Bringing Up Baby
You see this story a lot. Since I'm not ColumbusGuy, I'll actually tell you what it is: Stats say the U.S. has higher rates of infant mortality than other industrialized nations. (See, that's not so hard.)
But isn't it true that we don't measure them the same, since we try to save a lot of premature babies, while other nations don't and then don't count them? I'd at least like to see this mentioned, or debunked if meaningless.
posted by LAGuy @ 2:27 AM
9 Comments:
Thanks for recapping the story, LAGuy. I don't know whether we do count our lost children differently or try to save more preemies than in other developed countries -- but that still wouldn't explain the racial differences. If preemies explain the higher infant mortality rates, that would suggest that black mothers have much higher rates of having preemies -- which would still suggest insufficient or at least racially divergent prenatal care for black mothers.
Among the reasons for premature delivery of a baby are bacterial infection (now readily diagnosed and treated but possibly recurrent), elevated blood pressure, and drug use (particularly stimulants like nicotine and cocaine). All of these are more common among African American women if memory serves. Early prenatal care does make a differnce. Access to care does not always mean that it is used. Ann Arbor with more physicians per square mile than just about anywhere else would be difficult to describe as health care access concern. Michigan also has liberal medicaid coverage for child bearing women and children. Yet there are women (of any race) who do not have adequate prenatal care.
As to the original question, it is clear to me from my medical experiences that we are better counters than other countries.
AAGuy
This from the CDC is older but specifically breaks out the deaths due to short gestation. The trend is down over time, but it is among the top leading causes of infant deaths in the US. We are getting better and better at saving the lives of preemies.
However, here in the US we have other causes of low birth weight (the major risk factor for infant death), particularly the increasing rate of multiple births as we have improved our ability to assist in reproduction. Third-world countries are making progress in lowering the rate of low birth weight babies (and improving the infant mortality rate) as they improve prenatal care and the health status of the mother - aspects of obstetrical care that are almost universally implemented in the US.
Racial disparities in access to health care in the US are well documented. The correlation with social/economic status is overwhelming, but there is more to it. There are still racial disparities in treatments - even which treatments are offered as options. The evidence of bias is clear (for access and for treatment), yet nothing meaningful has been offered to eliminate it. Why do we let this happen? Or, perhaps more relevant, why do we keep electing leadership that is completely ineffectual in this arena?
AAGuy says areas with higher problems may have a lot of prenatal care available. It's certainly true in places like Washington D.C. and New York.
So I have to ask Anonymous #3, is this problem due to the people we elect (mostly Democrats running the cities and states and offering free health care)? Is this a top down problem, or a bottom up one?
Well, Anonymous No. 3, I'd like to know what this bias looks like. Are you telling me there's a doctor anywhere who's saying, even subsconsiously, "I'm not going to recommend care for this mother or baby because of race"?
How in the world could that be? I would think such people are less common than murderers, and I doubt there are enough murderers to make a statistical difference in this sort of number.
SWMBCg, etc.
I visited the doctor father of a college friend back in the '80's who gleefully told us about how he had been doing a residency in Philadelphia during the race riots of the '60's, and he was so tired of using novacaine for all the white heads that came in to the emergency room messed up, that when a few black heads came in needing care, "I used just a leeetle Novocaine." I was shocked and appalled by this story, and when he realized my reaction and that of my other friends, he quickly backtracked and spent the rest of the weekend calling us aside to tell us it wasn't really true.
No, he's not representative of all doctors, and yes, things have progressed since the '60's, but we haven't left the negative side of human nature behind us. I thought conservatives understood that.
Of course I failed to mention multiples artifical reproductive techniques (and possibly older aged parents) as possible causes of increased prematurity.
As to the other matter, clearly some are not getting care because of their perception of inability to pay (even if ultimately they would not be responsible to pay). But I think it is important to acknowledge that many are not accessing care for other reasons and despite as many barriers being removed as is possible. Not everything has a political solution.
The anecdote described by ?anon#3 is patently ridiculous. I have worked in health care more than 20 years and have never seen care changed based on race. Many of the doctors I work with are of different (and assorted) cultural backgrounds. Is it possible that race (has previously or) even now does play a factor in a few cases? Yes. Is this the basis for racial differences in access to care or number of prematures? Sorry.
This is Anon#3. First, a few references:
lung cancer surgery
epilepsy surgery
breast cancer surgery
more lung cancer surgery
surgery for female stress incontinence
cirrhosis
breast cancer
prostate cancer
kidney cancer
You are in denial (and/or you are white) if you think this isn't happening.
To Anon#4: real change is always driven from the bottom in this country. Change by the political system is incremental at best. Sometimes, that's a good thing.
#3, it's really hard to take you seriously here. You throw out the naked fact of racial disparities and conclude from that racism? You have got to be kidding. A thousand other possible causes don't occur to you, the vast majority of which are innocuous (at least regarding ill intent, if not in ultimate health effect)? Does one have to be white and/or in denial to believe in the most elemental logic?
SWMBCg, etc.
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