From the White House to the Washington Monument, imagery of the nation’s capital often conveys a sense of promise, hope, and justice for all. But for centuries, marginalized groups in Washington, D.C., have faced some of the country’s worst epidemics: from high maternal and infant mortality rates to homicide, drug addiction to HIV and AIDS outbreaks.

Speaking about her new book, “Death by Design: Producing Racial Health Inequality in the Shadow of the Capitol,” (University of California Press), Sanyu Mojola, Professor of Sociology and Public Affairs and the Maurice P. During Professor of Demographic Studies, said, “I was struck by the fact that the capital city of one of the greatest nations on Earth had some of the worst health outcomes in the country and decided to investigate why.”

The book draws on a range of historical and contemporary data sources, including archival materials, longitudinal quantitative data such as census, spatial, disease surveillance, and crime data, as well as life history and key informant interviews with local government officials, community leaders, and local organization officials, to explore how these problems began and why they continue into present day.

Read below for an excerpt from “Death by Design: Producing Racial Health Inequality in the Shadow of the Capitol.”

At the heart of this book is a story of the creation, design, and maintenance of America’s unequal playing fields of life and death. Its basic assertion is that at a population level, a large part of the variability of death rates across states, counties and neighborhoods is due to policy decisions that work together to create and sustain places that make groups of people more or less prone to early and/or chronic illness and premature death. The book focuses on examining the paradigmatic Black-White gap in illness and death and the story unfolds in the District of Columbia, the capital city, which has the nation’s largest racial life expectancy gap  – whether compared to states, territories, counties, or the thirty most populous cities, such as New York City, Los Angeles, Chicago, Houston, Baltimore, or Detroit. Black men and women born in Washington D.C. can expect to live a startling 18.01 years and 12.3 years less than their White men and women counterparts respectively.

I start from the city’s founding in 1790 and continue until 2022, drawing on multiple sources, including archival and contemporary materials, US Census and vital statistics data, and crime and disease surveillance data, along with life history and key informant interviews. I illustrate how the city’s physical, social and policy design contributed to the production of multiple, overlapping and interacting epidemics and the reproduction of racial inequality in illness and death throughout its history, despite dramatic social change. I focus more specifically on the last 60 years, examining HIV/AIDS, drug abuse and homicide in-depth, and more briefly examining COVID-19, the latest driver of the racial gap, as well as other causes of death. I describe the entangled histories of the city and Congress, and show how policies were both deliberately and benignly designed and implemented by Republican and Democratic, White and non-White actors. I show how these policies worked together to create - and importantly, recreate - disproportionate and premature illness and death for Black Americans across generations. By moving back and forth between the national and city stories, I will show that while DC’s story is a product of its peculiar history and status as a federal city, it is also, in some ways, a microcosm of the national production of racial health inequality, and what I am calling death by design.