Latest data reveal appalling gaps between black and white infant mortality rates

As I considered this first piece for The Health Divide blog, I couldn’t think of a more insistent topic than the infant mortality rate in California’s black community.

Our state, standing defiant on Obamacare and a symbol of healthy living, is also one in which black babies die nearly three times as frequently as white babies.

Before a two-year hiatus to become a journalism professor at USC and Cal State Long Beach, I reported on Alameda County’s investment in reducing its infant mortality rate — a heartbreaking measure of how frequently babies die before their first birthday.

The county had cut its rate for black infants in half by using funds from the federal Healthy Start Program to offer in-home visits from “godmother” public health nurses like Sandra Tramiel. The program reached 400 families a year with a down-home focus in nine Alameda ZIP codes with the highest mortality rates. During a typical home visit, a nurse might offer advice on how to stay healthy during pregnancy, tips for coping with stress, and guidance on caring for the new baby. Expecting mothers were signed up through gumshoe outreach at churches, hair salons, malls and housing projects.

But the county’s success in saving lives has not been replicated statewide — and an already appalling gap between white and black infant death has grown since then.

In January, the Centers for Disease Control and Prevention released state-by-state rates by race and ethnicity that found 9.55 deaths per 1,000 live births among black infants in California. The state’s rate for white infant death: 3.75 per 1,000 live births. In 2015, the figures were 9.35, and 3.92, respectively.

So why is a state seemingly committed to public health seeing the infant death rate grow for black babies while it declines for whites?

Experts say the answer can be found in what they call the social determinants of health, or the structural conditions in which people are born, grow, live, work and age.

Infant mortality has always been a fundamental measure of community well-being. The United Nations and the Central Intelligence Agency have kept global figures for years to educate personnel on the conditions they will face abroad.

As a mother navigates the health threats of her physical environment, she also shoulders the psychological load that comes with considering a child’s prospects to thrive in her world. “It’s about fear, anxiety, and uncertainty about having the resources you need to raise the child, whether that be proper housing, employment, or income,” said scholar Fleda Mask Jackson, who served on an infant mortality committee during the Obama administration.

Like the 9.40 rate in Romania, the 9.30 rate in Croatia, and the 9.20 rate in Thailand, California’s rate of 9.55 in its black community speaks to a mother’s exposure to poverty, housing shortages, pollution, and violence.

“It makes it that much more difficult to bring a child into this world when those barriers still exist,” said Fleda Mask Jackson, a visiting scholar at Spelman College who served on the Department of Health and Human Services Advisory Committee on Infant Mortality during the Obama administration.

And as a mother navigates the health threats of her physical environment, said Mask Jackson, she also shoulders the psychological load that comes with considering a child’s prospects to thrive in her world.

“It’s about fear, anxiety, and uncertainty about having the resources you need to raise the child, whether that be proper housing, employment, or income,” added Mask Jackson, whose latest research explores negative encounters with police in the black community and their impact on pregnant women.

The CDC’s infant mortality rates bear Mask Jackson’s premise out with exasperating clarity when you look at other states:

The black infant mortality rate is 14.28 per 1,000 live births in Wisconsin, the worst. It’s 13.40 in Alabama, and 10.52 in Texas, to name a few states that exceed California’s rate for blacks. By comparison, the United States’ overall rate is 5.89 deaths per 1,000 live births for all ethnic and racial groups.

The CDC report points out, somewhat optimistically, that the nation’s overall rate for blacks of 11.10 deaths per 1,000 births is lower in California and eight other states.

But when it comes to the gap between black and white infant deaths, California ranks 8th highest out of the 50 states and Washington D.C. My home state is a leader in this fundamental measure of inequality. (D.C. has the highest gap in the nation, with the district's black infant mortality rate more than four times higher than its white rate — see chart below.)

The disparate infant mortality rate is not the only measure of the increasing marginalization of the black community in California. Broad statistical examinations up and down the state have found similarly worrying figures, including a 2017 equity profile of the Los Angeles region by the nonprofit think tank PolicyLink.

And when you look at the rates for other ethnic and racial groups in California, the black rate is still more than double the overall rate for Hispanics. Infant mortality rates for Asians and Pacific Islanders were not included in the CDC study, but those calculated by the state of California itself have generally found them to be the lowest of all groups.

So, what can be done? Mask Jackson said little will change if we continue to deny what the black infant mortality rate truly is: a bellwether signaling the persistent inequality confronted by black communities in our state and the nation at large.

“Ironically, California has been one of the leading states in terms of health prescriptions,” she said. “But the distance between the haves and have nots is so great.”

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