Health

• Pages: 389-412
• Author: Khiara M. Bridges

389

Chapter 17

HEALTH

When it comes to health care, the U.S. is a big spender. Indeed,

the U.S. spends the most money on health care relative to other high-

income countries.

1

However, the large sums of money spent on health

care in the U.S. have not translated into a healthier population. In

fact, the U.S. appears to be unhealthier than the nations that it

considers its peers. When compared to countries like France, Japan,

the United Kingdom, and New Zealand, the U.S. has the lowest life

expectancies, the highest rate of infant and maternal mortality, and

among adults aged 65 and older, the highest rate of chronic illnesses

like diabetes and heart disease.

These facts raise many questions, and there are many avenues

of inquiry one might pursue in light of them. For example, we might

observe that the high spending on health care in the U.S. is, in part,

a function of the higher costs of health care in the country. We might

then question why health care costs are so high in the U.S., relatively

speaking. Why are MRIs and CT scans more expensive in the U.S.

than they are in other countries? Why is the private insurance price

tag on a coronary angioplasty in Australia a little over $10K while

that same surgery costs an average of $34K in the U.S.?

2

While critical thinkers about race may believe this avenue of

inquiry to be worthwhile, their intellectual commitments convince

them that the most compelling questions about the contradiction

between the U.S.’s high spending on health care and the low levels of

health of its population involve race and racism. Indeed, many

progressive thinkers are interested in how race and racism may

explain the U.S.’s status as the sickest among the wealthiest nations.

I. Introduction

“Health disparities” refers to differences in health states among

groups within a population. We might interrogate health disparities

1

The U.S. spends the most on health care when measured in terms of per capita

spending ($14,570) as well as percentage of the gross domestic product (17.6%).

National Health Expenditure Data, CTRS. FOR MEDICARE & MEDICAID SERVS., https://

www.cms.gov/data-research/statistics-trends-and-reports/national-health-

expenditure-data/historical (last modified Dec. 18, 2024).

2

See Delaney Tevis et al., How Do Healthcare Prices and Utilization in the

United States Compare to Peer Nations?, PETERSON-KFF HEALTH SYS. TRACKER (Sept.

4, 2025), https://www.healthsystemtracker.org/chart -collection/how-do-healthcare-

prices-and-use-in-the-u-s-compare-to-other-countries/#Totalännual%20health

ëxpenditures%20per%20capitaïnÜ.S.%20dollars,%202023%20(current%20pricesänd

%20PPP%20converted).

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HEALTH

Ch. 17

in terms of sex (i.e., what are the differences in the rates at which

people assigned male at birth and people assigned female at birth are

diagnosed with hypertension?), geographic location (i.e., what are the

differences in the rates at which people living in rural areas and

people living in urban areas are diagnosed with hypertension?), or

income (i.e., what are the differences in the rates at which people

with incomes <$25,000/year and people with incomes >$25,000/year

are diagnosed with hypertension?). Progressive race scholars are

most curious about health disparities in terms of race (i.e., what are

the differences in the rates at which white people and black people

are diagnosed with hypertension?). Further, they focus their

scholarly attentions on how racial disparities in health contribute to

the relative sickliness of the U.S. when compared to other wealthy

countries. They observe that if the country eliminated racial

disparities in health, then the overall health of the U.S. would

improve, moving the country closer to the health outcomes achieved

in other industrialized nations.

As a general matter, people of color are sicker and die younger

than their white counterparts.

3

For example, although the overall

infant mortality rate has declined over the years, racial disparities

persist. The infant mortality rate for black babies is 10.9 percent—a

number that is more than twice the infant mortality rate for white

babies (4.5 percent). The infant mortality rates for white babies is

also lower than American Indian/Alaska Native babies (9.1 percent)

and Latine babies (4.9 percent).

4

Another example: For the last forty years, black people have

been dying during pregnancy, childbirth, or shortly thereafter at

three to four times the rate of their white counterparts. In 2023, the

maternal mortality rate for black women was 50.3 deaths per one

hundred thousand live births, while the same rate for white women

was 14.5 deaths per one hundred thousand live births.

5

The Center

for Reproductive Rights reports that in some areas of Mississippi, the

maternal mortality rate for women of color is greater than the rate

3

For a comprehensive itemization of racial disparities in health, see Wendy L

Macias-Konstantopoulos et al., Race, Healthcare, and Health Disparities: A Critical

Review and Recommendations for Advancing Health Equity, 24 W. J. EMERG ENCY

MED. 906–918 (2023); see also INST. OF MED., UNEQUAL TREATMENT: CONFRONTING

RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE (Brian D. Smedley et al. eds., 2002).

4

Infant Mortality, CTRS. FOR DISEASE CONTROL & PREVENTION (Sept. 16, 2024),

https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html.

5

Donna L. Hoyert, Health E-Stat 100: Maternal Mo rtality Rates in the United

States, 2023, CT RS. FOR DISEASE CONTROL & PREVENTION, https://www.cdc.gov/nchs/

data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm (last

reviewed May 1, 2025).