study: Racism plays a role in premature births among black Americans – Los Angeles Sentinel | Los Angeles Sentry
Dr. Paula Braveman’s turning point came when her longtime patient at a community clinic in the Mission District of San Francisco crept through the front desk and knocked on her office door to say goodbye. .. He would no longer come to the clinic, he told her, because he no longer had the means.
It was a watershed moment for Braveman, who decided not only to treat sick patients, but also to advocate for policies that would help them become healthier when they arrived at the clinic. For nearly 40 years, Braveman has been dedicated to the study of the “social determinants of health”. We live, work, play, learn and study how the relationships in these places affect our health.
As director of the Center for Social Disparities in Health at the University of California at San Francisco, Braveman studied the relationship between neighborhood wealth and children’s health and how access to insurance affects prenatal care. A long-time supporter of transforming research into policy, she has collaborated with the San Francisco Department of Health, the United States Centers for Disease Control and Prevention, and the World Health Organization on major initiatives in health matters.
Braveman is particularly interested in the health of mothers and babies. The latest research examines what is known about the persistent gap in preterm birth rates between black and white women in the United States. Black women are about 1.6 times more likely than white women to give birth more than three weeks before due date. Premature infants are at increased risk for respiratory, heart and brain abnormalities, among other complications, so this statistic has alarming and costly health consequences.
Braveman wrote the journal in collaboration with a panel of experts brought together by March of Dimes, including geneticists, clinicians, epidemiologists, biomedical experts and neurologists. They investigated more than 20 suspected causes of preterm birth, including the quality of prenatal care, environmental toxicity, chronic stress, poverty, obesity and racism, best directly or indirectly racial disparity in rates. premature birth. I decided I was explaining.
(Note: In the analysis, the author uses the terms “upstream” and “downstream” extensively to describe what determines human health. Downstream risk is the most direct cause of health outcomes. The condition or factor that fuels downstream risk, and often what needs to be changed to prevent someone from getting sick. For example, toxic chemistry. People who live near drinking water contaminated with substances can get sick from drinking water. Use filters. The solution upstream is to stop the toxic chemical spill.)
KHN spoke to Braveman about the study and its findings. The length and style of the conversation have been changed.
Q: You have been studying preterm birth and racial disparity for a long time. Did you find anything that surprised you in this review?
The process of systematically examining all of the risk factors described in the literature and confirming that the history of racism was an upstream determinant of virtually all of the risk factors. It was a little surprised.
Another thing that impressed me a lot was when I saw the idea that genetic factors could be responsible for the black and white disparity in premature births. Genetic experts in this group concluded from evidence that genetic factors can affect the inequality of preterm births, but at best the effects are very small, in fact very small. low. That couldn’t explain the higher premature birth rate of black women compared to white women.
Q: I was not only trying to identify the cause of prematurity, but also to explain the racial differences in prematurity rates. Are there examples of factors that can affect premature birth that do not explain the racial disparity?
Although preterm birth appears to have a genetic component, it does not explain the black and white gap in preterm birth. Another example is an early selective cesarean section. This is one of the issues that contributes to preventable preterm births, but it doesn’t actually appear to contribute to the black and white gap in preterm births.
Q: You and your colleagues only cited one cause of preterm delivery earlier. It’s racism. How do you characterize the conviction that racism is the decisive cause upstream of the increase in premature birth rates among black women?
It reminds me of that saying: Random clinical trials wouldn’t be necessary to give certainty about the importance of skydiving if you jump out of a plane. For me at this point it’s close to that.
Reading the treaty – and we worked on it for a period of three or four years, so we had a lot of time to think about it – what other evidence we have, I don’t know if I can explain it that way.
Q: What have you learned about how mothers’ vast experience of racism throughout their lives affects the outcome of childbirth compared to what they experienced in a medical facility during pregnancy?
There have been many ways that racism affects a woman’s pregnancy, but one of the main ones is the biological pathways and mechanisms involved in stress and the physiology of stress. In neuroscience, it is clear that chronic stressors seem to be more harmful to health than acute stressors.
So it doesn’t make much sense to only watch during pregnancy. But that’s where most of the research has been done: pregnancy stress and racism, and its role in childbirth outcomes. Few studies have examined the lifelong experience of racism.
My colleague and I published a treatise asking African American women about their experiences of racism, but without even defining what we meant. Women have not spoken much to their health care providers about their experiences of racism during pregnancy. They spoke of their lifelong experiences, especially their return to childhood. And they talked about the areas of concern and constant vigilance, so even if they haven’t experienced an incident, their antennas should be prepared in case an incident does occur.
To sum up all we know about the physiology of stress, I spend money on lifelong experiences that are far more important than those during pregnancy. Premature birth is not well known, but because it is known, inflammation is involved and there is immune dysfunction, which leads to stress. Neuroscientists have shown us that chronic stress causes inflammation and dysfunction of the immune system.
Q: What do you think is the most important policy at this stage to reduce preterm births to black women?
I can say one or two policies, but I think it came back to the need to dismantle racism in our society. With all its symptoms. Sadly, “Oh, here’s that magic bullet. And that’s all it takes to fix the problem.
If you take the findings of this study seriously, well, you are saying that policies that track these downstream factors are not working. It is up to the upstream investments to achieve a more equitable and less racist society. After all, I think it’s a takeout, and it’s a tall order.
This article is available for California BlackMedia partners. KHN (Kaiser’s Health News).
KHN is a national newsroom that produces in-depth journalism on health issues. KHN, together with policy analysis and surveys, is one of the three main operational programs: KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the public.
study: Racism plays a role in premature births among black Americans – Los Angeles Sentinel | Los Angeles Sentinel Source Link Study: Racism plays a role in premature births among black Americans – Los Angeles Sentinel | Los Angeles Sentry