More education typically leads to better health, yet Black men in the U.S. are not getting the same benefit as other groups, research suggests.
The reasons for the gap are vexing, experts say, but may provide an important window into unique challenges Black men face as they try to gain not only good health but also equal footing in the U.S.
Generally, higher education means better paying jobs and health insurance, healthier behaviors and longer lives. This is true across nearly all demographic groups. And studies show life expectancy is higher for Black men with a college degree or higher, compared with those who have not finished high school.
But the increase is not as big as it is for whites. This comes on top of the many health obstacles Black men already face. They are more likely to die from chronic illnesses like cardiovascular disease, diabetes and cancer than white men, and their average life expectancy is lower. Experts point to a variety of factors that might play a role, but many say the most pervasive is racism.
Researchers note that while Black men and women face many of the same challenges, Black women generally have a longer life expectancy than Black men. (They also point out that for now it is difficult to draw conclusions about Hispanic people because of a lack of studies on these issues.) As a result, many experts say that these health problems stem from a persistent devaluation of Black men in U.S. society.
"At every level of income and education, there is still an effect of race," says David Williams, a professor of public health at Harvard University who decades ago developed a scale that quantified the connection between racism and health.
The precise difference in health gains between educated white men and educated Black men is hard to pinpoint because of differences in study designs. Some studies, for example, look at life expectancy, while others look at disease burden or depression.
Experts say, however, that the evidence is strong and convincing that these gaps have persisted over many years. A 2012 study published in Health Affairs, for example, found that life expectancy for white men with the most education was 12.9 years longer than for white men with the least education. For Black men, the difference between the most and least educated was 9.7 years.
In addition, other research shows how that gap plays out. A 2019 study examined the difference in years of "lost life" — years cut off because of health challenges — between the groups. Educated Black men lost 12.09 years of life expectancy, while educated white men lost 8.34 years, according to the study, published in the Journal of Health and Social Behavior.
Racism affects Black men's health and it is persistent, experts say.
"No matter how far you go in school, no matter what you accomplish, you're still a Black man," says Derek Novacek, who has a doctorate in clinical psychology from Emory University and is now at UCLA researching Black-white health disparities.
S. Jay Olshansky, a professor of epidemiology and biostatistics at the University of Illinois in Chicago and lead author of the 2012 study, says possible risk factors for various diseases and environmental issues could also play a role.
"I'd be very surprised if this wasn't part of the equation," he says. "The risk of diabetes and obesity is much higher among the Black population, even those that are highly educated."
Among other possible causes that researchers are probing are stress and depression.
"When you follow other groups with more education, depression declines," says Dr. Shervin Assari, who studies race, gender and health and is associate professor of medicine at Charles R. Drew University of Medicine and Science outside Los Angeles. "But when you look at Black men — guess what? Depression goes up."
Depression is often an indicator of physical well-being as well as a contributing factor to many chronic illnesses, such as hypertension, obesity and diabetes.
Isolated at Home and Work
Researchers who study the health of various racial and ethnic groups, as well as the social factors that influence health outcomes, see cause for concern. The findings suggest that the power of discrimination to harm Black men's lives may be more persistent than previously understood. And they could mean that improving Black men's health may be more complicated than previously believed.
"What has surprised me is how powerfully and consistently discrimination predicts poor health," says Williams.
COVID-19 has underscored the issue. As early as last April researchers noticed higher death and hospitalization rates for Black people. The patterns have continued: Black patients are nearly two times as likely as whites to die of the virus, while Black men have the highest rates of COVID deaths.
The COVID outcomes, Williams and others suggest in interviews, helped point out that the health and well-being of middle-class, educated Black men may have been overlooked.
Higher education hasn't brought about the health equity many experts had expected. While Black men have worse health than other groups if they are not educated, the data show they don't catch up to their white peers even when they are.
"What society has done to Black men is to corner them," Assari says.
Black men, even with an education, have less of a financial and social safety net than white men and that brings added stress, experts say. Also, as Black men climb corporate, academic or managerial ladders, many feel isolated. And social isolation is linked to poor health.
Thomas LaVeist, a sociologist and dean of the school of public health at Tulane University, says that in a white-dominated society, Black men are less likely to have accumulated social capital — for example, family members with high incomes or social and business connections — who can open doors for them.
And once hired into the workplace, they are less likely to have mentors, LaVeist says, and that lack of connections is associated with stress, depression and other factors that can lead to poorer health.
"There needs to be a designated effort to provide an on-ramp" for Black men, he says.
No matter what stage of life, or level of achievement, most have experienced an excess of cumulative adversity and continued racism.
"Your high socioeconomic status doesn't protect you from the impact or from the incidence" of racism, says Dr. Adrian Tyndall, associate vice president for strategic and academic affairs at University of Florida Health.
"That is difficult," adds Tyndall, who is Black. "If I were to walk out of this institution and into the community, where people don't know me, I could be called the N-word. And yeah, that's pretty depressing."
The Need to Prove Yourself
The cumulative effect of discrimination takes a toll psychologically and physiologically — but so does the anticipation of it.
"It's not just the actual exposure in dealing with these kinds of experiences, but it's 'What do you do before leaving home?' You're careful about your dress, your behavior, the way you look because of the threat of discrimination, and so you react," says Williams, the Harvard professor.
For example, when Williams, who is Black, first became a professor at Yale University, he wore a coat and tie every day. No one else in his department did that. And yet, he says, he kept up the practice for years.
LaVeist remembers getting onto an elevator at an academic medical center around 1990, shortly after earning his Ph.D., and a passenger wearing a white coat — presumably a doctor — asked LaVeist, who was dressed in a suit, to clean up a spill on the sixth floor.
"When I told him that I was a professor, he didn't speak," says LaVeist. "He simply didn't speak."
Greg Pennington has a doctorate in clinical psychology from the University of North Carolina and an undergraduate degree from Harvard, owns a professional consulting firm in Atlanta, and has worked with hundreds of men individually as well as dozens of Fortune 500 companies.
"It's not so much that [Black men] experience discrimination and depression 'even after' they have advanced degrees," he says. "It's more descriptive to say 'throughout the whole process.'"
Despite their academic credentials, Black men say, they often feel they need to prove themselves, which adds another layer of stress.
"It's almost like I can't fail; I'm representative of other Black males," says Woodrow W. Winchester III, director of professional engineering programs at the University of Maryland-Baltimore County. "Your value and your success are around advancing the collective."
What Can Be Done To Change The Dynamic
The bottom line, experts agree, is that discrimination has a lingering effect on health.
Dana Goldman, director of the USC Schaeffer Center for Health Policy and Economics, was co-author of the 2012 Health Affairs study on these chasms in health outcomes. Goldman says he agrees that the underlying cause is racism and adds that he thinks one solution is to improve education.
He and others suggested that schools, starting in the lower grades, need to provide Black students with more culturally appropriate curricula that bolster their self-image and help build social relationships between white and Black youngsters. Those efforts need to continue as students progress into higher education.
"The policy remedy is not just less racism but to improve the quality of our schools, occupational safety and public health," says Goldman.
Others agree that the findings suggest a need to reconsider broad policy changes – in education, housing and the justice system so that Black males feel confident and supported in pursuing better educations and jobs.
It will be a long-term project, says Williams, the Harvard professor.
"We need a Marshall Plan for all disenfranchised Americans," he says, but one that especially addresses implicit biases and how American society views and treats Black men.
Kaiser Health News is a nonprofit, editorially independent national newsroom funded by the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.