Racial disparities in mortality over time reflect divergent pathways to the current large racial disparities in health. The residential concentration of African Americans is high and distinctive, and the related inequities in neighborhood environments, socioeconomic circumstances, and medical care are important factors in initiating and maintaining racial disparities in health. Efforts are needed to identify and maximize health-enhancing resources that may reduce some of the negative effects of psychosocial factors on health. Health and health disparities are embedded in larger historical, geographic, sociocultural, economic, and political contexts. Changes in a broad range of public policies are likely to be central to effectively addressing racial disparities. R ac i a l di s pa r i t i e s i n h e a lt h in the United States are substantial. The overall death rate for blacks today is comparable to the rate for whites thirty years ago, with about 100,000 blacks dying each year who would not die if the death rates were equivalent. 1 This paper outlines factors in the social environment that can initiate and sustain racial disparities in health. Race is a marker for differential exposure to multiple disease-producing social factors. Thus, racial disparities in health should be understood not only in terms of individual characteristics but also in light of patterned racial inequalities in exposure to societal risks and resources.We illustrate some of these social processes by examining racial differences in mortality from 1950 to 2000 for five causes of death that reveal divergent pathways to current health disparities. Three of these causes of death-homicide, heart disease, and cancer-show wide disparities between black and white populations; two of these causes-pneumonia and flu, and suicide-show virtually no disparities. Data are available for blacks and whites for the 1950-2002 time period only. We present both absolute (black-white differences) and relative (black-white ratios) indicators of disparity.