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Milbank Q. 2005;83(1):5-39.

Mortality of white Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies.

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Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.


The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences.

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