Even in Infancy, Racial Inequality a Stain on American Life

In Escambia, minorities more than twice as likely to die before first birthday; UWF researchers hope to learn why

Pensacola — In Escambia County, children born to minority parents are more than twice as likely as their white peers to die before their first birthday.

This divide – which mirrors national trends – has confounded researchers for decades. Experts say the gap can’t be explained by medical factors alone, which leads some to suspect social forces might also play a role.

A team of researchers from the University of West Florida is preparing to embark on a project aimed at teasing out those hidden forces. The project, funded by the Florida Department of Health, is one part of a multi-phase initiative called “Attack Infant Mortality,” or AIM Escambia.

“It’s an issue of equal opportunity,” said Dr. Erica Jordan, an assistant professor of psychology at UWF who is leading the effort. “You can’t have equal opportunity if you’re already starting off with a significant disparity from the moment that you’re born.”

Infant mortality a national issue

Jordan will leave UWF in the fall to take a job at the University of Houston. Two of her colleagues, Dione King and Justice Mbizo, will assume responsibility for the project, with Jordan staying on as a consultant.

However, Jordan expects similar disparities will greet her in the Lone Star State. Indeed, minority families are at increased risk of poor birth outcomes throughout the nation, not just in Escambia County.

For every 1,000 infants born to white, American families in 2013, more than five died before their first birthday, according to the U.S. Department of Health and Human Services. For black families, the rate was more than twice as high.

Those numbers put the U.S. far behind most other developed nations, according to a report published by the department last year. The U.S. ranked 26th among the 29 countries in the Organization for Economic Cooperation and Development. Some of this variation could be explained by differences in the way countries measure infant mortality. However, even after the authors controlled for this variation, the U.S. lagged behind most European nations.

The situation is particularly grim for Escambia County families. From 2012 to 2014, 4.6 out of every 1,000 white infants born locally died before their first birthday, according to the Florida Department of Health. For black families, the rate was 13.1.

The problem is not new. Researchers have noted such disparities for decades. Despite years of targeted interventions, though, the gap remains stubbornly wide – a fact Dr. John Lanza, a pediatrician who heads the Florida Department of Health in Escambia County, said he finds troubling.

“Every child deserves to live a full life,” Lanza said. “If there’s something that we don’t know right now that we need to know in order to keep those children alive, I want to find out what it is.”

Lanza and his team, working in conjunction with the Escambia County Healthy Start Coalition, have spent two decades trying to answer this question, with limited success. A few years ago, they decided to sit down and analyze what they had learned.

“One of the things we found, which largely mirrors what the literature shows, is that a black woman, regardless of where she lives in the state of Florida or her educational level or her income level, was always going to have an increased risk of a poor birth outcome,” Lanza said.

“In other words, it’s not all about the person moving,” Lanza said, though he added researchers have found moving can play a role. “It’s not all about the mother’s nutrition or the baby’s nutrition. It’s not all about underlying diseases. It’s not necessarily a physical, medical item I can identify or any item we had previously been able to identify. So I came to the conclusion that there was some other aspect we were missing, some social factor.”

Stress, discrimination could play role

“Some social factor …” But what? That’s where Jordan comes in.

Up until now, the work of AIM Escambia has focused mostly on encouraging young women to make healthier choices — things like quitting smoking, getting proper nutrition and exercise or taking folic acid — that can reduce their risk of losing a child.

Still, Jordan said such choices, alone, wouldn’t be enough to solve the problem. With that in mind, Jordan and her team this summer will embark on a new phase of their project, a community-wide survey aimed at documenting the experiences of Escambia County women in the early years of their life – before they ever conceive a child, or even conceive of conceiving a child.

“We’re really trying to paint a picture of life experiences in the preconception period for different groups of women in Escambia County,” Jordan said. Their goal is to identify patterns in the data and, hopefully, suggest some answers as to why so many black babies are dying.

Researchers don’t know what picture the data will paint, but they have some hypotheses.

“There is a lot of research out there looking at stress and a concept called ‘weathering’ within the black female population, which deals with a summation of all these stressful factors a black woman has to deal with as opposed to a white woman in our society,” Lanza said.

Jordan was more direct.

“One thing we are exploring is racism, certain stressors that trickle down from ideologies,” Jordan said. “If you belong to a minority group, or if you belong to a group that has been traditionally disenfranchised, traditionally marginalized, kept from not only tangible health resources, but also sort of stigmatized and treated unfairly, this could present an additional layer of stress that can affect you from cradle to grave, (or) so the theory goes.”

Jordan said this notion might be hard for some to swallow. However, the idea that social forces can have a tangible effect on public health is far from novel, she said.

“It would have been unthinkable even a couple decades ago to think, ‘Oh these … sort of fuzzy social factors that are difficult to get a grasp on can be affecting physical health,’” Jordan said. “But now, more and more, this is being accepted. You have studies by the National Institute of Health that suggest stress, that suggest disenfranchised groups are differentially affected in terms of their health outcomes.”

Depending upon what the researchers find, Lanza said lawmakers might need to consider taking a different approach to addressing existing health disparities.

Jordan said, at the very least, modifications to the health system might be necessary to close the gap.

“We can’t just undo our current system,” Jordan said. “But … if we were to find that we had significant risk across the life course that seemed to be contributing to babies being born already several steps behind in terms of health, we would have to take a look and see what kind of creative approaches we could take that fit within our system … to greater support moms, dads, infants so that we eventually have healthier citizens throughout the lifespan.”

Written by T.S. Strickland