Hurricane Katrina puts the health effects of poverty and race in plain view

The sinking of the Titanic, during which women in first class cabins were more likely to survive than those booked into cheaper decks, has been used to illustrate the effects of income and social class on health (T LaVeist, personal communication, 2005). In the aftermath of hurricane Katrina, Americans have been shocked and shamed to realise that they still don't have enough lifeboats for all of our citizens. Live images of uncollected corpses and families clinging to rooftops made vivid what decades of statistics could not: that being poor in America, and especially being poor and black in a poor southern state, is still hazardous to your health.

This may truly be a “teachable moment” about the impact of poverty and race on health. The gap in health between white and black Americans has been estimated to cause 84 000 excess deaths a year in the United States, a virtual Katrina every week.1 Because the victims gradually succumb to various diseases such as diabetes, cardiovascular disease, alcohol and drug abuse, cancer, and HIV infection, they rarely capture the public's attention in the way the victims of Katrina have. As a result, health inequality has persisted despite decades of important health gains, economic growth, and progress on racial issues in the United States.

It would be a mistake, however, to assume …