When the Bough Breaks

I got a 4 out of 10 on the Health Equity Quiz.  The answers to these questions were really eye-opening, both about the success of the U.S. medical system compared to other countries, as well as about how much wealth and social class determine health.  Considering how much we Americans invest in our healthcare, I had expected us to be better than 29th in the world in terms of longevity!  I was also surprised by how much the health of individuals in the U.S. depends on class level, versus other factors like smoking or exercise.

When the Bough Breaks documents how the effect of racism against African Americans—which many Caucasians think is a thing of the past—is still powerful enough to severely increase the rate of premature births for African American mothers.  Even correcting for education and wealth, which usually predict the health of newborns, African American women are three times more likely than white women to birth premature or underweight babies.  Researchers have shown that this risk is not due to any genetic basis from African heritage.  In fact, the rates of premature birth rates in African immigrants to the U.S. are equal to those of white Americans.  This trend stops after the first generation of immigrants, however.  After that, the immigrants’ future generations suffer from the same high risk of underweight babies as African Americans.

This prompted researchers to consider how the chronic stress of racism across a woman’s life might impact her pregnancy.  Since stress hormones play a natural role in triggering labor, women with constantly high levels of these hormones are more likely to go into early labor.  Stress can also limit bloodflow to the placenta and cause inflammation inside the uterus, both limiting fetal growth and prompting premature delivery.

Social structures like racism, as well as economic, environmental, and political forces can contribute to the health of individuals.  While I generally focus on the biological and lifestyle factors that influence health, these other aspects can be very important.  For example, political action and the environment both influenced the spread of disease in North Africa when government initiatives built dams on the Nile River.  Bringing water sources close to new populations increased the prevalence of a parasitic disease called schistosomiasis, which thrives in water snails.  The culture of these affected areas determines who develops the disease, and how it has progressed.  Since many women in this area are Muslim and do not swim, the disease mostly afflicts fishermen and young boys.  Since a symptom of the disease, blood in the urine, is interpreted as a rite of passage for boys, few of the afflicted individuals recognize it as a sign of illness and seek treatment.

4 thoughts on “When the Bough Breaks

  1. I was also greatly surprised by the Health Equity Quiz. I really had thought we would have been doing better in terms of health than other countries around the world. Seeing these statistics really does make you wonder how to fix the issues. As far as fixing the affects of racism on African American women’s birthing rates, racism itself would have to be wiped out. However, as you also mentioned, many Caucasians already believe this has occurred. We don’t realize the actions that are made and the subconscious decisions that hurt African Americans.
    I don’t think we will ever have a world were racism does not exist but I do think it is possible to minimize it. The best way in which to accomplish this would be at an individual level. We would need to find a way to show people that they are acting racist; they are making conscious or even subconscious decisions that are fed by their own racism. Once people realize this and except this, change can begin. If a person realizes they are acting in a racist way they can make conscious decisions to push back that racism and try to treat all persons equally. It would take a lot of work on behalf of all persons in the world as well as all generations to come in order to alleviate the health problems for African American women and their babies.
    As for pros and cons, we will always have persons who resist change, who resist that they make racially determined decisions. There will always be people who believe they are better than someone with a different skin color. It would be impossible to completely diminish racism. However, if we could get the majority of people to realize their bad decisions based on race and get them to consciously make better decisions we can allow African American women to have a better chance at full term pregnancies.

  2. To minimize disparity between groups in terms of rates of preterm infants, it is necessary to reduce and eliminate the sources of chronic stress suffered by African American women and more broadly, by minority communities—that is, stereotyping, prejudice, and discrimination. Researchers speculate that the cumulative lifetime stress of racism results in elevated levels of stress hormones, occludes circulation to the placenta, and causes intrauterine inflammation, all of which trigger premature parturition. Hence, social solutions are in order, such as public awareness campaigns to inform people about implicit racism, racial profiling, and the arbitrary, non-biological nature of racial divisions, and to facilitate celebrating diversity in heritage. Pros of this approach are making people conscious of deliberate and inadvertent racism to prevent it beforehand, and creating intercultural sensitivity, while cons are that people are resistant to change. Citizens’ demanding of political change is also required, including enacting fair hiring policies and affirmative action to increase academic admissions opportunity.
    Individual and community initiatives can also be effective, such as designing task forces to recruit ethnically diverse staff in workplaces, lobbying school boards to include an anti-racism curriculum, organizing anti-racism protests, petitioning media for more positive racial coverage, and engaging local government to review laws for institutional inequalities. In these cases, the responsibility is in the hands of individuals to promote inclusion, physicians to inform about health discrepancies between groups, and individuals to mobilize for collective action. The downside of all these strategies is the slow pace of legislative reform and layers of bureaucratic red tape, but the upside is that making a change in the law books can leave a lasting legacy to provide protection against discrimination. In such a climate, ethnic minorities would suffer fewer effects of a state of hyper-vigilance in anticipation of racial harassment, would have less activation of the stress response, and give birth to fewer preterm babies.

  3. Prior to this case study, I had never heard that African American citizens have higher rates of premature births. I find it particularly disturbing that this trend is only present in U.S. born citizens and not immigrants. I think that an outreach program is necessary to properly inform the population of the fact that the effects of racism are still felt today. I personally did not believe that racism was still an issue until taking college sociology courses; the biggest reason for this being the demographics of my hometown (95% White, 0.8% African American, 1.7% Native American, 0.8% Asian, 0% Pacific Islander, 0.77% Hispanic or Latino, 0.22% from other races, and 1.33% from two or more races, according to the 2000 census) I think that if there was an outreach program at the national level made with the intent of informing the population that racism is still in fact an issue and causes serious harm to its victims, that we as a nation would take the issue of racism more seriously and work to end it. I feel that many people simply lack perspective on the issue and believe as I did that racism is largely irrelevant in this day and age, and would be more supportive of attempts to end racism if they had evidence that racism is still present in the United States.

  4. I didn’t watch this case study, but it sounds very interesting. I had no idea that rates of premature births were much higher among African American mothers. As others have expressed in these comments, the statistics presented are disturbing, especially given that education and wealth were corrected for.

    I think the only true solution to the problem of premature births among African American women would be to eliminate racism against minority groups and communities. Even given the best intentions, this is a lofty goal because racism is not a tangible object. Eliminating racism would mean eliminating other contributors such as discrimination and prejudice. I think a solution would be to target a nationwide audience with a public outreach program that brings to light the effects of racism and ways to reduce it. Ideally, this program could help minority and Caucasian communities relate to each other and help alleviate sources of stress and prejudice. The goal would be to help reduce chronic stress in African American women and thereby reduce their likelihood of giving birth prematurely. This is a social and individual solution because it would rely both on the person’s personal decisions and on the interaction between groups of people and communities. I think the government should play a large role in initiating this program because the health problem affects people across the nation, not just those limited to a particular community. However, it is ultimately up to the individual to become educated and aware of their behavior toward minority groups.

    A benefit of this solution would be that racism could be reduced significantly given enough participation across the country. Additionally, nationwide involvement and communication would help keep everyone on the same page. However, a clear con would be that any nationwide outreach program is hard to put into practice given sheer number of people it would have to reach to be effective. It would be hard to enforce and organize such a project. Furthermore, if an individual chooses not to participate or chooses to discriminate against others, it would be difficult to change their minds.

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