North Carolina
Black Americans still suffer worse health. Here’s why there’s so little progress.
By Fred Clasen-Kelly and Renuka Rayasam
KFF Health News
KINGSTREE, S.C. — One morning in late April, a small brick health clinic along the Thurgood Marshall Highway bustled with patients.
There was Joshua McCray, 69, a public bus driver who, four years after catching COVID-19, still is too weak to drive.
Louvenia McKinney, 77, arrived complaining about shortness of breath.
Ponzella McClary brought her 83-year-old mother-in-law, Lula, who has memory issues and had recently taken a fall.
Morris Brown, the family practice physician who owns the clinic, rotated through Black patients nearly every 20 minutes. Some struggled to walk. Others pulled oxygen tanks. And most carried three pill bottles or more for various chronic ailments.
But Brown called them “lucky,” with enough health insurance or money to see a doctor. The clinic serves patients along the infamous “Corridor of Shame,” a rural stretch of South Carolina with some of the worst health outcomes in the nation.
“There is a lot of hopelessness here,” Brown said. “I was trained to keep people healthy, but like 80 percent of the people don’t come see the doctor, because they can’t afford it. They’re just dying off.”
About 50 miles from the sandy beaches and golf courses along the coastline of this racially divided state, Morris’ independent practice serves the predominantly Black town of roughly 3,200 people. The area has stark health care provider shortages and high rates of chronic disease, such as diabetes, high blood pressure, and heart disease.
But South Carolina remains one of the few states where lawmakers refuse to expand Medicaid, despite research that shows it would provide medical insurance to hundreds of thousands of people and create thousands of health care jobs across the state.
The decision means there will be more preventable deaths in the 17 poverty-stricken counties along Interstate 95 that constitute the Corridor of Shame, Brown said.
“There is a disconnect between policymakers and real people,” he said. The African Americans who make up most of the town’s population “are not the people in power.”
The U.S. health care system, “by its very design, delivers different outcomes for different populations,” said a June report from the National Academies of Sciences, Engineering, and Medicine. Those racial and ethnic inequities “also contribute to millions of premature deaths, resulting in loss of years of life and economic productivity.”
Over a recent two-decade span, mounting research shows, the United States has made almost no progress in eliminating racial disparities in key health indicators, even as political and public health leaders vowed to do so.
And that’s not an accident, according to academic researchers, doctors, politicians, community leaders, and dozens of other people KFF Health News interviewed.
Federal, state, and local governments, they said, have put systems in place that maintain the status quo and leave the well-being of Black people at the mercy of powerful business and political interests.
Across the nation, authorities have permitted nearly 80 percent of all municipal solid waste incinerators — linked to lung cancer, high blood pressure, higher risk of miscarriages and stillbirths, and non-Hodgkin lymphoma — to be built in Black, Latinx, and low-income communities, according to a complaint filed with the federal government against the state of Florida.
Federal lawmakers slowed investing in public housing as people of color moved in, leaving homes with mold, vermin and other health hazards.
And Louisiana and other states passed laws allowing the carrying of concealed firearms without a permit even though gun violence is now the No. 1 killer of kids and teens. Research shows Black youth ages 1 to 17 are 18 times as likely to suffer a gun homicide as their white counterparts.
“People are literally dying because of policy decisions in the South,” said Bakari Sellers, a Democratic former state representative in South Carolina.
KFF Health News undertook a yearlong examination of how government decisions undermine Black health — reviewing court and inspection records and government reports, and interviewing dozens of academic researchers, doctors, politicians, community leaders, grieving moms, and patients.
From the cradle to the grave, Black Americans suffer worse health outcomes than white people. They endure greater exposure to toxic industrial pollution, dangerously dilapidated housing, gun violence, and other social conditions linked to higher incidence of cancer, asthma, chronic stress, maternal and infant mortality, and myriad other health problems. They die at younger ages, and COVID shortened lives even more.
Disparities in American health care mean Black people have less access to quality medical care, researchers say. They are less likely to have health insurance and, when they seek medical attention, they report widespread incidents of discrimination by health care providers, a KFF survey shows. Even tools meant to help detect health problems may systematically fail people of color.
All signs point to systems rooted in the nation’s painful racist history, which even today affects all facets of American life.
“So much of what we see is the long tail of slavery and Jim Crow,” said Andrea Ducas, vice president of health policy at the Center for American Progress, a nonprofit think tank.
Put simply, said Jameta Nicole Barlow, a community health psychologist and professor at George Washington University, government actions send a clear message to Black people: “Who are you to ask for health care?”
Past and present
The end of slavery gave way to laws that denied Black people in the U.S. basic rights, enforced racial segregation, and subjected them to horrific violence.
“I can take facts from 100 years ago about segregation and lynchings for a county and I can predict the poverty rate and life expectancy with extraordinary precision,” said Luke Shaefer, a professor of social justice and public policy at the University of Michigan.
Starting in the 1930s, the federal government sorted neighborhoods in 239 cities and deemed redlined areas — typically home to Black people, Jews, immigrants, and poor white people — unfit for mortgage lending. That process concentrated Black people in neighborhoods prone to discrimination.
Local governments steered power plants, oil refineries, and other industrial facilities to Black neighborhoods, even as research linked them to increased risks of cardiovascular and respiratory diseases, cancer, and preterm births.
The federal government did not even begin to track racial disparities in health care until the 1980s, and at that time disparities in heart disease, infant mortality, cancer, and other major categories accounted for about 60,000 excess deaths among Black people each year. Elevated rates of six diseases, including cancer, addiction, and diabetes, accounted for more than 80 percent of the excess mortality for Black and other minority populations, according to “The Heckler Report,” released in 1985. During the past two decades there have been 1.63 million excess deaths among Black Americans relative to white Americans. That represents a loss of more than 80 million years of life, according to a 2023 JAMA study.
Recent efforts to address health disparities have run headlong into racist policies still entrenched in health systems. The design of the U.S. health care system and structural barriers have led to persistent health inequities that cost more than a million lives and billions of dollars, according to the national academies report.
“When COVID was first hitting, it was just sort of immediately clear who was going to suffer the most,” Ducas said, “not just because of differential access to care, but who was in a living environment that’s multigenerational or crowded, who is more likely to be in a job where they are an essential worker, who is going to be more reliant on public transportation.”
For example, in spring 2020, the North Carolina health department, led by current Centers for Disease Control and Prevention Director Mandy Cohen, failed to get COVID testing to vulnerable Black communities where people were getting sick and dying from COVID-related causes at far higher rates than white people.
And Black Americans were far more likely to hold jobs — in areas such as transportation, health care, law enforcement, and food preparation — that the government deemed essential to the economy and functioning of society, making them more susceptible to COVID, according to research.
Until McCray, the bus driver in Kingstree, South Carolina, got COVID in his mid-60s, he was strong enough to hold two jobs. He ended up on a feeding tube and a ventilator after he contracted COVID in 2020 while taking other essential workers from this predominantly Black area to jobs in a whiter, wealthier tourist town.
Now he cannot work and at times has difficulty walking.
“I can tell you the truth now: It was only the good Lord that saved him,” said Brown, the rural physician who treated McCray and many patients like him.
Federal and state governments have spent billions of dollars to implement the Affordable Care Act, the Children’s Health Insurance Program, and other measures to increase access to health care. Yet, experts said, many of the problems identified in “The Heckler Report” persist.
When Lakeisha Preston in Mississippi was diagnosed with walking pneumonia in 2019, she ended up with a $4,500 medical bill she couldn’t pay. Preston works at Maximus, which has a $6.6 billion contract with the federal government to help people sign up for Medicare and Affordable Care Act health plans.
She is convinced that being a Black woman made her challenges more likely.
“Think about how many centuries the same thing has been happening,” said Preston, noting how her mother worked two jobs her entire life without a vacation and suffered from health conditions including diabetes, cataracts, and carpal tunnel syndrome. Today Preston can’t afford to put her 8-year-old son on her health plan, so he’s covered by Medicaid.
“We consistently offer healthcare plans that are on par, if not better, than those available to most Americans through state and federal exchanges,” said Eileen Cassidy Rivera, a Maximus spokesperson.
In email exchanges with the Biden administration, spokespeople insisted that it is making progress in closing the racial health gap. They said officials have taken steps to address food insecurity, housing instability, pollution, and other social determinants of health that help fuel disparities.
President Joe Biden issued an executive order on his first full day in office in 2021 that said “the COVID-19 pandemic has exposed and exacerbated severe and pervasive health and social inequities in America.” Later that year, the White House issued another executive order focused on improving racial equity and acknowledged that long-standing racial disparities in health care and other areas have been “at times facilitated by the federal government.”
“The Biden-Harris Administration is laser focused on addressing the health needs of Black Americans by dismantling persistent structural inequities,” said Renata Miller, a spokesperson for the administration.
The CDC, along with some state and local governments, declared racism a serious public health threat.
U.S. Rep. Alma Adams, a North Carolina Democrat, pushed for “Momnibus” legislation to reduce maternal mortality. Yet federal lawmakers left money for Black maternal health out of the historic Inflation Reduction Act in 2022.
“I come to this space as an elected official, knowing what it is like to be poor, knowing what it is like to not have insurance and having to get up at 3, 4 in the morning with my mom to take my sister to the emergency room,” Adams said.
In the 1960s in North Carolina, Adams and her family would take her sister Linda, who had sickle cell anemia, to the emergency room because they had no doctor and could not afford health insurance. Linda died at the age of 26 in 1971.
“You have to have some sensitivity for this work,” Adams said. “And a lot of folks that I’ve worked with don’t have it.”
Governor’s veto
The website for Kingstree depicts idyllic images of small-town life, with white people sitting on a porch swing, kayaking on a river, eating ice cream, and strolling with their dogs. Two children wearing masks and a food vendor are the only Black people in the video, even though Black people make up 70 percent of the town’s population.
But life in Kingstree and surrounding communities is marked by poverty, a lack of access to health care, and other socioeconomic disadvantages that have given South Carolina poor rankings in key health indicators such as rates of death and obesity among children and teens.
Some 23 percent of residents in Williamsburg County, which contains Kingstree, live below the poverty line, about twice the national average, according to federal data.
There is one primary care physician for every 5,080 residents in Williamsburg County. That’s far less than in more urbanized and wealthier counties in the state such as Richland, Greenville, and Beaufort.
Edward Simmer, the state’s interim public health director, said that if “you are African American in a rural zone, it is like having two strikes against you.”
Asked if South Carolina should expand Medicaid, Simmer said the challenges South Carolina and other states confront are worsened by health care provider shortages and structural inequities too large and complicated for Medicaid expansion alone to solve.
“It is not a panacea,” he said.
But for Brown and others, the reason South Carolina remains one of the few states that have not expanded Medicaid — one step that could help narrow disparities with little cost to the state — is clear.
“Every year we look at the data, we see the health disparities and we don’t have a plan to improve,” Brown said. “It has become institutionalized. I call it institutional racism.”
A July report from George Washington University found that Medicaid expansion would provide insurance to 360,000 people and add 18,000 jobs in the health care sector in South Carolina.
“Racism is the reason we don’t have Medicaid expansion. Full stop,” said Janice Probst, a former director of the Rural and Minority Health Research Center in South Carolina. “These are not accidents. There is an idea that you can stay in power by using racism.”
South Carolina’s Republican governor, Henry McMaster, in July vetoed legislation that would have created a committee to consider Medicaid expansion, saying he did not believe it would be “fiscally responsible.”
Expanding Medicaid in the state could result in $4 billion in additional economic output from an influx of federal funds in 2026, according to the July report.
Beyond health care coverage and provider shortages, Black people “have never been given the conditions needed to thrive,” said Barlow, the George Washington University professor. “And this is because of white supremacy.”
North Carolina
As energy needs grow, North Carolina faces solar roadblocks
North Carolina’s solar energy landscape is at a crossroads as the state works to meet its ambitious climate goals.
Under House Bill 951, passed in 2021, North Carolina is required to cut carbon emissions in the energy sector by 70% from 2005 levels by 2030 and achieve carbon neutrality by 2050. However, meeting these targets is proving difficult as energy demand surges.
Jeff Hughes, a commissioner with the North Carolina Utilities Commission, says that it’s challenging to maintain grid reliability while pursuing aggressive decarbonization goals.
“If we have two gigawatts of load coming in the next three or four years, it’s going to be very difficult to model our way, to solarize our way out of it,” Hughes said, pointing to the growing demand from industries like AI-driven data centers.
Duke Energy, the state’s largest utility, has said fossil fuels are essential to ensuring reliable power amid increasing demand. Critics argue that the company’s reliance on natural gas and coal could derail progress toward cutting emissions.
North Carolina has long been a leader in solar energy, initially driven by smaller, five-megawatt projects. Today, the focus has shifted to larger installations, which are more efficient but face growing local opposition.
Carson Hart, CEO of Carolina Solar Energy, said scaling up has been key to increasing clean energy capacity. “Moving to these bigger projects has been really beneficial for getting more megawatts in the ground and meeting the state’s climate goals,” Hart said. But she noted that large projects often draw pushback from residents concerned about aesthetics and land use.
Rural areas are at the heart of the state’s solar boom, hosting about 80% of large-scale projects. Reginald Bynum Jr., director of community outreach at the Center for Energy Education, said rural North Carolina plays a critical role in meeting the state’s clean energy goals.
“My job is to make sure rural communities don’t miss the movement,” Bynum said. “These projects bring jobs, economic growth, and opportunities to areas that desperately need them.”
The economic impact of solar energy is substantial. In counties with significant solar development, property tax revenues have increased by as much as 1,600%, according to the North Carolina Sustainable Energy Association. These funds have supported schools, infrastructure, and emergency services in areas facing population declines and economic challenges.
The state’s clean energy sector also supports more than 110,000 full-time jobs, according to a report from e2, with many more expected as solar development continues.
Hughes said the state’s carbon plan, which is updated every two years, will play a key role in charting a path forward.
“There’s a lot of check and adjust that will occur over the next few years,” he said.
As North Carolina advances its solar energy ambitions, balancing the needs of developers, communities, and environmental goals will be essential to achieving a sustainable and reliable energy future.
North Carolina
3 men charged in connection with woman’s death at Cook Out restaurant in North Carolina
Two men have been charged with murder in the death of 29-year-old Davicia Jean Ann Lee at a Cook Out restaurant in Durham, North Carolina, last month. A third is facing a weapons charge.
Two men have been charged with murder in the fatal shooting of a woman at the fast-food restaurant Cook Out in North Carolina.
Twenty-three-year-old Alexander Kenyon Carlton Jr. and 19-year-old Calvin Jerade Spence Jr. have been charged with first-degree murder in the killing of 29-year-old Davicia Jean Ann Lee late last month in Durham, the Durham County Sheriff’s Office said in a news release on Friday.
A third man, 18-year-old Jamari Treyvon McKnight, is charged with one count of going armed to the terror of the people, which basically means terrorizing someone with a weapon like a gun.
USA TODAY could not immediately find attorneys representing the three men.
The shooting occurred just after 10:30 p.m. on Oct. 26 at the Cook Out on South Miami Boulevard, according to the sheriff’s office. When deputies arrived at the scene, they found Lee dead.
The sheriff’s office called the shooting “an isolated incident” that happened after shots broke out following a fight, WNCN-TV reported.
Arrests made in fatal shooting of Davicia Jean Ann Lee
Detectives arrested Spence and Carlton on Thursday and took them to the Durham County Detention Center without bond on charges of carrying a concealed gun, felony conspiracy, going armed to the terror of the people and first-degree murder, the sheriff’s office said.
McKnight was also taken into custody and arrested Thursday night on misdemeanor going armed to the terror of the people, according to the sheriff’s office. The Morrisville police arrested him and he is currently being held in the Wake County Detention Center until his first court appearance, the agency added.
The investigation into Lee’s homicide is ongoing, while all findings are now in the process of being turned over to the Durham County District Attorney’s Office for prosecution, according to the sheriff’s office.
North Carolina
USC Trojans Predicted to Flip Recruits from Utah, North Carolina Before Signing Day
The USC Trojans are in pursuit of flipping two class of 2025 recruits, Nela Tupou and Alex Payne. Can the Trojans flip one or both of these players before national signing day?
Nela Tupou Player Profile
Nela Tupou is a 6-4, 220 pound tight end/defensive end out of Folsom, California. He is rated as a three-star recruit and ranked as the 43rd-best ATH in the class of 2025 per 247Sports.
Tupou committed to the Utah Utes in February of 2024, but he just recently visited USC last weekend for the Trojans’ 28-20 win over the Nebraska Cornhuskers.
On3 is now predicting that Tupou will likely flip this commitment from Utah to USC.
Alex Payne Player Profile
Alex Payne is a 6-5, 265 pound offensive tackle out of Gainesville, Florida. He is rated as four-star recruit and ranked as the 16th-best offensive tackle in the class of 2025.
Payne committed to the North Carolina Tar Heels in January of 2024, but he as well as Tupou, visited USC last weekend.
In 247Sports recruiting analyst Tom Loy’s updated crystal ball prediction, he had Payne flipping his commitment from North Carolina to USC. Loy has a good track record of predicting where recruits will end up as his all-time hit rate for predicting recruits’ final destinations is 81.64 percent.
USC Bolstering Up Offensive Line to Go Along With Weapons
One of the glaring holes for the USC Trojans this season has been the offensive line. For USC to bounce back next season, they will have to get much better in the trenches. This has been exposed in their first season in the Big Ten. Landing Tupou, who can both be a factor in the run blocking scheme as a blocker, and Payne, one of the top tackle prospects in the country, would go a long way for next season and the future of the program.
Barring a flurry of transfer portal decisions, the Trojans will have an abundance of skill position talent coming back next season.
Freshman running back Quinten Joyner has been the second best back this season behind senior running back Woody marks.
Four of the Trojans five leading receivers are sophomores. Makai Lemon, Zachariah Branch, Ja’Kobi Lane, and Duce Robinson all have shown flashes of potentially being a number one wide receiver next season.
Add in the Trojans starting sophomore quarterback Jayden Maiava and they have one of the youngest teams in the Big Ten. If USC continues to address the offensive line in the last days of the 2025 recruiting cycle and in the transfer portal this offseason, the Trojans could be a dangerous team next season.
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