Life expectancy for white Americans has been greater than for African Americans for as long as records have been available. Life expectancy for all Americans has been lower than for all Canadians since the beginning of the 20th century. Up until the 1970s, this disparity could be explained by the higher mortality rates of African Americans. Since then, white Canadians have lived longer than white Americans. This paper examines two issues: the continuing importance of race in America and what happened in the 1970s to cause the life expectancy of white Americans to fall below that of all Canadians.
Kunitz argues that the policies forming the American welfare state have contributed substantially to both disparities in mortality rates within the U.S. and those between the U.S. and Canada. He examines the life expectancies at birth in the two countries over time, as well as the age-specific rates of death due to causes that the European Consensus Conference on Avoidable Mortality agreed were amenable to interventions by health care systems. These “avoidable” causes of death include maternal mortality, chronic rheumatic heart disease, Hodgkin's disease, breast cancer, tuberculosis, asthma and hypertension, among others. Kunitz chronicles how the legacy of racism has affected America's welfare state and led to diminished access to services for African Americans. He also examines the effect that Canada's social insurance programs—particularly the implementation of universal health coverage in 1972—has had on mortality rates in that country. His findings show that “the Canadian health care system serves the interests of Canadians better than the U.S. health care system serves the interests of white Americans, not to mention African Americans.” Kunitz acknowledges the difficulty of making truly accurate comparisons across race and citizenship, but finds consistent evidence of the impact of unequal access to health services on life expectancy.