Available From UC Press

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.
 

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.
 

"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