By Jason Semprini

Infant mortality is a common indicator of a country’s overall health and economic progress. In the United States, an African American baby is twice as likely as a White baby to die during their first year of life. This fact embodies the country’s struggle with racism. While the U.S. rate of infant mortality hovers around five children per 1,000 births (26th worldwide), the death rate for African American children under five is closer in ranking to Thailand or Libya. New research from the National Birth Equity Collaborative in New Orleans explores the relationship between infant mortality rates and institutional racism, and finds that racial inequities in employment and education negatively impact African American infant mortality, but have no effect on white infant mortality rates.

Researchers have previously attempted to explain the widening gap between mortality of African American and White babies as a matter of genetics, environment, or behaviors. These theories conflict with recent findings. Using life-course models and analyzing the “weathering” effects of “growing up as a person of color,” the field has shifted from exploring racial differences toward a better understanding of racial discrimination. This paper explores another social determinant of health—racial disparity—and the effects it may have on infant mortality. The authors use race and aspects of privilege in America to illustrate that unequal access to resources can influence maternal health. According to this model, the distribution of resources disproportionately disadvantages African American infants. The authors test the hypothesis: “does structural racism—racially disproportional unemployment, access to health care, and inequities in education—increase black infant deaths.”

Using national birth data, the investigators obtained all birth and infant death records from 2010 to 2013 and calculated the infant mortality rate by race in each state. The study categorized exposure to racism using indicators such as incarceration, low educational attainment, unemployment, and poverty. Levels of structural racism were determined by calculating the ratio of African-Americans to Whites in each data point (i.e. ratio of black to white unemployment rate). Adjusting for population-specific and state-level measures, the authors calculated the relative risk of infant mortality given exposure to various racial inequities. However, the study was limited in its inability to assess infant mortality and discrimination measures on a more localized level. There was also no effort to categorize individual infant births and deaths by family demographics related to racism, which indicates an area for future investigation.

The findings revealed that states with elevated levels of structural racism had higher relative risk of infant mortality for black mothers. For example, as the ratio of black to white unemployment rose, so too did infant mortality. The converse was not true. The authors found no effect on white infant mortality from any change in black to white unemployment. Most notably, lower levels of disparities in education were associated with a 10 percent reduction in the infant mortality rate.

Improving quality and access to care are critical components of America’s continued health care reform efforts. However, little progress can be achieved if we fail to identify the effect of institutional racism on these disparities. This study paves the way for future research into the realm of racial health disparities in America and provides evidence for exploring interventions at the systematic level.

Article source: Wallace, Maeve, Joia Crear-Perry, Lisa Richardson, Meshawn Tarver, and Katherine Theall. “Separate and unequal: Structural racism and infant mortality in the US,” Health & Place 45, (2017): 140-144.