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