Cities in the United States have undergone major social transitions during the past two decades. Three notable factors in these shifts have been the development of a black political elite sustained rates of black poverty, and intensified racial segregation. Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature. This article reports analyses of data from all U.S. cities with a population of 50,000, at least 10 percent of which is black. These results indicate substantial geographic variation in black-white infant mortality rates. Racial residential segregation, black political empowerment, and black and white poverty are the characteristics that distinguish cities that have a high degree of disparity in black-white infant mortality from cities that do not.