With Age, Blacks Fall Into Poverty as Their Health Worsens

Abstract:

As Black Americans age, the impact of structural long-term economic racism and health disparities converge to offer a dismal outlook for their final years. Black older adults are sicker and more vulnerable to chronic diseases and illnesses than are older White Americans. This health crisis comes to a head at a critical time: when they are most vulnerable financially, with low incomes and heavily dependent upon Social Security. This article examines the historical roots of today’s racial disparities in health and finances and proposes solutions such as housing assistance and greater access to healthcare to improve outcomes.

Key Words:

ageism, discrimination, finance, healthcare, racism, Social Security  

As Black Americans age, the impact of structural long-term economic racism and health disparities converge to offer a dismal outlook for their final years.

Black older adults are sicker and more vulnerable to chronic diseases and illnesses than are older White Americans (CIGNA, 2014). This health crisis comes to a head at a critical time: when they are most vulnerable financially, with low incomes and heavily dependent upon Social Security.

These disparities were highlighted during the COVID-19 pandemic, when Black Americans suffered disproportionately both economically and in terms of health. Many deaths during the pandemic were related to pre-existing chronic conditions. The impact of COVID was so strong that life expectancy of Black and Latino Americans dropped by three to four times that for Whites in the United States (Andrasfay & Goldman, 2021).

As with most economic downturns, Black Americans in 2020 were less prepared fiscally and were impacted to a greater extent. They faced a sharp rise in unemployment and wage loss due to the pandemic, which had a big impact on their savings habits (Edwards & Lopez, 2021). They also were concentrated in low-pay service jobs, which put them on the frontlines during the pandemic (Pryor & Tomaskovic-Devy, 2020). Historically, they have had lower savings and lower net worth than White Americans (Moss et al., 2020).

The strains brought by the pandemic only added to the stress already carried from enduring decades of racism, and its impact on the mental and physical health of Black Americans. Per the American Psychological Association (2018), “… Exposure to cumulative experiences of racism has resulted in limited access to resources such as education, employment, health care, housing, and political participation, contributing to health disparities and increased rates of mental health disorders such as depression, anxiety, and dementia” (para. 5).

This is compounded by structural ageism and ableism, which result in older and disabled Black Americans’ exclusion from social activities; difficulty accessing healthcare, community services, and other vital supports; and discriminatory policies.

Black Elders and the Racial Wealth Gap

“If you’re the average Black person in America and you can’t participate in wealth generating activities because of the system, when you get to retirement you’re not going to have as much wealth,” said Gary Cunningham, former CEO of Prosperity Now. “Even in the middle class, Blacks don't have as much wealth for retirement as the dominant group because there are generational transfers that occur as well” (G. Cunningham, personal communication, May 9, 2023).

• In Black households headed by someone between the ages of 55 and 64, median total assets in 2019 were $54,530, compared with $383,900 for White households in the same age group (Black Wealth Data Center, n.d.).
• One-third of older Black couples and nearly two-thirds of unmarried Black elders rely upon Social Security for nearly all of their income (National Committee to Preserve Social Security and Medicare [NCPSSM], 2022).
• The median White family has 10 times the wealth of the median Black family; Black Americans earn $1 million less than White Americans in their lifetimes (Noel et al., 2019).

While Black older adults make up 9% of the older adult population, they represent 21% of those older adults living below the federal poverty level, and the poverty rate for Black elders in the United States is more than twice the rate for all elders (Diverse Elders Coalition, n.d.).

Our economic structures also sideline older people and people with disabilities due to misconceptions about their capability. This particularly impacts people of color, as they are disproportionately represented in low-wage work that often requires physical strength (19.2% of Latinx and 14.3% of Black workers vs. 8.6% of White workers; Cooper, 2018).

As a result of these inequities, Black Americans earn less, save less, and are ill-prepared for retirement.

Forty percent of U.S. households are expected to run out of money in retirement, and that number jumps to well over 50% for Black Americans (Groves, 2023).

Only 50% of Black Americans are covered by a retirement plan, compared to 60% of White Americans (John et al., 2022). Black individuals are heavily concentrated in low-paying and part-time jobs that don’t offer retirement plans.

Structural Racism Robbed Blacks of Homes and Property

Between segregation, redlining, and outright racism, Black Americans have been prevented from creating generational wealth through homeownership via laws and policies by local, state, and federal governments and businesses. Race riots in Tulsa, OK, and dozens of other American cities left once-thriving Black communities damaged and destroyed by angry White mobs.

Black World War II veterans were denied benefits awarded to White veterans, including Veterans Administration mortgage loans and other housing assistance, educational assistance, and health benefits. The loss of generational housing wealth of these Black veterans is incalculable.

Social Security

White families have about 6 times more in average retirement savings than do Black families, because workers with lower earnings have a harder time saving.

The average White male earns $2.7 million over a lifetime, while the average Black male earns $1.8 million. Social Security is crucial for Black women, who typically live longer than Black men (NCPSSM, 2022). The average Social Security income in 2019 for Black men ages 65 and older was $14,409, compared to $12,806 for Black women in the same age group (Social Security Administration, 2021).

The convergence of these issues is particularly devastating for Black women. They earn about $1 million less than White men over their careers (National Women’s Law Center [NWLC], 2021). They are more likely to sacrifice employment to serve as care providers for spouses or children. Also, their jobs are concentrated in the low-paying service industry without pensions or other retirement savings (Frye, 2021). And because Social Security payments are based on wage history, Black women end up with lower monthly checks.

According to NWLC (2021), “Between 2014 and 2018, nearly one in four (22%) Black women in the U.S. lived in poverty, and Black mothers are only paid 50 cents of every dollar paid to white fathers. Moreover, Black women are more likely than white women to be the primary breadwinners for their families, which impacts their ability to build wealth and savings.” As a result, Black families are more vulnerable to ageist and ableist structural barriers to employment and healthcare, often passed over by employers, and have a higher rate of disability, due to lack of access to medical care.

As Black women age, they are more likely to age alone with low income and burgeoning health issues. They have limited access to medical care and high-cost drugs. They increasingly will face discrimination related to race, age, gender, and disability (White, 2023).

Black Elders and the Racial Health Gap

A major concern is that older Black Americans face declining physical and mental health and increased isolation and loneliness when they are also crippled by low or no income and reduced Social Security payments.

Black elders are at higher risk for heart diseases, stroke, cancer, asthma, influenza, and pneumonia, diabetes, and HIV/AIDS compared to White Americans, according to the U.S. Department of Health and Human Services’ Office of Minority Health (OMH, 2021).

“Time does not equal progress,” said Dr. Keith C. Ferdinand, professor of medicine at the Tulane University School of Medicine. “Life expectancy has gradually increased over the last several decades for all Americans. But there's a persistent White-Black mortality gap. And it’s primarily driven by cardiovascular disease” (K. Ferdinand, personal communication, May 12, 2023).

“Health issues are more problematic for Blacks because they suffer from comorbidities—hypertension, diabetes, kidney disease at a younger age,” said Dr. Celia Maxwell, associate dean of research at the Howard University College of Medicine. “If you're starting to have these chronic diseases and you are diagnosed earlier, when you’re ages 20 to 49, obviously, by the time you get older, you’re in worse shape, just because you have had these comorbidities so much longer,” she added. “By the time you get to 65, you’ve had a chronic illness for 40 plus years, as opposed to if you start in your late 40s, early 50s.” (C. Maxwell, personal communication, May 2, 2023).

Those problems manifest themselves in the already fragile health of Black Americans, which progressively worsens as they age.

• Nearly 4 in 10 Black men ages 18 or older have high blood pressure, a rate 30% higher than that of White men; Black men’s risk of a stroke is twice that of White men (OMH, 2023b, 2023c). For Black women, 45% of those ages 18 and older have high blood pressure, a rate 60% higher than White women (Mieres, n.d.).
• Black women are 41% more likely to die of breast cancer than White women (American Cancer Society, 2022, p. 15).
• Black men in 1990 had a 47% higher cancer death rate than White men, which by 2016 dropped to a 19% higher death rate (American Cancer Society, 2019). 
• Black Americans are 60% more likely to be diagnosed with diabetes than Whites, and nearly twice as likely to be hospitalized (OMH, 2023a). 
• Blacks are more than twice as likely as Whites to suffer from Alzheimer's and other kinds of dementia (Steenhuysen, 2023). 

The impact of COVID in the Black community is long term. One of the effects of the pandemic is that cardiovascular mortality is worsening among Black Americans (K. Ferdinand, personal communication, May 12, 2023).

The Impact of Structural Racism on the Health of Black Older Adults

“I think a good deal of [poor health outcomes for older Black Americans] is attributed to systematic racism,” said Maxwell. “Some of it might be attributed to genetics. But even with genetics, if you get consistently good care, you mitigate some of the bad outcomes. So … implicit bias and racism plays a role also. You're getting sick with chronic illnesses earlier.”

“Obviously some of it is due to lifestyle—your diet is poor,” she added. “But you live in a food desert, really no supermarkets. What you usually have is these little corner markets…. It’s mostly pre-packaged, sodium, high sugar, high-fat foods.”

“So now we've seen some youngsters 15, 16, 17 with hypertension, obesity, with early diabetes,” said Maxwell. “That should not happen.” (C. Maxwell, personal communication, May 2, 2023).

Black Americans face more lifetime stress than White Americans because of racial inequality and discrimination. They’re more likely to prematurely lose close family members, including children. Losing a child by age 40 increases the risk of developing dementia, which Blacks already face a higher risk of developing compared to Whites (Umberson et al., 2019). By the time Black Americans turn 60, they are 90% more likely than their White peers to experience at least four deaths of family (Stern, 2017).

Healthcare

Mistrust of health professionals runs deep in the Black community. The medical community has a long history of mistreating Black Americans—from experiments on enslaved people to the forced sterilizations of Black women and the infamous Tuskegee syphilis study, in which treatment was withheld from hundreds of unknowing Black men for decades so doctors could track the course of the disease (Horstman et al., 2022).

“If you were Black, in the ’40s or early ’50s, you really couldn't see a dentist in many communities unless this dentist was Black,” said Maxwell (personal communication, [May 2, 2023]). “Do you know who they would send you to? The veterinarian. So, the distrust of healthcare stems from a lot of things including memories of abusiveness.”

Maxwell said the same communities that don’t have supermarkets also don’t have decent healthcare. “So, it's multifactorial,” she added. “It has to do with implicit bias, some racism, there’s some unequal provision of services, particularly if people are Black or brown and your provider is not. He or she can't understand your particular circumstance. Seniors as a whole have a harder burden to bear and seniors of color particularly have a big burden” (C. Maxwell, personal communication, [May 2, 2023]).

Regina Koepp, a geropsychologist based in Atlanta, GA, wrote that the stress Black Americans experience as a result of racism is associated with mental health conditions like depression, anxiety, insomnia, and other serious conditions such as post-traumatic stress and substance use disorders: “It’s essential that aging, health care, and mental health providers strive for greater awareness and training to properly address race-related stress and the toll racism takes on African American older adults” (Koepp, 2020).

A recent study on disability, race, and ethnicity said that 1 in 4 members of the Black community have a disability (Slayter, 2021). And there are questions about doctor training and clinical drug trials being overwhelmingly tilted to Whites. A New York Times story examined how dermatologists are trained to diagnose problems with White skin, which often look different on dark skin (Rabin, 2020). And Black women say they are often dismissed or ignored by medical care providers (Washington et al., 2022).

The serious health problems faced by tennis champ Serena Williams after the birth of her first child and the death of three-time Olympic medalist Tori Bowie from “complications of childbirth” put in sharp relief the harsh realities facing Black women at childbirth. Three out of the four women who ran the 4 X 100 relay in the Rio De Janeiro Olympics had life-threatening pregnancies, according to Bowie’s teammates Allyson Felix and Tianna Bartoletta Madison (Cohen & Cash, 2023).

Black and Latino older adults also said they commonly experienced racial discrimination and bias in the U.S. Healthcare system, according to the Commonwealth Fund. “The findings highlight the dual challenges of racism and ageism these individuals face in getting the medical attention they need” (Horstman et al., 2022).

Social Isolation

Social isolation leads to a host of health-related issues for all older adults, but especially Blacks. Ferdinand said that a lack of adequate transportation affects access to health services and healthy foods: “Those patients with limited means and with social isolation are more prone to cardiovascular risk, are less able to get access to appropriate healthcare, or even … preventive care, access heart healthy diet, fresh fruits, vegetables, new sources of protein” (K. Ferdinand, personal communication, May 12, 2023).

Black people, especially older Black people, are relegated to poor, high-crime metropolitan areas due to decades of redlining, cycles of poverty, and a long history of segregation. Additionally, older Blacks who live in isolation or in neighborhoods where safety is a concern will not be able to maintain physical activity.

Drug Prices

Drug prices often put treatment out of reach for low-income Americans, especially poor Black elders. New drugs appear to improve the ability to survive diabetes, but they can cost more than $11,000 a year (Amin et al., 2023). New medications for heart disease can cost more than $4,000 a year (Hirschler, 2015). The high cost is a barrier. “So now, the White-Black mortality gap is not potentially improved but may even widen” (K. Ferdinand, personal communication, May 12, 2023).

Also, there are few Blacks in clinical trials. ProPublica found that in trials for 24 of 32 cancer drugs approved by the FDA since 2015, fewer than 5% of the patients were Black, though they make up 13.4% of the U.S. population (Chen & Wong, 2018). That leaves questions as to whether the drugs are as effective in Black patients or if there are more or different side effects.

Protect Our Care (2021), an organization dedicated to making affordable and equitable healthcare available for all, said 30% of people who take prescription drugs struggle to pay for them. The burden is especially heavy for those earning less than $40,000 per year, whose medication costs are greater than $100 per month. “These factors disproportionately impact Black Americans, who are more likely to require medications for chronic health conditions, while simultaneously earning household median incomes nearly $30,000 less than White counterparts,” the report said (Protect Our Care, 2021).

Helping Older Black Americans Face These Challenges

Housing assistance, financial assistance programs, and improving access to healthcare and education, as well as increasing in-home elder care, can help solve some of the issues. Programs to help eradicate housing discrimination, age discrimination, and discrimination against people with disabilities would also help.

But, as with all the racial health and wealth gap issues, some of the surest solutions involve government programs and government funding—which may be difficult to find in today’s atmosphere of political polarization.

“Maintaining the status quo translates into another 200 years before African Americans have the same level of wealth as their white counterparts,” said the Center for American Progress. “The Black-white wealth gap is a product of intentional systematic policy choices. The only way to correct this wrong is to make intentional systematic changes in response” (Hanks et al., 2018).

Rodney A. Brooks is an award-winning journalist who writes about retirement and racial health and wealth disparities. He has written for many publications, including USA TODAY, The Washington Post and National Geographic, and is the author of Fixing the Racial Wealth Gap: Racism and Discrimination Put Us Here, But This Is How We Can Save Future Generations (August Press, 2022).

Photo credit: Shutterstock/Bricolage

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