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University of California Press

About the Book

Washington, DC, has the nation's largest racial life expectancy gap, and it has experienced many of the nation's worst epidemics, including maternal and infant mortality, homicide, heroin overdoses, and HIV/AIDS. These epidemics have disproportionately affected African Americans. Why and how does racial health inequality exist and persist? Starting from the city's founding in the late 1700s and drawing on a range of sources—including archival material, life history interviews, and census, vital statistics, and disease surveillance data—this book illustrates how the physical, social, and policy design of the city contributes to the production and reproduction of disproportionate Black death.
 

About the Author

Sanyu A. Mojola is Professor of Sociology and Public Affairs and Maurice P. During Professor of Demographic Studies at Princeton University. She directed Princeton's Office of Population Research from 2020 to 2024.
 

Table of Contents

Contents
 
List of Illustrations
 
Introduction
 
Part One. Racial Containment and Health in Historical Context
Overview
1. The First Era: 1790–1890
2. The Second Era: 1890–1950
3. The Third Era: 1950–Present
 
Part Two. Sex, Love, and HIV in a Syndemic Zone
Overview
4. The HIV Epidemic Among Gay and Bisexual Men
5. The HIV Epidemic Among Heterosexual Men, Women, and Trans Women
 
Part Three. The SAVA Syndemic: Drugs–HIV/AIDS–Homicide
Overview
6. First Comes Heroin: 1960–2016
7. Then Comes Cocaine: Late 1970s–2010s
8. Paying for a Habit: Commercial Sex and Drug Addiction Treatment
9. Homicide Redux and Life in a Syndemic Zone
 
Part Four. Mass Incarceration and Syndemic Amplification
Overview
10. Creating Mass Black Incarceration in DC
11. The DC Prison Syndemic and Community Amplification
 
Part Five. Racial Containment and the City's HIV/AIDS Epidemic Response
Overview
12. Intersectional Politics and the AIDS Epidemic
13. Controlling an Epidemic: The Successes and Limits of Technocratic Expertise
 
Conclusion
 
Appendix: Methodological Note
Acknowledgments
Notes
Bibliography
Index

Reviews

"Why did Washington, DC—the nation's capital—have the worst HIV epidemic in the United States in 2009? With characteristic brilliance, Sanyu Mojola identifies racial containment as the key factor. She systematically unpacks the social, legal, political, ideological, and economic ways in which containment of Black people has fueled persistent health inequalities and related syndemics—synergistic epidemics of substance misuse, HIV, and violence—across generations, resulting in one of the nation's worst racial life expectancy gaps. A must-read for anyone interested in social public health."—Judith D. Auerbach, Professor of Medicine, University of California, San Francisco

"Relying on an extensive body of primary and secondary sources, Mojola weaves together a compelling history of Washington, DC, to explain how it has earned the dubious distinction of having the nation's largest life expectancy gap. The result is a major contribution to our understanding of health and health inequities as products of a long history of policies in multiple domains that have reproduced, often purposefully, White and class privilege through a process of racial containment. The best medicines will not eliminate these inequities. Instead, a systematic, multisectoral, intentional commitment to and investment in the lives of Black people is urgently needed."—Kim Blankenship, Distinguished Professor of Sociology, American University

"In Death by Design, Mojola uses Washington, DC, as a case study to advance and convincingly support a comprehensive epidemiological model that clearly delineates how specific social and ecological processes generate stark Black-White differentials in health and mortality, not only in the nation's capital but, by extension, throughout the United States. It constitutes a major scientific contribution to the understanding of disease production."—Douglas S. Massey, Henry G. Bryant Professor of Sociology and Public Affairs emeritus, Princeton University