I’m reading this fantastic book by Michael Marmot called The Status Syndrome^[1], and in it he talks about how social factors–income, occupational prestige, social status, education–play important roles in the health of populations. He gets much more detailed and actually outlines what the Status Syndrome is, but I won’t ruin the ending of the book for you.

What I want to focus on here is society’s effect on health. Specifically, I’m going to talk about how racism affects infant mortality rates and the evidence against race.

Sir Michael Marmot is also mentioned in the incredibly interesting PBS series, Unnatural Causes: Is inequality making us sick?. In hour two of this series, they discuss infant mortality.^[2] There are many causes for infant mortality — SIDS^[3], congenital abnormalities, and being born too early and underdeveloped are the three main reasons.

The United States ranks as one of the lowest in the industrialized world in terms of infant mortality — with a whopping rate of 6.3/1000. To put that into perspective, Sweden has 2.75/1000 and Cuba is on par with us at 5.9/1000.^[4][5]

That’s pretty bad considering we are also the nation that spends the most per capita on health care…^[6] But that’s not what is really interesting here. The most interesting thing is the breakdown by race.

It turns out, African Americans have two and a half times the infant mortality rate of white women. Unimpressed? You’re an intelligent person and you say that this must be attributed to racial differences–African American women are, generally, in a lower socioeconomic status (SES) than white women and that is the deciding factor. Due to their lower SES, less African American women are able to afford prenatal care or continue to work while pregnant longer or something of that sort. However, it turns out that when you adjust for education, the infant mortality gap actually widens. College educated African American women have a rate of 10.2/1000 vs the 3.7/1000 of white college educated women. That’s on the same scale as a white woman with no high school education (9.9/1000). Obviously, income and education is not the deciding factor here.

If that is the case, it is easy to assume that the cause must be genetic in nature. Perhaps being of African descent is in and of itself what is causing the higher infant mortality rate. How would you test that? Well, one research team did it by weighing African American babies to recently immigrated African babies and white babies. We know this is a reasonable comparison because genetic variations within a population take generations upon generations (thousands of years for humans) to cause any sort of significant difference. Therefore, women of African descent should have the same baby weight as African American women. What they found was that the African babies (immigrant) were the same weight as the white babies and both were significantly heavier than the African American babies.

The finding is profound. It means that the act of growing up black in America is enough to negatively affect the weight of your child. Why? Racism. Researchers found that women who felt racially prejudiced were twice as likely to give birth to underweight babies. The public health implactions here are significant. For so long, health care in America has been focused around the hospital and doctor. Through social epidemiology, public health, and other forms of social research, we’re discovering that the external factors to your health are much more dramatic than previously imagined.

[Image by lulazzo via Flickr.]

1. Yes, for class. But it’s good and light enough that I’d recommend it to others for casual reading. [go back]
2. The number of infants who die within the first year of life. Usually expressed as a fraction of 1,000 (live)births. [go back]
3. Sudden Infant Death Syndrome [go back]
4. CIA Worldfact Book [go back]
5. It should be noted that the methodology of these reports has recently been called into question, but that post is for another day. [go back]
6. I don’t have a real citation for this because it is such a generally accepted fact, but if you need one look for Healthcare in the US by Kovner. [go back]