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Tue May 14, 2013
Disturbing statistics about infant mortality reflect Michigan's health disparities
Too many babies are dying in Michigan.
That’s not speculation – that’s based on some disturbing statistics. And even now, in 2013, those statistics say that a baby’s chance of living past his or her first birthday can largely depend on the color of the baby’s skin.
In Michigan, the infant mortality rate has been persistently higher than the national average.
More specifically, a baby born to a black mother is almost three times more likely to die before its first birthday than a baby born to a white mother.
Michigan Radio's Dustin Dwyer reported in August about Michigan's infant mortality disparity for State of Opportunity:
Using a three-year moving average for Michigan’s mortality rate for African-American babies, we would be behind every advanced nation, tucked between countries like Malaysia and Syria.
Arline Geronimus is a professor of Health Behavior and Health Education at the University of Michigan and works for the Institute for Social Research.
Thirty years ago, Geronimus advanced a hypothesis that explained the disparity between white babies and babies of color.
Her hypothesis suggested that marginalized groups of women, such as African Americans, begin to develop diseases and conditions at a younger age than women who live in more privileged conditions.
These conditions, like high blood pressure, affect pregnancy. High blood pressure (hypertension) is one of the biggest risk factors for poor birth outcomes.
I described rates of hypertension among black women that weren’t just higher than white
women -- many already knew that – but the age dimension of that disparity enlarged exactly over the reproductive ages.
If you think about hypertension as a stress-related disease, you can begin to understand why groups who have less and are subject to marginalization would have more exposure to, and need to cope actively with stressors.
Essentially, women who have to cope with more stress due to poverty levels and marginalization are more susceptible to stress related diseases – like high blood pressure – and high blood pressure leads to higher infant mortality rates.
Factors that influence the health of marginalized women
Education level and income are determining factors that influence an individual’s health, but there’s more that must be taken into account when examining a woman’s maternal health during pregnancy.
Brenda Jegede is the project coordinator for PRIME – Practice to Reduce Infant Mortality through Equity, which is a part of the Michigan Department of Community Health.
Jegede acknowledged the importance of education and income as factors that determine health, but she said that there’s more to it than that.
At PRIME, Jegede said that concepts like health equity and institutional racism play a big role in the discussion of what influence a woman’s health.
“We try to understand how those concepts play into the policies and procedures we develop at the state level and how that impacts women and their families. We’re looking at how we can do business differently because for decades we haven’t reduced racial disparities.”
These factors are key to understanding why a 30-year-old black woman still has a higher rate of infant death than a white woman of the same age.
“A 30-year-old black woman probably had to work much harder to get where she is and is probably paid less than someone else. She may not have the same opportunities with promotions or even places to live because we have segregated residential areas,” Geronimus said.
Due to these factors that directly affect women of color, Geronimus said that marginalized women are dealing with things on a psycho-social level because of the energy it takes to work against institutionalized racism on a daily basis.
“It activates stress processes which cause weathering and wear and tear on a range of body system like deregulated blood pressure and blood sugar.”
What needs to be done?
1. Changing our perspective
Both Geronimus and Jegede said that an important step in reducing health disparities is to look at entire populations instead of individual behaviors.
Additionally, shifting the study of women’s health from the nine months they are pregnant to a longer examination of a woman’s entire life course is important in understanding health disparities.
Geronimus said that the dynamic between clinicians and the pregnant women they care for can be influential as well.
“Did the clinician make her feel comfortable? Did they assume that she had bad behaviors or cultural practices? Are there places where the woman can go to buy the food she needs?” Geronimus asked.
2. Looking at zip codes instead of DNA
“The areas in which segregation has occurred in Michigan has tended to segregate people of color not only in low income communities, but places where there’s lots of diesel fuel and high lead concentration. These areas tend to have little access to healthy foods but lots of access to fast foods or liquor stores,” Geronimus said.
In five or ten years, Jegede hoped that the concepts that are being learned today will no longer be new ideas, and that talking about race as a factor in health disparities isn’t something that people shy away from.
“We will have a tremendous gain if we made that change.”
Michigan Radio's State of Opportunity team recently spent several months looking into the state's disturbingly high infant mortality rate and what's being done to try to fix it. You can check out those reports here.
-- Lucy Perkins, Michigan Radio Newsroom
To hear the audio, click the link above.
State of Opportunity