the questions I address by examining pathways that contribute to health disparities and identifying points of intervention. The pathways involved are numerous and complex and operate at the individual, family, neighborhood, and institutional levels. Our work on race differences in cardiometabolic risk show that the disparity is not fully explained by differences in lifestyle factors, such as smoking, diet, and exercise, or in measures of access to care and treatment, such as insurance status and the use of prescribed medication. Thus, other factors beyond individual behaviors and access to health care are at play in sustaining these disparities.
You might ask: “What factor or constellation of factors is formidable enough to divide health along racial lines?” I and many others contend that racial injustice interlocked with social and economic disadvantage are at the root of the problem. Decades of adversity and marginalization have relegated racial minorities to the lowest rungs of our social ladder and have restricted their access to resources and opportunities that improve life chances. Moreover, older blacks face the stress and burdens of a race-conscious society, which further challenge their health throughout their life course, leading to the striking racial disparities we see in late life.
The image I have depicted of the aging experience of older blacks in particular, and racial minorities in general, may seem grim, and the task of ending racial injustice to achieve health equity may seem insurmountable. However, as a self-proclaimed optimist, I recognize and acknowledge the progress that has been made and believe that more progress will come through want and necessity. But to maintain this momentum, we need a social commitment to end health disparities and fight for health equity, a commitment that avoids a misguided “colorblind” rhetoric that obscures the history of racial injustice and fails to address the specific needs of minority communities. Rather, we need to embrace color-conscious and diversity-affirming social initiatives that strive for and will eventually lead to racial equity in health, well-being, and successful aging.
Editor’s note: The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the USC Leonard Davis School of Gerontology.