health or at greatest risk of illness relative to the general population. This would certainly include black and American Indians and Alaska Natives, but also significant portions of other racial and ethnic groups. Another priority might be explaining differences that go in unexpected directions or are of unexpected size. If, for instance, the reasons for the Asian advantage in mortality and the more limited Hispanic advantage could be understood, that might provide hints about how to improve population health generally. Such arguments need not exclude research attention to other health differences, whether for theoretical or practical reasons, and would have to be qualified by what is not known yet about health differences. We briefly consider arguments about the importance of differences before turning to explanatory factors.


The main reasons for concern about health differences are their relationship to the well-being of individuals and to society as a whole. These two concerns are different and sometimes even at odds: in some circumstances, for instance, societal well-being might demand that individuals be quarantined, whether or not this is beneficial to their own health.

What is an individual’s well-being? Beyond health and economic well-being generally, it includes many other important dimensions, such as physical security, the freedom to participate in society, love and companionship, and the sense of being treated fairly. All such dimensions of well-being should be considered together, but we concern ourselves here, for illustration, with the health and income dimensions. There are important complementarities between health and income. Health is needed to earn income, and to enjoy it. Income is needed to ensure health, and people with lower incomes suffer from worse health and live shorter lives. Health and income should not be thought of as two separate contributors to well-being; they are intimately connected. Physical functions are involved in almost all aspects of earning a living and consuming goods, and health problems have different effects on different activities.

Many people care about the well-being of individuals, and many care particularly about those who have the lowest levels of well-being (Rawls, 1971). In the United States, the income component of well-being varies by race; black earnings and incomes are lower than white earnings and incomes, for example. Health differences show the same pattern. As a result, the racial gap in either income alone or health alone understates the racial gap in well-being (Deaton, 2002). In addition, blacks in the United States have historically suffered from deprivations beyond income and health, particularly deprivations of civil rights. Given this background of historical and current deprivation in multiple dimensions, racial differences

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