Black men’s health is one of the greatest untapped opportunities to advance health equity in America, Dr. Okey K Eniya states. He explains why conversations about Black men’s health too often begin and end with documenting disparities and why we are asking the wrong questions and missing out on creating the most impact in this column, “Reconstructing and Reimagining Black Men’s Health: Why investing in Black men’s health may be one of America’s greatest opportunities to advance health equity, strengthen our economy, and build healthier communities.”
Every generation inherits moments that invite us to rethink what is possible.
I believe we are living through one of those moments.
Across the country, conversations about healthcare, education, workforce development, civic participation, economic mobility, artificial intelligence, institutional trust, and the future of our democracy are converging in ways they rarely have before.
To me, this is more than a policy moment.
It is a political and policy window of opportunity.
An opportunity to intentionally reconstruct and reimagine the systems that shape health.
Over the past several weeks, I reviewed a series of studies examining Black men’s health, life expectancy, health equity, and the economic costs of health disparities. Individually, each study offers an important insight. Together, they point to a conclusion that I believe should reshape how we think about health equity in America.
The research is giving us more than evidence of disparities.
It is giving us direction.
For decades, conversations about health equity have largely centered on healthcare.
Expand insurance coverage.
Increase access to care.
Improve quality.
Encourage healthier behaviors.
These investments matter.
But after synthesizing this body of evidence, I have become increasingly convinced that we may be asking the wrong question.
Instead of asking,
“How do we improve healthcare?”
perhaps we should ask,
“Where can we make the greatest impact?”
The evidence increasingly suggests one answer.
Black men’s health is one of the greatest untapped opportunities to advance health equity in America.
And if we fail to invest accordingly, we are not only perpetuating preventable inequities. We are also leaving billions of dollars in human potential, economic productivity, and community leadership unrealized.
My perspective on this issue has been shaped by experiences across research, public health practice, congressional policymaking, federal advocacy, and community engagement. Those experiences have convinced me that meaningful change requires connecting evidence to policy, policy to practice, and practice back to the communities we seek to serve.
That perspective also shaped The John Henry Health Equity Playbook, where I argue that Black men’s health should not be viewed solely through the lens of healthcare. It should be understood as an interconnected challenge involving physical and mental health, economic stability, civic engagement, and the systems that influence opportunity throughout the life course.
A recent analysis examining differences in life expectancy between Black and white Americans found that Black men continue to experience substantially shorter life expectancy than white men. Importantly, the disparity is not driven by a single disease. Rather, it reflects the cumulative effects of cardiovascular disease, cancer, homicide, injuries, and other preventable causes of death occurring across the life course. The study also found that deaths among young and middle-aged Black men disproportionately widen the life expectancy gap because they represent decades of potential life lost instead of deaths occurring later in life.¹
A second study reinforces this point.
Within the high-risk population they examined, Cai and colleagues found that Black men experienced a substantially larger racial life expectancy gap than Black women. Among Black men, heart disease, homicide, and cancer accounted for much of the difference.²
These studies do not tell us that Black men account for a specific percentage of the overall Black-white health gap.
That calculation has not been made.
What they do tell us is something equally important.
Black men bear one of the largest burdens of premature mortality in the United States.
Because many of these deaths are preventable, and because they occur earlier in life, improving Black men’s health represents one of the greatest opportunities to reduce racial disparities in longevity.
That distinction matters.
Too often, conversations about Black men’s health begin and end with documenting disparities.
Documentation is necessary.
But documentation alone does not improve health outcomes.
The more important question is:
What do these findings invite us to do differently?
For me, they invite us to think differently about where strategic investments can create the greatest return.
As I reflected on these studies, another question came to mind.
Nearly every analysis compares Black men to white men.
There are valid methodological reasons for doing this. Historically, white populations have often served as the reference group because they have generally experienced greater social, economic, and political advantage than historically marginalized populations.⁶
But a reference group is a methodological choice.
It is not a definition of optimal health.
That distinction matters.
Increasingly, health equity scholars are encouraging us to think differently about what success should look like.
Rather than asking,
“How do we help Black men achieve the same outcomes as white men?”
perhaps we should ask,
“What is the highest attainable level of health for Black men?”
Those are fundamentally different questions.
The first measures progress against historical averages.
The second challenges us to imagine what becomes possible when structural barriers are removed and opportunities are expanded.
It also reminds us that non-Hispanic white populations do not universally represent the healthiest benchmark. Several Asian American populations and the well-documented Hispanic mortality advantage demonstrate that longer life expectancy is possible under different social and demographic circumstances.
The goal, therefore, should not be to make Black men “more like white men.”
The goal should be to ensure that every community has the opportunity to achieve its highest attainable level of health.
That is precisely the vision behind Targeted Universalism, a framework that establishes a universal goal while recognizing that different communities face different barriers and therefore require different strategies to reach the same destination.⁷
It is also one of the foundational principles underlying The John Henry Health Equity Playbook.
Whenever I advocate for Black men’s health, I occasionally hear a familiar question.
“Why focus specifically on Black men?”
It is a fair question.
My answer is simple.
Specificity does not mean being exclusionary.
Public health has always relied on specificity.
We have dedicated initiatives for maternal health.
Veterans’ health.
Children’s health.
Rural health.
Alzheimer’s disease.
Cancer survivorship.
HIV prevention.
No one assumes these efforts imply that other populations are unimportant.
Instead, they recognize a basic truth.
Different populations experience different barriers.
Evidence-based solutions require evidence-based specificity.
Black men are no exception.
The research demonstrates that Black men experience one of the largest racial life expectancy disadvantages in America and bear a disproportionate burden of premature mortality from preventable causes.¹ ²
Recognizing that reality is not exclusionary.
It is evidence-based.
More importantly, improving Black men’s health benefits far more than Black men themselves.
Healthier fathers strengthen families.
Healthier workers strengthen the economy.
Healthier entrepreneurs create jobs.
Healthier community leaders strengthen neighborhoods.
Healthier voters strengthen democracy.
When Black men thrive, everyone benefits.
This is the essence of Targeted Universalism.
We pursue a universal goal while using targeted strategies to address the distinct barriers different populations face.
Specificity is not about excluding others.
It is about being precise enough to solve the problem.
As I was writing The John Henry Health Equity Playbook, I kept returning to one question:
If Black men’s health is one of America’s greatest untapped opportunities, what would it actually look like to invest in it?
That question fundamentally changed how I approached the book.
Most policy reports conclude with recommendations.
I wanted to conclude with an invitation.
That is why The John Henry Health Equity Playbook ends with an Investment Prospectus.
I intentionally chose the language of investment because it changes the conversation.
Too often, Black men’s health is discussed primarily in terms of deficits, disparities, and costs.
Those realities are important.
But they are not the whole story.
An investment perspective asks a different set of questions.
Instead of asking,
“How much will improving Black men’s health cost?”
it asks,
“What returns can we generate if we invest intentionally?”
That is a fundamentally different way of thinking about public policy.
It challenges us to move beyond documenting disparities and toward mobilizing resources.
It encourages us to think like investors, not just analysts.
It asks policymakers, healthcare leaders, employers, philanthropic organizations, insurers, researchers, and community organizations to consider not only the cost of action, but also the cost of inaction.
Because every investment carries an opportunity cost.
The question is no longer whether we will invest.
The question is where we will invest.
There is another reason Black men’s health deserves greater national attention.
It is not only a public health imperative.
It is an economic one.
Researchers at the Johns Hopkins Bloomberg School of Public Health estimated that health disparities among Black and Hispanic men cost the United States economy more than $450 billion over a four-year period. Black men alone accounted for $341.8 billion of those losses. Much of that burden resulted from premature death, representing the loss of workers, entrepreneurs, fathers, taxpayers, mentors, and community leaders.³
The story does not end there.
A more recent national analysis estimated that racial and ethnic health inequities cost the United States between $421 billion and $451 billion in 2018 alone, with most of the burden attributable to the poor health of the Black population.⁴
Think about what that means.
Every preventable heart attack.
Every delayed cancer diagnosis.
Every homicide.
Every unmanaged chronic disease.
Every premature death.
These are not simply personal tragedies.
They are lost human capital.
Lost innovation.
Lost productivity.
Lost entrepreneurship.
Lost civic leadership.
Lost tax revenue.
Lost economic growth.
Viewed through this lens, improving Black men’s health is not simply about reducing disparities.
It is about expanding opportunity.
It is about strengthening our workforce.
It is about improving economic competitiveness.
It is about increasing the return on investments we have already made in education, workforce development, and community development.
In other words, health equity is not merely a healthcare strategy.
It is an economic development strategy.
One of my favorite observations comes from the Advisory Board, which summarized decades of public health research with a simple but profound insight.
Medical care accounts for only one portion of what determines health outcomes.
The conditions in which people are born, grow, live, learn, work, worship, and age often exert an even greater influence.⁵
Healthcare matters.
So do:
Healthcare treats illness.
Systems produce health.
That insight reinforces something I have come to believe throughout my career.
Health is more than healthcare.
It is shaped by the policies we enact.
The neighborhoods we build.
The schools we fund.
The jobs we create.
The transportation systems we design.
The environmental conditions we tolerate.
The civic institutions we strengthen.
Or fail to strengthen.
This is precisely why The John Henry Health Equity Playbook intentionally extends beyond healthcare.
The Playbook is organized around three interconnected pillars:
Those pillars are intentionally connected because life is interconnected.
Educational attainment influences employment.
Employment influences income.
Income influences housing.
Housing influences stress.
Stress influences chronic disease.
Chronic disease influences life expectancy.
These are not separate conversations.
They are parts of the same system.
As I reflect on this body of research, I also find myself reflecting on the current sociopolitical landscape.
Periods of significant policy discussion invite us to ask bigger questions than how to improve individual programs.
They invite us to consider how we might reconstruct and reimagine the systems that shape people’s lives.
I believe we are in one of those moments.
Whether the issue is healthcare, education, workforce development, housing, artificial intelligence, economic mobility, or civic participation, there is growing recognition that many of our institutions were designed for a different era.
Some continue to serve us well.
Others require thoughtful redesign.
That reality presents a unique opportunity.
Not simply to reform existing systems.
But to intentionally improve them.
For me, this is where Black men’s health becomes much more than a healthcare conversation.
It becomes a conversation about institution building.
About how we design systems that create opportunity.
About how we remove barriers that prevent people from reaching their full potential.
About how we ensure that health equity is reflected not only in our aspirations, but also in our policies, investments, and partnerships.
The research discussed throughout this essay reinforces that improving Black men’s health will require coordinated action across multiple sectors.
That is not a weakness of the challenge.
It is an invitation to think differently.
To move beyond fragmented solutions.
To strengthen partnerships across sectors.
To align policy with evidence.
To align investment with opportunity.
And to intentionally build institutions that are better equipped to meet the needs of the communities they serve.
To me, that is what reconstruction and reimagining look like.
Not returning to what existed before.
But intentionally building something better.
Not because change is fashionable.
But because the evidence demands it.
Not because Black men are the only population experiencing disparities.
But because the evidence suggests that strategic investments in Black men’s health can generate benefits that extend far beyond Black men themselves.
That is exactly what systems thinking teaches us.
Systems scientists often talk about leverage points, places within a complex system where relatively focused interventions can produce disproportionately large improvements across the entire system.
I believe Black men’s health represents one of those leverage points.
Viewed through this lens, Black men’s health is not a niche issue competing for attention.
It is a strategic opportunity capable of generating broad societal returns.
Improving Black men’s health strengthens families.
It strengthens the workforce.
It strengthens communities.
It strengthens civic participation.
It strengthens economic productivity.
It strengthens population health.
That is why I believe Black men’s health should not be viewed as a competing priority within health equity.
It should be viewed as one of the ways we advance health equity.
Focusing on Black men does not narrow the health equity agenda.
It strengthens it.
Specificity does not mean being exclusionary.
It means directing our attention, our partnerships, our policies, and our investments toward the places where the evidence suggests they can produce the greatest impact.
That is what systems thinking teaches us.
When you strengthen a leverage point, you strengthen the entire system.
One lesson has become increasingly clear to me throughout my career.
Research is essential.
Policy is essential.
Practice is essential.
But none of them, by themselves, are enough.
Real progress happens when evidence informs policy, policy informs investment, investment strengthens institutions, and institutions improve people’s lives.
That is the journey I hoped to capture in The John Henry Health Equity Playbook and operationalizing through my non-profit the John Henry Institute for Black Men’s Health and Policy Innovation.
The Playbook is not simply a collection of policy recommendations.
It is a framework for translating research into action.
For connecting healthcare with economic stability.
For connecting civic engagement with health outcomes.
For helping policymakers, healthcare leaders, employers, philanthropic organizations, insurers, researchers, and community organizations see themselves as partners in improving Black men’s health.
This is also why I concluded the Playbook with an Investment Prospectus.
Rather than ending with another list of recommendations, I wanted to invite readers to think differently.
The Investment Prospectus asks us to move beyond asking,
“What will this cost?”
and instead ask,
“What becomes possible when we invest intentionally?”
What becomes possible when more Black men have access to preventive care?
What becomes possible when communities are safer?
When educational attainment improves?
When employment opportunities expand?
When trust in institutions grows?
When civic participation increases?
Those are not simply health questions.
They are questions about America’s future.
The Investment Prospectus is an invitation to move beyond documenting disparities.
It is an invitation to finance solutions.
It is an invitation to align public policy, private capital, philanthropy, healthcare, research, and community leadership around one shared objective.
Helping every Black man achieve his highest attainable level of health.
Because when Black men thrive, the returns extend far beyond Black men themselves.
Every generation inherits opportunities to strengthen the institutions it leaves behind.
I believe this is one of those moments.
The research is giving us more than evidence of disparities.
It is giving us direction.
A direction that challenges us to reconstruct and reimagine the systems that shape health.
A direction that challenges us to move beyond fragmented approaches and toward coordinated investment.
A direction that challenges us to recognize that health equity is not only about healthcare.
It is about opportunity.
It is about institutions.
It is about partnership.
It is about leadership.
And it is about intentional investment.
That is why I believe Black men’s health is one of America’s greatest untapped opportunities.
Not because Black men matter more than anyone else.
But because investing where the evidence points has the potential to strengthen the entire system.
The challenge before us is not choosing between universalism and specificity.
It is learning how to use specificity in service of universal progress.
Specificity does not mean being exclusionary.
It means being intentional.
It means being evidence-driven.
It means recognizing where investments can create the greatest return for individuals, families, communities, and our nation.
If we embrace that mindset, improving Black men’s health becomes much more than a public health priority.
It becomes an opportunity to strengthen America’s human capital.
To expand economic opportunity.
To improve community well-being.
To build institutions that serve all of us more effectively.
That is the invitation behind The John Henry Health Equity Playbook.
It is an invitation to reconstruct and reimagine.
To move from documenting disparities to designing solutions.
To move from identifying problems to financing progress.
To move from awareness to intentional investment.
The question is no longer whether Black men’s health deserves our attention.
The evidence has answered that.
The question is whether we are willing to invest with the intentionality this moment requires.
Because investing in Black men’s health is not simply an investment in Black men.
It is an investment in America’s future.
Elevate,
Dr. Okey K. Enyia
Follow Dr. Enyia on his Substack, Where Purpose Meets Policy.
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