violence, advocating organized community re-
sponse as an effective deterrence.
Perry, Barbara.In the Name of Hate: Understanding
Hate Crimes. New York: Routledge, 2001. Argues
the controversial thesis that hate crimes are em-
bedded in continuing patterns of white racism
and prejudice against subordinate minorities.
Thomas Tandy Lewis
See also African Americans; Byrd murder case;
Crime; Crown Heights riot; Diallo shooting; Fer-
guson, Colin; Homosexuality and gay rights; Jew-
ish Americans; King, Rodney; Los Angeles riots;
Louima torture case; Police brutality; Race relations;
Shepard, Matthew; Supreme Court decisions.
Health care
Definition Production and consumption of
medical services, as well as health outcomes
Although most measures of health improved for the United
States and Canada during the 1990’s, medical costs in-
creased greatly and health care organization and financing
remained highly controversial.
Good health and long life are among the many bene-
fits enjoyed by countries with a high level of income
and economic development. The same process that
generated technology to augment production
brought repeated major discoveries and inventions
that have revolutionized the medical care available
to most people. Health, however, is not primarily de-
termined by medical care. It also reflects genetic
inheritance and lifestyle choices such as diet, ex-
ercise, avoiding risk factors such as smoking, ex-
cessive alcohol consumption, addictive drugs,
obesity, recreational violence, and irresponsible
sexual activity. Education has a large influence on
health. Better-educated people take better care
of themselves, both in and out of the medical sys-
tem. Persons with less than a high school educa-
tion have death rates at least double those with
education beyond high school. Public health and
sanitation programs—including a clean water
supply, sewage disposal, pollution control, pure
food, and drug surveillance—are also important.
While the United States and Canada are very simi-
lar in regard to most of these factors, the two
countries differ significantly in regard to public
policies toward the financing of medical services.
Health indicators for the United States and Can-
ada were already good in 1990 and became signifi-
cantly better over the decade. In 1990, a female baby
could expect to outlive her male counterpart by
seven years. For women of age fifty, the gap was
about five years, and for women of sixty-five it was
slightly under four years. Life expectancy at birth is
heavily influenced by nonmedical factors such as
murders, automobile accidents, and smoking, all of
which affected men much more than women.
Over the course of the 1990’s, life expectancy for
men increased to a much greater extent than for
women, lowering the gap substantially and equaliz-
ing the ratio of men to women surviving into ad-
vanced age. Both medical and nonmedical influ-
ences were important. Deaths from automobile
accidents declined in absolute numbers, from
47,000 in 1990 (17.9 per 100,000 population) to
43,000 in 2000 (14.9 per 100,000). Greater use of
seat belts, often mandated by law, helped. Murders
declined strikingly, from 23,000 in 1990 to 16,000 in- The proportion of cigarette smokers among
persons eighteen years and older fell from 25.5 per-
cent in 1990 to 23.2 percent in 2000. Suicides
decreased from 12.4 per 100,000 in 1990 to 10.4 per
100,000 in 2000. The proportion of older people
receiving flu vaccinations increased markedly, from
about one-third in 1989 to nearly two-thirds in 2000.
The U.S. Department of Health and Human Ser-
vices publicationHealth United States 2002presents
comparative data estimating life expectancy for indi-
viduals in high- and middle-income countries. Esti-
408 Health care The Nineties in America
Life Expectancy in the United States,
1990 and 2000Age Gender 1990 2000 % Change
At birth Male 71.8 74.3 3.5
Female 78.8 79.7 1.1
At age 50 Male 26.4 27.9 5.7
Female 31.3 32.0 2.2
At age 65 Male 15.1 16.2 7.3
Female 18.9 19.3 2.1Source: Statistical Abstract of the United States, 2008, p. 75.