Throughout its history, Washington, DC has experienced many of the nation's worst epidemics, including maternal and infant mortality, homicide, heroin overdoses, and HIV/AIDS. And these epidemics have disproportionately affected African Americans. Why and how does such racial health inequality exist and persist? Starting from the city's founding in the late 1700s and tracing into the present—and drawing on a range of sources, from archival material and life-history interviews to census, vital statistics, and disease surveillance data—this book illustrates how the city's physical, social, and policy design contributes to the production and reproduction of disproportionate death among African Americans.