The Death Gap: How Inequality Kills

Ansell identifies three primary reasons for the inequalities in the US healthcare system: Healthcare being treated as a commodity rather than a right; implicit racial bias; and the resource constraints faced by healthcare institutions serving disadvantaged communities. These factors collectively lead to poorer health outcomes for minorities and the poor.

One example of healthcare disparity is the higher breast cancer mortality rate among Black women compared to white women. Despite similar incidence rates, Black women are 40% more likely to die from breast cancer, primarily because they tend to be diagnosed at more advanced stages. As Ansell explains, the discrepancy is not biological but is caused by structural violence. The quality of breast cancer screening and treatment is often lower in predominantly Black neighborhoods due to under-resourced facilities and less-specialized care, leading to missed diagnoses and delayed treatments.

Ansell recounts the story of a middle-aged African American woman whose obvious breast cancer was missed in a mammogram read by a non-specialist radiologist. This incident underscores how lack of access to quality care contributes to higher mortality rates. While the task force’s efforts, including the employment of health navigators to guide patients to high-quality care, have led to some improvement, many challenges remain.