African Americans and Death

 As an African American woman, I am particularly interested in how we as a people approach death and dying. 

The relationship of biology to biography points to unknown ancestries for many African Americans.   Modern genotype testing can generate analysis based in common genomes indigent to certain global regions.  Genealogical research can unearth family connections from census data and official records but African Americans have a long history of constructing family relationships out of common tragedy, shared lack or sheer desire.  Many of us have “play” Mamas, sisters, brothers, ‘Papas”.  Sometimes they were substitutes, placed properly in spaces of absence or psychic holes of racism.   The fragility of common blood calls back a time when communities functioned as part of a collective identity – we identified in terms of neighborhoods families, clans, towns, cities, geographic regions.  The great migration upset those social groupings and functions.  Churches once again stepped in as vehicles of social cohesion and response.  Further industrialization scattered family groupings and memories.  It became harder and harder to make it home for the funeral.  Technological advances present options for extending life that have not existed previously and yet as more of us live longer, more of us are admitted to nursing homes.

What were the demographics of 20th century Black America?  We are close to being 14% of the total U.S. population, yet 50% of us still live in the south.

What are the health issues most critical to African Americans? – life expectancy for American blacks has historically been less than that for whites, with gender differences a factor.  Black men on average live 9 years less than White men.  – Causes of death have changed also,  in 1900, and how are they different in 2013?

Slavery is still close enough in time so that black graveyards are major depositories of funerary art and traditions – evidence of cultural life and ritual observance on the passing of death by African Americans

Dr Payne makes the point that “racial classifications of human populations are politically and/or socially determined” 1.  In the U.S., the system of racial classifications that justified the importation, enslavement and subjugation of 6 million Africans was a carefully crafted cloak of law, religious justification and social behaviors that evolved colony by colony as the United States took form as a nation. Philosophical justification came later as economic decisions created a hybrid nation and people founded by those seeking liberty; a liberty only made possible by the denial of the same to whole classes of people identified by the color of their skin.

  Such is the legacy of legalized segregation and the resulting social isolation that leaves racially based inequalities in opportunities for education, housing and health care that continue to exist today.  One aspect of health care are the services provided or lacking and decisions made about end of life care, options and preferences.  Extensive documentation exists to tell us that racially influenced attitudes, cultural beliefs, traditions and beliefs about death and dying keep African Americans at the mercy of their grief and ambivalence about life, instead of accepting the transition into old age and death as the seasons of evolution they so clearly are.  As African Americans continue to be mirror reflections of the dominant cultural values, we remain subject to the prevailing ideas that death is unnatural, undesireable, ugly, unpleasant, at best to be avoided at worst to be hidden away and cosmeticsized into acceptance.  After a lifetime of cosmetic surgery, we purchase a gold plated casket as a final resting place for our loved one.  We then pump the body full of toxic chemicals and poison Mother Earth with several hundred pounds of cement, metal and non-biodegradeable chemicals as a tribute of love.  This would be ludicrous , if it didn’t so closely resemble the scenario recently enacted and publicized to millions of people with the Michael Jackson and Whitney Houston deaths & memorial services.

 As a culture we must take back our dignity and restore it to the deathing process.  We must integrate death into a holistic attitude of life that reveres both the beginning and ending of life.  They are in fact, two sides of the same coin.  Birth and Death are equally reverential while we mark our efforts to create an interim experience that is peaceful, joyous and free.

 This page will look at the factors associated with the racial classification of African American such as poverty, low health literacy, access, and utilization, psychological beliefs about death and dying, as well as such life denying, risk taking behaviors such as drug and alcohol use, the hip-hop values that glamorize death and the phenomenon of black on black homicide.  We will also look at communication patterns and codes of privacy and silence that prevent us from having meaningful discussions about the end of life with our loved ones while they are healthy and vital.  No one wants to be at the mercy of a hard sales pitch for burial supplies and arrangements while in the emotional throes of loss.  Death can be a transformative process for all involved.  As African Americans we can bring it back into homes, can perform the sanitary preparation rituals on the body and can allow our grief to solidify family bonds.  If we talk about distribution of property, think of the arguments that can be avoided if the family is clear before a death exactly who will get what.

The premises underlying this page include:

1) Documented disparities continue to exist in health care access, literacy and use.  Blacks continue to have lower life expectancy and higher death rates than whites proportional to their percentage of the US population.

2) African Americans have fewer advanced medical directives in place and yet prefer all possible measures to prolong life.

3) Death impoverishes 1/3 of all American families – that impact could be minimized by education and careful option consideration.

4) Less research is done on the causes and management of diseases that affect African Americans and the demand for organs and tissue donation soars among this group.

5) The impact of hip-hop culture and the glamorization of death among African American is a form of suicide.

6) The loss of traditionally African American cemeteries, burial grounds and mortuary businesses signal a decline in African American life and culture.

 Since slavery, African Americans have put a high value on education as a vehicle of transformation.

This same value can be used to take proactive stance about health disparities and behaviors that put us at greatest risk


  1. 1 
  2. While African-Americans constitute about twelve percent of the US population, the Guttmacher Institute estimates that thirty-three percent of the abortions occurring in the United States are performed on black women. visited 09/15/09


Much of the content of this page has been culled from other sites and collected here.  I have endeavored to give credit where credit is due, however any omissions are inadvertant and will be corrected as soon as correct and appropriate credit is supplied.


An intellectual discourse derived from The Last Miles of the Way Home 2004 National Conference to Improve End-of-Life Care for African Americans

Historical & Sociological Perspectives on Death & Dying in the African American Community-Witness of HistoryAbstract | CommentaryThe Witness of History: Cultural Narratives at the End of Life Historical & Sociological Perspectives on Death & Dying in the African American Community-Witness of HistoryKarla F.C. Holloway, PhDINTRODUCTION I have found a space in this collection of papers that is both academic and personal. It is a space of research and scholarship on death and dying in African American communities, and it is the space of a citizen of that community touched personally by the kinds of stories that I have shared in Passed On: African American Mourning Stories—A Memorial. 1 The stories I recall there cohere into a collective cultural memory, and that memory frames a certain understanding based on “How We Die,” a color-coded death—the residue of riots, executions, suicides, targeted medical neglect—a range of bodily violence. They are stories that urge us not to forget. And in resisting the urge myself to forget the unspeakable, I have researched and excavated a particular view of black death that seems, in its intimacy with African American life, a cultural haunting, a “re-memory” in the way that Toni Morrison’s novel Beloved insists that “not a house in the country ain’t packed to the rafters with some dead Negro’s grief.” 2Although I wanted to both find the expression of that grief and follow it to its conclusion, I knew as well that black folks, whose indomitable and remarkable presence articulates the best of this country’s spirit, intelligence and politic, bridges this cultural haunting with hope, grace, and resilience. Given that paradox, I wanted to come as close as I could to these final moments as represented in biography, performed in literature and the visual arts, and experienced within the records of both history and memory. James Baldwin made clear the associative nexus between black memory and the experience of black death, writing in The Evidence of Things Not Seen that “memory makes its only real appearance in this life as this life is ending.” (page xv)It is an appropriate view of our dying where the only thing we know for sure are the times past. Memory is our touchstone, and I rely on it here to help shape and explore the experience of African America with black death.That private anticipation of death and dying which figures itself into the experiences of black folks throughout their lives is so persistent and so much more prevalent than it is for other Americans that lamentation and mortification became a part of the race’s public persona. The twentieth century’s literature and film, its visual arts and music (from early-era spirituals to latter-day rap as well as contemporary street corner memorials) consistently called up the ghostly presence of a passed-on narrative. Black culture’s dead and dying stories were inextricably linked to the ways that the nation experienced, perceived, and represented African America. Whether one recalls what W.E.B. Du Bois called the “sorrow songs,” spirituals such as Soon I will be done with the Troubles of de world , the burning crosses of the Klan, or the burning communities whose rebellions provoked white rage and violence, black folk have come to know black death. The cycles of our daily lives—whether as infant or as an elder—were so persistently interrupted by the specters of death that we worked this experience into the culture’s iconography and included it as an aspect of black cultural sensibility. Little wonder that rap artists like Tupac Shakur or the Ghetto Boys titled their albums “Resurrection” or created cover photos where they lay reposed in caskets. They knew the marketability of images of death and dying were intimately tied to the ubiquitous experience of black death and dying.African American mourning stories revolve around the angst of the liberal circulation of black death, that is, without discrimination between black parents and their youngsters, elders, and their adult children. All could find an eerie familiarity with the fact that the formative years, the waning years, and each day between these is haunted by the spiritual’s refrain, “soon one morning, death will come a-calling.” The dead and the ways of our dying have been as much a part of black identity as have been the ways of our living.I. Suffer the children Certainly our singular stories and memories drift toward, are shared, and are finally echoed within community narratives. And, because a community’s identity is fully and expressively engaged in its youth, there is a space as undeniable as it is pitiful in history’s acknowledgement of the ways that black children are forlorn legates of the cultural experience with black death.For many of us, the story of children’s experiences with “public” death is fixed with five youth. One is Emmett Till who was called affectionately “BoBo” by his mother when she sent him from their Chicago home to visit relatives in the south. His lynching in Mississippi in 1954 is remembered by still-aggrieved generations—a lingering melancholy in the memory of black folk. Bobo’s loss is a familiar because ironically, scores of years later, we still find no lack of familiarity with a storied loss like this one of sons and souls of black folk. Indeed, one of the most striking stories of black cultural history is the recurrent narrative of parental loss.The second public moment, which was seared into our national memory, is the 1963 assassination of four little girls, Cynthia Wesley, Addie Mae Collins, Carole Robertson, and Denise McNair, who were murdered in a Ku Klux Klan-engineered bomb blast during a summer Sunday school service in Birmingham, Alabama, at the Sixteenth Street Baptist Church. We rehearse the memory of this story so consistently that it has even appeared in our fiction. Consider the text of the following passage from Toni Morrison’s novel, Song of Solomon :Every night now Guitar was seeing little scraps of Sunday dresses—white and purple, powder blue, pink and white, lace and voile, velvet and silk, cotton and satin, eyelet and grosgrain. The scraps stayed with him all night… bits of Sunday dresses that… did not fly; they hung in the air quietly, like the whole notes in the last measure of an Easter hymn. Four little colored girls had been blown out of a church…. 3No fiction, however, could displace the pathos of the factual moments—in this instance recalled by a heartsick Mamie Till Bradley, who went to identify her son Emmett’s body when he was returned to Chicago :I didn’t want that body…. That couldn’t be mine. But I stared at his feet and I could identify his ankles. I said, those are my ankles. Those are my knees. I knew the knees… and then I began to come on up… until I got to the chin and mouth… those were Emmett’s teeth, and I was looking for his ear. You notice how mine sort of curls up… Emmett had the same ears…. [T]he one eye that was left, that was definitely his eye, the hazel color confirmed that, and I had to admit that that was indeed Emmett and I said that this is my son[;] this is Bobo. 4Although the story of children reveals something especially poignant in our histories of death and dying, there is a dimension of the business of burial—the occupation of the funeral professionals, where children give us a particularly thoughtful glimpse into the labor and work days of “death care providers”—funeral home directors and morticians. These youngsters also appear in stories about these adults because of the generational link between many black mortuary professionals.

Many youth grew up in homes that housed both the family and the family’s business. One young man explained to me how he grew up to “stand next to his father” working right alongside him in the funeral home. He saw his first dead body at thirteen while “looking for his father in the back rooms of the funeral home, ducking his head into hallways, calling out for Pops, opening and closing doors,” until he picked the door to the embalming rooms and saw ’gentlemen back there embalming.’” He was pensive as he recalled how he “used to really dislike coming down here, I was quite frightened about death and dying and bodies.” But he has now inherited his father’s business, passing it on and keeping it in the family, in the way that has come to be common among black mortuary professionals.

Despite their nearness to the profession, children whose parents were in the business harbored as many strange understandings of what happens in the back rooms of their homes as did their friends who did not live as intimately with death. A brief vignette from some of my discussions with some of the smallest children of black funeral directors and morticians, who have been known to march into the annual business meeting of the black professional association, the National Funeral Directors and Morticians Association, proudly wearing T-shirts printed with the association logo and the phrase “Future Mortician.”

In my interviews with them, I asked about their parents’ jobs. “He fixes dead peoples,” one explained. “They hang them [the deceased] up to dry, and then they dress them up and put them in those boxes.” Another happily shared with me, “I get to push around the baskets [caskets],” but then he added a more cautionary note, “But I can’t go in there where he gets the dead peoples from.” Curious about their knowledge, I pressed further. “Where do they come from?” I asked.

“From the hospital,” one child told me assertively and with just a bit of exasperation at my lack of knowledge. But then another youngster interrupted his age-mate with a correction. “No? No he don’t! He gets them out of the freezer and has to wait thirty minutes, and then he can come in to eat dinner. After that, then they unfreeze, and he puts clothes on them and then we put them in the car and I help.”

“He gets them out from under the ground.” I was told by an eight-year-old girl—interested in showing off her superior knowing. She continued. “And then, he puts those fancy dresses on them [the industry’s name for these is “garments”], and then he puts them back. After that we can eat.”

There was another participatory mode that children have in my research that was informative about the subject but very distant from this telling. The stories that emerged from African American children’s deaths brought the morbid experiences of African American communities into sharp focus. One would anticipate that theirs should be unexpected events in the life/death cycle. But from their too familiar circumstances and oft-anticipated occasions emerged a perspective of a community’s life that told a larger story than the single, pitiful event of a child’s dying and burial.

Stories like Emmett Till’s haunted our fiction, appeared in autobiography and memoirs, and because of the excess of their generation and our response, became our folk and news stories. In essence, children’s stories persist long past their passing on, and their deaths made apparent both the persistence of memory and the necessity of memorial.

One form of memorial appeared in the artistry of the photograph. Whether they were Polaroid shots stuffed between family photos in an old black page album, or the formal photographs of the dead by professionals as James Van Der Zee and Richard Samuel Roberts, the documentary record of black death was captured in black and white. We begin to get a glimpse of this ironic intersection of creative imagination and damnable public circumstance with the great migration of the second decade of the twentieth century. It dramatically impacted African American’s experiences with death and dying, and in this era, the dead were disproportionately young. In Harlem, for example, some funeral directors whose parents were in the business during the 1920s and 1930s recalled to me the seemingly “endless” procession of small white caskets that became ordinary as black children succumbed in disproportionate numbers to the tuberculosis epidemic and the pneumonia—called “consumptive disease”—that ravaged the community. An October 24, 1929, article in the New York Times led with the headline that “Congestion Causes High Mortality” and detailed the 40% higher death rate in the crowded neighborhoods of Harlem than the rest of the city. There was a ready and available source for artistry like that of Harlem photographer James Van Der Zee.

Van Der Zee was well known for his vivid documentary pictorials of Harlem lifestyles, but he was celebrated as well for the powerful photographs of mourning that he took early in the century. He understood his work was in the tradition of archive and documentary. His photographs might be the only way that some families would have to remember a child.

One especially poignant Van Der Zee portrait shows a wife gently leaning over her husband as he sits cradling their dead infant. The image is intentionally constructed as a domestic vignette. The father is in what seems to be a rocking chair and a radio in the background suggests the setting is the family’s front parlor. The dead baby, dressed in white garments like those worn for a christening and nestled in his father’s arm, looks as if asleep and both parents’ affect suggests an eerie peace as they look lovingly down on their child with a calm that belies the fact of the still life story constructed for the photographic occasion. Van Der Zee explained that the picture was not taken in their home, but it was composed and shot “in the funeral parlor. [A] radio was in the picture to make it look more homelike. It belonged to the undertaker anyway. It was my suggestion to have them hold the child while the picture was being taken to make it look more natural.”

When asked how the parents felt about holding the dead child he replied, “Well it was their baby…. Most of these babies, they all died of pneumonia; chest gets filled up with colds because they were living in cold flats. It was a common thing in those days for people to be without heat.” 5

Contemporary accounts suggested the most dreaded disease in the densely populated projects of Harlem was pneumonia. But tuberculosis as well took its toll.

A 1934 survey of 20,000 residents of Harlem revealed that 3% had pulmonary tuberculosis. The disease was so pervasive, that one city block was known among the epidemiologists as the lung block. These were the days of segregated medical care. Most hospitals in the city that were treating tuberculosis refused to admit “Negro” patients, so they were squeezed into the wards of Harlem Hospital, just as they were packed into the blocks of Harlem streets and its tenement houses. Both kinds of congestion contributed to the virulence of the disease: a fact that led to the high morbidity and mortality. Harlem Hospital was referred to as ’the morgue’ in the community and there was great distrust of its facilities. The common story in the streets was that you went there to die.

But the story of children’s deaths was not limited to the early century. And it was not limited to the terror of Emmett Till’s boyhood vulnerability or to the benign neglect of white racism. At the end of the twentieth century, the backlog of children’s violent deaths in some urban areas made weekday rather than weekend funerals an ordinary event in some cities and led funeral directors in other cities to refuse to handle the funerals of children. One funeral director in Buffalo, NY, expressed to me the concern of the professionals. Explaining to me his reluctance to handle the funerals of children and youth he said, “They come in here with guns and all, and they act up.”

Youth cultures, always dramatic, noticeable, and brittle, carried through their drama with their dying. Elaborate rituals evolved for gang deaths in Los Angeles —testimony to the familiarity of this particular dimension of cultural death.

A cottage industry furnished floral tributes draped in gang colored ribbons, sweat shirts and T-shirts with the deceased member’s name in a variety of fonts and with a choice of texts like “R.I.P. Homie.” Street corner memorials, with children’s toys stacked on a sidewalk, poetry sketched on building walls, and declarations of love and goodbye messages scrawled on sidewalks became familiar, if transient, urban markers.

The business has had an ambivalent response to the deaths of children. These are generally not businesses whose finances are especially liquid. Nevertheless, understanding that a business philosophy should be forward thinking, and because children’s funerals were nearly always unexpected, “we encourage our funeral directors to absorb the costs for a child’s funeral,” a North Carolina funeral director and officer in the state NFDMA explained to me. “The average person does not expect to lose a child, and there’s no generally no insurance to cover the cost of their burial.” But because of the precarious finances that haunt too many black businesses, this was a decision that some African American funeral directors were hesitant to make.

Although every funeral had the potential of adding to their income, some were reluctant to carry this loss, even though it would likely and eventually lead to other business from that bereaved family. I was told by some of the younger members of the profession whose investment in finance and planning was substantial that, “If you do the baby well, when the mother or daddy dies, we’ll get them on down the road.” With a critique of some of their colleagues, they noted that “some of them don’t see it, but children’s funerals give directors exposure to a particular customer base.”

At the end of the twentieth century, these narratives of business and exchange and their embedded texts of absence and loss found themselves woven into a cultural fabric. Black death—that is, the dying of African Americans that was in some way related to cultural identity—continued to be specific and identifiable, as did the cultural familiarity with and acknowledgment of the consequences of loss.

II. Looking back, and wonderING

The stories of the twentieth and twenty-first century professionals are deeply indebted to the history of the profession. The dense weave locking the threads of black death framed the history of the century as well as its people.

After the Civil War, America’s troubling response to its newly freed black citizenry was a constructed pattern of violence. The extent to which lynching became associated with black presence rather than black conduct inculcated a sense of vulnerability. And as the nineteenth century turned, the violence directed toward blacks did not dissipate. In fact, it increased. It was the singular, colored vulnerabilities of these victims that made the crime so wicked and vicious. And it was the shared understanding and experience and anticipation of that vulnerability, whether one was directly affected by this violence, or just afraid of it, that cooperated in forging a cultural association, a shuddering memory, if you would, between color and death.

On too many occasions, these were not just crimes of a raging mob in pursuit of one or two persons. Sometimes an entire community was targeted. In Rosewood, Fla, the precipitating event was a familiar one—the accusations of a white woman against a black man. The concluding event was as familiar.

On New Year’s Day 1923, all of Rosewood—its homes and gathering places, the lodge and the churches, as well as its residents were marked for destruction and death. Seventy years after the New Year’s Day tragedy, journalist Lori Rozsa wrote of Rosewood survivors as:

… still tortured with the lingering image of a parent or grandparent being lynched or shot, of the family home being burned to the ground, of crawling through the woods in the dead of night… hiding from an armed and crazy mob… hunted and attacked for nothing more than their color… black man whose left arm was paralyzed was forced to dig his own grave, then was shot and shoved into it. Another black man was hung from a tree in his front yard when he told the posse he couldn’t lead them to the alleged rapist. A pregnant woman was shot as she tried to crawl under her porch for protection when the mob rode in. 6

And if one might think that these were events of an early century, we need only recall the 1998 lynching of James Byrd in Texas and one might as easily include the 1999 murder of Amadou Diallo, who stood in the vestibule of his New York City apartment building and judged suspicious by policemen, was shot more than three dozen times. Such recurrent moments required studied ceremonial response. It called for ritual.

The century’s consistency seemed to be that black folk were likely to die before their time in America. And given this sensibility, and what I have come to understand both differentially and together as both the urge toward life and an insistent hope, the black community nurtured two institutions—churches and funeral homes—both which would succor this grief and contain these narratives. Our community gained both expression and experience in handling this seemingly inevitable complication of black life.

While one might have anticipated black folk as overwhelmed by the persistence of such a history, stammering and stuttering a fractured response to living in America, instead the spiritual stature of the black church gave its community a powerful witness. And the spirit that invested in both the ministerial anticipation and the mortuary experience gave balm and solace in deeply personal and specifically professional ways. The close association of the black pastor and mortician represented a consummate merger of cradle to grave services as two institutions that were both consistently defined through their racial exclusivity shared clientele for the most critical ceremonies in one’s life.

Ironically, though, the black church has been both a haven from the outer world, while, at the same time, vulnerable to its hatred and resentment. Its own visibility, coupled with society’s understanding of its racial association and business made the edifices themselves susceptible to racial hatred. Throughout the twentieth century, black churches were assaulted—the target of bombs, arson, and vandalism specifically because of their racial activism and racial identification.

One dimension of my research, an exploration of How We Die speaks to the complicity of other institutions, including the institution of medicine in particular. I’ve mentioned the way in which, early in the century, Harlemites distrusted Harlem Hospital. But mid-century, this time in the South, distrust of the care doled out by doctors and hospitals, and deaths from what were equally treatable diseases, would fuel a similar mistrust. Black men died of what they were told was their “bad blood.” Tuskegee Hospital at Tuskegee Institute, Alabama, was the site of the murderous maltreatment where white physicians participated in a project funded by the National Public Health Service to study the effects of syphilis on black men, certain that the effects of the disease—especially in terms of syphilitic heart disease—were racially distinct.

His only way of proving his hypothesis, as he explained in a letter to a colleague, was “the continuance of the observation of the Negro men used in the study with the idea of eventually bringing them to autopsy.” 7

In other words, the physician watched syphilis progress and made no attempt to treat it. “As I see it,” one of the doctors observed, “we have no further interest in these patients until they die.” At which time the autopsy, necessary to get the data to fuel the study’s hypothesis, was urged on the families. The Public Health Service offered burial stipends in exchange for permission to perform the autopsy.

For forty years, black men in the Tuskegee study died, went blind, or experienced insanity in an egregious violation of medical ethics and in a prejudicially distorted hypothesis of medical science. Trust in hospitals and in the government, never strong in the black community, especially in concert with the numbers of hospitals who refused black patients, even those emergency victims of accidents, was further eroded by this sorry episode. To some, then, the way in which this legacy of mistrust re-emerge later in the century, specifically during the AIDS crisis that began in the 1980s was no surprise.

Like the other issues in black American history, the funeral industry was not far behind in its response to the crisis, and like the public response, it too suffered from misinformation and panic. More than one black mortician at a 1990s convention of the professional association explained to me how these professionals were “especially susceptible” to “the AIDS,” and it was clear, in our discussion, that they didn’t just mean because of their contact with body fluids.

One black-owned chemical company’s response to the fear in the black mortuary community was to manufacture a special fluid for the embalming of victims of AIDS, not so euphemistically labeled “AIDS O’Dyne.”

Whether as late century AIDS or as early century tuberculosis, when it came to death rates, race was a consistently predictable factor in patient mortality. This was true in every decade of the century, for urban as well as rural areas, and for northern as well as southern regions. The following (Table 1) is illustrative of the point of black death and dying.

Table 1
Tuberculosis Death Rates, 1939-41

Chicago, Illinois 45.4 250.1
New York, New York 40.4 213.0
Philadelphia, Pennsylvania 44.3 203.5
Detroit, Michigan 36.5 189.0
Los Angeles, California 49.7 137.3
Reproduced from Drake and Cayton, Black Metropolis (204)

Given what some in the death care industry could interpret here as a market survey, it is possible to use these kinds of statistics to understand how the financial aspects of death and dying came to matter greatly in black communities. One dimension of the early twentieth century evolution of the black funeral home was the way in which the role and perception of the mortician in the black community were closely associated with issues of class and social status.

As the century began, the mortician emerged as a businessman in a community of few independent black-owned businesses. Sometimes, he was the only one, other than the preacher who wore a suit during the week, and the fact that it may have been his only suit mattered less than the fact that his business gave him license to wear it on days other than Sunday. Indeed, the “24/7” suit and the authority it brought was not insignificant to the decisions some young men made to go into “the business.” From his perspective, his appearance was an important and visible sign of status, from his consumers’ perspective, as was widely noted among members of the professional organization, “Our people like to put on a good show.” But “show is going to cost you,” as one Tennessee funeral director explained to me, even then recognizing the way in which, among black folk, performance—its drama, elegance, and extravagance—was critical to the occasion.

Many families were concerned not only about the overall extravagance of the occasion, but also about its details. A Tennessee funeral director told me, “Cars are important for our people. We want to have four or five cars in the procession. It’s something our folk are looking for.” Another interrupted and said,

But at the same time, we do strange stuff like—with my business, we have white cars. Everybody in the city knows we have white cars. And then folk come to me, make arrangements for the service: pick out the casket, select the flowers, get the obituary ready, all of this and then they say, “Just one thing: I want black cars.” Now they tell me—why’d they come to me in the first place? Everybody knows we’ve got white cars. If they wanted somebody’s black limousines, they should’ve gone across town. Sometimes we just don’t make sense!

In addition to the issues of cars, caskets are the most attended to item on the list of costs—and a number of stories I found were related to financing an expensive casket.

Some funeral directors complained that “our people” still believed that caskets were reused from burial to burial. Even though America was not the home of “slip coffins” with hinged bottoms that could be lowered halfway into the grave and then opened, dropping the bodies into the earth, stories of reused coffins were recycled in black communities. One Louisiana funeral director told me about a time when he drove one of the limousines in a funeral procession. He left the cemetery following the hearse after the graveside service had ended. Both he and the driver of the hearse looked back and noticed that one of their staff had been inadvertently left at the grave site. The hearse’s driver turned around to go back and get him. To a person, the mournful occupants of his car emerged from their grief just long enough to comment sarcastically: “See, I told you they go back to get the caskets!”

In upstate New York, one black family has habitually stayed behind at the graveyard on the occasion of a death in the family. After the other mourners leave, family members bring out hammers and axe handles to bang and dent the casket before it is lowered into the grave. The mortician who told me this story said:

We keep telling them we don’t reuse these caskets, begging them not to destroy their purchase, but they want to make certain that after they are through with it, that there is nothing but damaged goods left behind. So now we all know what’s going to happen whenever somebody in that family goes. I just sit in the car and wait while they just go on hammering and banging away until they make that beautiful casket look like it came out of a war zone…. It’s just pitiful to see.

By mid-century, suppliers to the funeral home business were fully appreciative of the money available from its culturally concerned clientele. As black consumer culture started to make its own ’dent’ on advertising and product strategies, one of the largest casket companies in the business, Batesville, designed a line of caskets that catered to black families, complete with an “African” inspired fabric selections that could be made into funeral garments for the deceased. The pity is that a best-seller among this line, the Kente Casket, with its Kente cloth bunting and even an option for an exterior metal in the Kente design, was used mostly by baby-boomer aged parents to bury their teen-aged or adolescent children—a decision that not only pointed to the market-line strategy but to the available market, and cultural experience of black death that guaranteed the viability of the product line.

III. A season of despair, the power of hope

To discover these stories and those who have lived them, I’ve wandered the exhibits in a museum of the funeral industry and congratulated soon-to-be graduates as they waited for final reports from their mortuary school examination. I have visited with funeral directors and morticians in the places where they practice and the spaces where they plan (Las Vegas, Nev, in 1996). I have stopped at roadside memorials and lingered in museums and art galleries. I have consulted archives and manuscripts that ordinarily would be a historian’s labor—talked with physicians, casket manufacturers, casket shopkeepers, hospice administrators, makers of funeral “garments,” reporters, palliative care teams, embalming chemical businessmen, hospital chaplains, neighborhood ministers, and neighborhood residents.

I also went to the places where, quite frankly, I found as much ease and quiet as was intended for the residents. My graveyard visits, interspersed between the research and writing brought certain calm. I came to depend upon their silence and solitude, feeling comfort and ease in these stilled cemetery spaces. Many times I traveled to them alone but sometimes with my husband or daughter.

Some years into this process, I left behind the sense I was searching for tombstones. I was looking instead for Harriet, or Billie, or Richard. It became a personal, even an intimate sojourn among my cultural kin.

When we found Billie Holiday’s grave in New York City, the lyrics and melody of God Bless the Child moved from memory to mouth and soon, I was standing before the tombstone she shared with her mother, in full voiced song. An elderly white couple tending a grave some rows down left their work and came to where I stood with Billie and her mother and asked if I knew her. Before I could help it I heard myself say, oh yes, she’s my great aunt. Of course, it wasn’t at all true, but at that moment, I felt like kin. Well, we take care of her, they told me. Whenever we come to tend our parents’ graves, they said, we clear away any weeds in front of Miss Holiday’s as well. I was touched by their neighborliness and told them so. I think I even said the family will be so grateful. I know I could have said this, it would have been easy…poetic license.

I left a flower at the grave sites of the twentieth century African Americans whose memorials I wanted to assure with this project. And despite all the various shades that have dimmed the past years of my own life, I can remember distinctly each moment when I discovered a grave.

The shivering embrace of the chilled air on the fall afternoon in Paris is with me still. At Le Cimetiere du Pere-LaChaise, I walked without sense or care of the time that was passing, down byways thickened with monuments. I did not know then that there was a cemetery map that would have led me directly to the columbarium and Richard Wright’s space there among the cremated.

Later, I actually came to prefer to search without a map, to wander these serene spaces unguided, giving the imaginations I constructed on my grave meanderings time to develop. When the caretaker in Monaco told me that not one of legendary singer and performer Josephine Baker’s children came to visit their mother’s (1986) grave, my English “tsk, tsk” echoed hers in French.

Others have their stories as well. I was grateful, for example, for the controversial decision of his family to keep Arthur Ashe and his mother Mattie in Richmond’s historically black cemetery, Woodland. There is a history of segregated graveyards in this country and the stories you discover about them are both like the lyrical images of the distinct decorative art that sketch designs in conch shells across the gravestones, or carefully broken vessels left beside the grave, noting the spirit’s break with the world of the living.

There are as well the nearly disabling stories of shame associated with these segregated distinctions, like veterans being denied burial in flag-draped coffins when they are returned from wars, as recently as Vietnam, or stories like Whitney Elaine Johnson’s, an infant who had been buried in Barnett Creek Baptist Church Cemetery in Thomasville, Georgia, when church deacons approached her obviously grief-stricken white mother and black father and asked that they exhume their daughter’s body and move her to a cemetery that would accept blacks.

I found that the memories did not begin and end with those I researched. I, too, was shaping my own in this journey. There were experiences that helped me understand this new terrain that I was negotiating and the business of burial. For example, when my husband and I went in search of Ida B. Wells-Barnett the fearless anti-lynching crusader, suffragist, women’s rights advocate and journalist, the personnel in the cemetery office looked at us carefully. But then they surprised us both and asked if we were married. I said yes, wondering why that was in any way relevant. But when she followed up her question by asking if we were interested in a plot for ourselves, I realized the business of burial never concludes.

Perhaps one of the most poignant postmortems of the century is the way that for a moment near the century’s end, Malcolm X’s modest grave site in Ferncliff Cemetery told the story of a summer tragedy and echoed his own prophetic words: “I always knew I would die a violent death, in fact, it runs in my family.”

His grave site had been marked with the small, flat-against-the-ground brass plate, riveted to a concrete slab, characteristic of all in the cemetery in Ardsley-on-Hudson.

But thirty years after his had been secured to its place, in the summer of 1996, I looked for Malcolm. At first I was merely disappointed to find the site had been disturbed and his marker removed, temporarily replaced with a bouquet of flowers, withered in the summer’s sun, and a T-shirt, with Malcolm’s own words emblazoned in red across the black cloth. Was it taken by a souvenir hunter? Perhaps. But the absence of his marker prompted an appreciation for the tragic generational vitality of his own prophecy, and it brought me to tears. This was the summer of the death of his wife, Betty Shabazz, which she suffered at the hands of their grandson, Malcolm. Her body, but not her name, had already been placed in the grassy bronzed pathways of Ferncliff.

The stories of graveyards do not only point inwards, towards the personal, but outwards as well, to the public. Certainly the dramatic difference between the final resting places of two men of the century’s most significant stature and renown—Malcolm X and Martin Luther King Jr.—suggests a very interesting post-mortem narrative. We did not look very long before we found a parking place near the city block in Atlanta, Ga, that had become King’s grave site, mausoleum, museum, historical center, and souvenir store. It was early on a Sunday morning, and the city streets were not very busy. The mega-block of King’s memorial revealed the constantly evolving post-mortem capitalist construction of his singular legacy. But when the site is juxtaposed against the modest grave site of Malcolm, who is buried in a place full of gone-but-not-forgotten souls, the narrative text of culture, capital, and memory is declared, and this merely through juxtaposition. I felt as if I had made a requisite tourist stop, as I stood staring across at King’s sarcophagus safely isolated in the middle of a reflecting pool; but that was all I felt.

Those who gave shape and contour to African America in the twentieth century are neither fully memorialized in the photographs of their grave sites nor in the narratives that composed Passed On. But those who are here might appropriately stand in for the others. The very last grave site I visited before I brought this project to its end was actually the first. I returned to Paris and Pere LaChaise. My daughter Ayana was with me, and I wanted her to see Richard Wright. It was the summer of 2000—the first grave site trip I had taken in about two years. We took the subway from our hotel on the left bank, easily changing stops at Odeon, and Strasbourg-St. Denis without any difficulty. I knew the way back. It was an early morning and the cemetery gates reliably rose into view as we climbed the stairs up from the Metro.

The day was cool but bright and sunny, and we were in no hurry. We strolled casually, shifting back and forth between the stone paths that edged the cemetery’s thicket of small mausoleums to the gravelly roadway that stretched out before and beyond them, remarking only on the chestnut trees that lined the road and the way the sun stretched and streaked between leafy vistas. I told Ayana how I used to collect chestnuts on my walks home from school when I was young, and string them into necklaces. We were relaxed and at ease until we got to the site of those who had been cremated. There I stopped silent, stilled but for the tears that clouded my sights.

Just as I neared the conclusion of this project, everything I had written transformed from page to personal when my own son was killed. Standing there in that cemetery, thinking of my child, our son, her brother, I could go no further. And so we left together, her hand in mine, turned toward home.

In many ways, this project, and its aftermath constitute my own journey and how I finally came to the space where bearing witness was less choice than necessity. Writing these stories became a way of memorial, a measure of hope in the midst of seasons of despair.

I conclude here with a message from a black sermon—words and ideas that have historically captured what I have come to understand as the spirit of African America. Despite its vulnerability and challenge, despite its intimate arrangement with black death, black life urges us all toward hope. And “The power of hope,” as that sermon reminds us, “is the power to run and not be weary, to walk and not faint…The power of hope is the power to stand, when no one will stand with you, and having done all to stand, stand anyhow.” That sermon then turns to a preacher in James Baldwin’s novel, Another Country.

The preacher’s homily speaks both to fictional moment and fact when he says to a grief-stricken family: “Don’t lose heart, dear ones—don’t lose heart. Don’t let it make you bitter. Try to understand. Try to understand. The world’s already bitter enough; we got to try to be better than the world.” 8

It is my hope that the power of witness and the resilience of memory is one way to be better than the world.


1. Excerpted and developed from Karla FC Holloway. Passed On: African American Mourning Stories—A Memorial. Durham, NC : Duke University Press; 2002.

2. Morrison T. Beloved. New York, NY : Alfred A. Knopf; 1972;5. 3. Morrison T. Song of Solomon. [publication city, state: publisher; year:89-90].

4. Thomas J. Emmett’s Legacy. Chicago Tribune. September 5, 1995:5.

5. Van Der Zee J, et al. The Harlem Book of the Dead. Dobbs Ferry, NY : Morgan and Morgan; 1978:83.

6. Rozsa, L. Massacre in a Small Town. Atlanta Journal and Constitution. January 17, 1993:M1-4.

7. Jones JH. Bad Blood: The Tuskegee Syphilis Experiment. New York, NY : Free Press; 1981:132.

8. Wallace M. The Promise of Hope in a Season of Despair. Passed On: African American Mourning Stories—A Memorial. Durham, NC : Duke University Press; 2002:189-192.

In Collaboration With:
Duke Institute on Care at the End of Life
Initiative to Improve Palliative Care for African Americans (IIPCA)



Californians’ End-of-Life Care Differs by Race and Ethnicity

March 16, 2007

In California, the most populous and diverse state in the country, significant racial and ethnic differences exist at the end of life, according to several reports commissioned by the California HealthCare Foundation. These reports – the first in a new series of CHCF-supported projects focusing on end-of-life issues – found significant variations in the expectations, experiences, and decisions of patients and their families in the months preceding death.

“As California’s diverse population grows older, ensuring quality care at the end of life for everyone takes on even greater significance,” Mark D. Smith, M.D., M.B.A., president and CEO of CHCF, said Thursday at the Association of Health Care Journalists conference in Los Angeles. “By supporting research and projects to improve the quality of end-of-life care, CHCF sees an opportunity to help make California a national example of best medical practices and culturally appropriate care.”

One report released today, Racial, Cultural, and Ethnic Factors Affecting the Quality of End-of-Life Care in California,reviews and analyzes current data, along with new research from focus groups and surveys. The report examines the causes and patterns of death and dying and the impact on the delivery of health care.

“Focusing on patterns across populations can reveal information about access and disparities and is useful for policymakers thinking about improving the health care system,” said LaVera Crawley, M.D., M.P.H., a Stanford University medical ethics researcher and lead author of the report. “Clinical providers, on the other hand, should balance these racial, ethnic, and cultural factors with the preferences of each individual patient.”

The key findings include:

Cultural, Coverage Gaps in Hospice Care

Hospice care is generally considered the “gold standard” for end-of-life care in California and across the country. However, there is wide variation in preferences for care among various racial and ethnic populations. In addition, there are significant limitations on the availability and appropriateness of hospice for some patients.

  • Requirements for hospice enrollment can conflict with the preferences of patients; in particular, African Americans and Latinos may not want to forgo acute therapies not covered by Medicare’s hospice benefit, the report concluded. Medicare and most private insurance companies require a life-expectancy prognosis of six months or less to be eligible for hospice services and do not cover care that combines both hospice (pain management and supportive services) and such curative or life-prolonging services as chemotherapy or dialysis.
  • Ethnically diverse populations are significantly less likely to use hospice care than whites. In 2004, for example, of those who died while receiving hospice services, only 4% were Asian American, 6% were African American, and 15% were Latino, contrasted with 74% who were white.
  • Sudden deaths due to accidents and assaults are comparatively higher among young Latinos (16%), African Americans (11%), and Native Americans (14%) than among whites (7%) and Asian Americans (8%). However, the report found that some end-of-life services, such as family support programs and bereavement counseling, are lacking in most emergency departments.

Palliative Care, Competence Fall Short

While the majority of Californians die in hospitals and nursing homes, few of the state’s hospitals – and even fewer skilled nursing facilities – offer organized palliative care services, according to the report. (Palliative care is the term for providing care for symptom relief and improved quality of life, rather than care aimed at a cure. Palliative care can be provided simultaneously with curative treatment.) Regarding other palliative care issues, the report found:

  • The undertreatment of pain is prevalent among the elderly, poor, and racial and ethnic minorities.
  • Recent legislation requiring palliative care training for physicians in order to renew their medical licenses did not address cultural sensitivity even though many may lack those skills. The report recommends new training opportunities for the broad spectrum of the EOL health care workforce.

Communication and Trust

Language barriers, lack of clinician training, and miscommunication can result in mistrust, said Dr. Crawley. “Mistrust is not the solitary experience of the patient, but rather the outcome of a process involving at least two parties – the one who trusts and the one who is trusted.”

“Clearly race and ethnicity are important – but not the sole determinant – in end-of-life preferences and care,” said Dr. Smith. “CHCF will continue to work in this area to promote care that is consistent with patient and family wishes, cost-effective, and based on the best clinical evidence.”

Additional Materials

CHCF has compiled the following materials about end-of-life care:

  • Attitudes Toward End-of-Life Care in California (results of a statewide telephone survey conducted in 2006)
  • Death and Dying in California(snapshot)
  • Hospice in California: A Look at Cost and Quality (snapshot)

These materials and Dr. Crawley’s report are available through the links below. An audio report of Dr. Smith’s press briefing will be available soon.

About the Report

On behalf of CHCF, the report’s authors (LaVera Crawley, M.D., M.P.H. and Marjorie Kagawa Singer, Ph.D., R.N., M.N.):

  • Performed a comprehensive systematic review of qualitative and quantitative literature on core end-of-life issues, conducted by the Agency for Healthcare Quality and Research;
  • Analyzed 2004 Death Public-Use Files from the California Department of Health Services, Office of Health Information and Research;
  • Conducted focus groups with health care providers in Los Angeles and Fresno;
  • Conducted original survey research with pharmacies in Fresno;
  • Reviewed curriculum offerings to meet the AB 487 mandate;
  • Conducted narrative interviews with selected key informants, identified experts and other stakeholders; and
  • Incorporated co-authors’ previous scholarship and work in this area.

About the California HealthCare Foundation

The California HealthCare Foundation (CHCF), based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems.

Contact Information

Steven Birenbaum
California HealthCare Foundation 

Monica Novoa
Hershey Cause

Color Coded Death

Death as a final option of freedom from enslavement:

  Most enslaved African Americans in North America died enslaved, leaving no documentation of their lives unless listed in a master’s will or plantation account book, or perhaps remembered decades later in a former slave’s narrative. For some, death was the only “emancipation” they could hope for, as we read in these selections.

  • “Grave . . . the only refuge for the slave.” George Moses Horton holds a rare position in American literature—one of the few black poets who was published while still enslaved. White benefactors helped him publish his poems in newspapers and books to support a “freedom fund,” but the profits never equaled the amount demanded by his owner, and Horton remained enslaved until the general emancipation of 1865.1 In this poem entitled “Slavery,” Horton intones “Is it because my skin is black / That thou should’st be so dull and slack, / And scorn to set me free? / Then let me hasten to the grave, / The only refuge for the slave, / Who mourns for liberty.” The “thou” of the poem is left ambiguous. A master? God? Fate? Pity? The reader?
  • Suicide as freedom. How many slaves chose death rather than continue life enslaved? “In the United States today,” writes Dr. David Lester, a psychologist and suicide researcher, “suicide is less common among African Americans in general than in whites . . . [which] may represent an African worldview which accepts suicide only as a very last resort in the face of extreme stress.”2 Calculating an approximate suicide rate among enslaved African Americans, Lester notes the difficulty of gathering unambiguous data on slaves’ deaths, whether natural or at their own hand. Thus, analysis of the number, motivation, and consequences of slave suicide must include anecdotal evidence, i.e., first-person accounts and second-hand reports to supplement numerical data from census and plantation records. The selections here offer a representative sample of this evidence from slave narratives, former slave interviews (as transcribed by the interviewers), and antebellum African American newspapers. To what extent was suicide a form of resistance? to what extent “a very last resort”? [1]

Discrepancies in health access, education and service

          Rural vs. Urban: In 2007, the majority of Blacks lived in the South (56 percent), while 34 percent of white population lived in the South. . Of the ten largest places in the United States with 100,000 or more population, Gary, Indiana has the largest proportion of Blacks, 83%, followed by Detroit (82%).[2] In 2004, 1 out of every 4 Blacks lived in N.Y. Fla, or GA.  Blacks represented less than 5% of the population in 20 states.[3]

“The existence of health disparities between racial and ethnic groups is common knowledge among public health wonks. But the average American may find the numbers shocking: In impoverished urban areas like Harlem, one-third of black girls and two-thirds of boys who reach their 15th birthdays don’t reach their 65th. That’s almost triple the rate of early death among average Americans.

While the inner-city ghetto is an extreme case, a broad national trend ranges across a variety of health problems, from prostate cancer to hypertension. Since World War II, Americans’ health outcomes have generally improved. For minorities, though, progress has come slowly. Blacks now die at a rate comparable to the death rate for whites of 30 years ago. Every year, 100,000 more African Americans die than would be the case if black and white death rates were the same. For many diseases, the situation is worsening: In 1950, blacks had a slightly lower cancer death rate than whites. By 2000, the rate was 30 percent higher among blacks.[4]

 Current information about the biologic and genetic characteristics of African Americans, Hispanics, American Indians, Alaska Natives, Asians, Native Hawaiians, and Pacific Islanders does not explain the health disparities experienced by these groups compared with the white, non-Hispanic population in the United States. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific health behaviors.

Even though the Nation’s infant mortality rate is down, the infant death rate among African Americans is still more than double that of whites. Heart disease death rates are more than 40 percent higher for African Americans than for whites. The death rate for all cancers is 30 percent higher for African Americans than for whites; for prostate cancer, it is more than double that for whites. African American women have a higher death rate from breast cancer despite having a mammography screening rate that is nearly the same as the rate for white women. The death rate from HIV/AIDS for African Americans is more than seven times that for whites; the rate of homicide is six times that for whites.[5]

The leading causes of death are used frequently to describe the health status of the Nation. Over the past 100 years, the Nation has seen a great deal of change in the leading causes of death (see figure 8). At the beginning of the 1900s, infectious diseases ran rampant in the United States and worldwide and topped the leading causes of death.  A century later, with the control of many infectious agents and the increasing age of the population, chronic diseases top the list.[6]

What are the population patterns?

 In July 2008, 41 million people in the United States, or 13.5 percent of the civilian noninstitutionalized population, were Black.[7] The foreign-born Black population was about 2.6 million, or 8 percent of the total Black population, in 2004. About 66 percent of foreignborn

Blacks were born in Latin America and about 30 percent were born in Africa. About one-half of foreign-born Blacks entered the United States in 1990 or later, and almost 1 of every 2 foreign-born Blacks was a naturalized citizen.[8]

Poverty rates remained statistically unchanged for non-Hispanic whites (8.2%), blacks (24.5%) and Asians (10.2%) in 2007.[9]

Where do black people live?

The ten states with the largest Black population in 2008 were New York, Florida, Texas, Georgia, California, North Carolina, Illinois, Maryland, Virginia, and Michigan.  Combined, these 10 states represented 59% of the total Black population                            

What is the “average” educational profile? In 2007, 80% over the age of 25 had earned a high school diploma.  More Black women than Black men had earned at least a bachelor’s degree (16 percent compared with 14 percent), [10]

What are other indications of class stratification?

Income level

In 2007, the U.S. Census bureau reported that 24.5 percent of African-Americans in comparison to 8.2 percent of non-Hispanic Whites were living at the poverty level. In 2007, the unemployment rate for Blacks was twice that for non-Hispanic Whites (8 percent and 4 percent, respectively). This finding was consistent for both men (9 percent compared with 4 percent) and women (8 percent compared with 4 percent).[11]

How many Blacks have private health insurance?

In 2007, 49 percent of African-Americans in comparison to 66 non-Hispanic Whites used employer-sponsored health insurance. Also in 2007, 23.8 percent of African-Americans in comparison to 9 percent of non-Hispanic Whites relied on public health insurance. Finally, in 2007, 19.5 percent of African-Americans in comparison to 10.4 percent of non-Hispanic whites were uninsured.

What is the age profile of those who die?

Infant Mortality rate:

For African-Americans, the mortality rate is nearly double that of the United States as a whole, with 9.3 deaths per 1,000 births.[12]

Who is the largest group of deceased and what is the cause of death?

Cuses of death:

Ten Leading Causes of Death (Both Sexes, All Ages)

African Americans Whites
1. Heart disease 1. Heart disease
2. Cancer 2. Cancer
3. Cerebrovascular Disease or Stroke 3. Cerebrovascular Disease or Stroke
4. Diabetes 4. Chronic Lower respiratory disease
5. Unintentional accidents 5. Unintentional accidents
6. Homicide 6. Diabetes
7. HIV/AIDS 7. Influenza and Pneumonia
8. Respiratory Disease (COPD) 8. Alzheimer’s Disease
9. Nephritis, Nephrotic syndrome and nephrosis 9. Nephritis, Nephrotic syndrome, and nephrosis
10. Septicema 10. Suicide

Source: CDC, National Vital Statistics Report, Vol. 53, Nov.17, March, 2005[13]

medically underserved populations, such as racial and ethnic minorities, experience disproportionately greater suffering and compromised health from cancer compared to the U.S. population as a whole. This is due in large part to delayed diagnosis coupled with less than appropriate patient care. (2)  In addition, individuals of all ethnic backgrounds who are poor, lack health insurance, or otherwise have inadequate access to quality cancer treatment experience higher cancer incidence, higher mortality rates, and poorer survival rates. (3,4) [14]

Breast Cancer Death Rates By Race And Age

African American women ages 35 to 44 have a death rate from breast cancer twice that of white women the same age. Below, a look at how many deaths are caused by breast cancer per 100,000.[15]


*Includes Alaska Native; **includes Pacific Islander

Source: Office Of Minority Health Resource Center

Credit: Alyson Hurt

Beginning in their 20s, into their 50s, black women are twice as likely to die of breast cancer as white women who have breast cancer. In older black women, cases of breast cancer decline, but the high death rates persist.

Overall, breast cancer deaths have been declining for nearly a decade (by 2 percent annually), yet deaths of African-American women have been dropping at a much slower pace. In 2009, an estimated 40,170 women will die from breast cancer. Nearly 6,000 will be African-American women.[16]

According to the Office of Minority Health [5], HIV infection is the fifth leading cause of death for people who are 25-44 years old in the United States, and it is estimated that 850,000 to 950,000 U.S. residents are living with HIV infection, one-quarter of whom are unaware of their infection. HIV/AIDS impacts African Americans particularly hard.

  • It is the leading cause of death for African American men ages 35-44. 
  • Additionally, Black women are 18 times more likely to be diagnosed with HIV in 2003 than white women.[17]


 While death rates from cancer continue to drop among African Americans, the group continues to be diagnosed at more advanced stages and have lower survival rates at each stage of diagnosis compared to whites for most cancer sites. The report estimates that among African Americans in 2009, there will be about 150,090 new cases of invasive cancer diagnosed and about 63,360 cancer deaths. The most commonly diagnosed cancers among African American men will be prostate (34 percent), lung (16 percent), and colon and rectum (10 percent). Among African American women, the most common cancers will be breast (25 percent), lung (12 percent), and colon and rectum (11 percent). Cancer of the lung will be the most common cause of cancer death in both African American men (31 percent) and women (23 percent), followed by prostate cancer in men (12 percent) and breast cancer in women (19 percent). African Americans have the highest death rate of any racial and ethnic group in the U.S. for most cancers,” said Otis W. Brawley, M.D., American Cancer Society chief medical officer. [18]

How many Black people are incarcerated?

Of the 301.6 million inhabitants in the United States, African Americans comprise 13.1% (roughly over 40.7 million. [19]

According to NAACP Legal Defense and Educational Fund, Inc.’s “Death Row Report (2009),” 3,297 inmates are on death row in the United States – 3,239 males (98.24%) and 58 females (1.76%). African Americans constitute 41.58% (1,371).[20]

          What ages?

          How many die in prison?

How many Blacks are victims of homicide every year?

African Americans comprise 13% of the population,  however 43% of all murder victims in 2007 were African American.  “

African Americans, especially African American Women, suffer deadly violence from family members at rates decidedly higher than for other racial groups in the United States. However, it is observed that research concerning family violence among African Americans is inadequate.[21]

  • Overall, African Americans were victimized by intimate partners a significantly higher rates than persons of any other race between 1993 and 1998. Black females experienced intimate partner violence at a rate 35% higher than that of white females, and about 22 times the rate of women of other races. Black males experienced intimate partner violence at a rate about 62% higher than that of white males and about 22 times the rate of men of other races.

Callie Marie Rennison. and Sarah Welchans, U.S. Dep’t of Just., NCJ 178247, Intimate Partner Violence (2000), available at

  • African-American women experience significantly more domestic violence than White women in the age group of 20-24. Generally, Black women experience similar levels of intimate partner victimization in all other age categories as compared to White women, but experience slightly more domestic violence. (Estimates are provided from the National Crime Victimization Survey, which defines an intimate partner as a current or former spouse, girlfriend, or boyfriend. Violent acts include murder, rape, sexual assault, robbery, aggravated assault, and simple assault.)

Callie Marie Rennison, U.S. Dep’t of Just., NCJ 187635, Intimate Partner Violence and Age of Victim, 1993-1999, at 4, (2001), available at

  • Approximately 40% of Black women report coercive contact of a sexual nature by age 18.

Africana Voices Against Violence, Tufts University, Statistics, 2002,

  • The number one killer of African-American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.

Africana Voices Against Violence, Tufts University, Statistics, 2002,

  • In a study of African-American sexual assault survivors, only 17% reported the assault to police.

Africana Voices Against Violence, Tufts University, Statistics,


African Americans comprise While African Americans comprise 13.5% of the U.S. Population, 43% of all murder victims in 2007 were African American, 93.1% of whom were killed were African Americans.

Victimizations of African Americans from violent crime which include the following; rape/sexual assault, robbery, aggravated and simple Assault was 24.3% in 2007, with the highest percentages of victimizations within the age ranges of 15-24 totaling a percentage greater than 38%

While African Americans comprise 13.5% of the U.S. Population, 43% of all murder victims in 2007 were African American, 93.1% of whom were killed were African Americans.

Victimizations of African Americans from violent crime which include the following; rape/sexual assault, robbery, aggravated and simple Assault was 24.3% in 2007, with the highest percentages of victimizations within the age ranges of 15-24 totaling a percentage greater than 38%.



More than 400 patients have died using Oregon’s “Death with Dignity” law. But not one has been African-American.[22]




[1] cited 01/28/2010

[2] African American Profile – – cited 1/05/09

[3] The American Community, Blacks: 2004, – cited 1/05/09

[6] ibid

[7] African American Profile – – cited 1/05/09


[8] The American Community, Blacks: 2004, – cited 1/05/09


[10] ibid

[11] ibid


1.  Intercultural Cancer Council – ICC. Strategic directions 2000-2002. Unpublished report, September 1999.
2.  Institute of Medicine. Haynes MA, Smedley BD, editors. The unequal burden of cancer. An assessment of NIH research and programs for ethnic minorities and the medically underserved. Washington, DC: National Academy Press; 1999.
3.  American Cancer Society. Cancer and the socioeconomically disadvantaged. Atlanta, GA: American Cancer Society; 1990.


[18] ScienceDaily. Retrieved January 6, 2010, from

[20] ibid

[22] – cited 01/06

African Americans & Grief: A Bibliography

Passed On – African American Mourning Stories – Karla FC Holloway, 2003 Duke University Press

African Americans & Grief (Series in Death, Dying) – Paul C. Rosenblatt, Beverly R. Wallace, Routlidge 2005

Lead Me Home: An African-American’s Guide Through the Grief Journey – Carleen Brice, Harper Perennial, 1999



African Americans IN Bereavement: Grief as a Function of Ethnicity

Anna Laurie, Robert A. Neimeyer, University of Memphis, Tennessee

Omega -Vol. 57(2) 173-193, 2008


Of Broken Bonds and Bondage: An Analysis of Loss in the Slave Narrative Collection – Anna Laurie, Robert A. Neimeyer,   University of Memphis, Tennessee

Death Studies, 34: 221-256, 2010


Sociocultural considerations for working with Blacks experiencing loss and grief;  Barrett, R. K, In K. J. Doka & J. D. Davidson (Eds.), Living with grief: Who we are, how we grieve. Philadelphia:  Hospice Foundation of America.  (1998).


Death and dying in the Black experience: An interview with Ronald K. Barrett, Ph.D. Innovations in End-of-Life Care, -3(5), 173-178 (2001)

Grief is Good  – Hilary Hart:

African American Homicide Bereavement : Aspects of Social Support that Predict Complicated Grief, PTSD, and Depression,  Laurie E. Burke, Robert A. Neimeyer and Meeghan McDevitt- Murphy, University of Memphis

Omega , Vol. 61, 1-24 (2010)




African Americans and Death — 6 Comments

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