Infant Mortality Down, But Higher For Minorities

Carol M. Ostrom, Seattle Times, Oct. 16

Infant mortality in King County has dropped dramatically since its peak 20 years ago, but a persistent gap separating ethnic groups remains, according to a public health report delivered yesterday to the King County Board of Health.

African-American and American Indian/Alaska Native babies in the county have more than twice the risk of dying within the first year of life compared to white, Hispanic or Asian babies, the report shows.

“It is simply unacceptable that such gaps in the health status of our residents remain,” said King County Executive Ron Sims, who spoke to the board. “There remain wide and persistent disparities by race and by socio-economic status.”

Sims and health-department officials urged board members to begin a broader discussion of the effects of institutional racism on infant mortality in the county.

“As you’ll hear from the authors of this report, we’re learning that large societal factors such as racism and socio-economic status need to be addressed if we are to fully achieve a reduction in infant mortality . . . ,” Sims said.

The report, compiled by Public Health—Seattle & King County, is titled, “Racial Disparities in Infant Mortality: An Update King County 1980-2002.”

Overall, there was good news. In King County in 2002, there were 97 infant deaths, an all-time low rate of 4.5 deaths per 1,000 live births. The infant death rate has dropped 56 percent since it peaked 20 years ago.

For the first time, in 2002 Seattle’s infant-mortality rate dropped below the rate in the rest of the county. Seattle’s rate in 2002 was 3.6 deaths per 1,000 live births, compared to non-Seattle King County’s rate of 4.6.

Washington state as a whole reported 5.2 deaths per 1,000 births.

All of these were well below the United States average of 7 deaths per 1,000 births.

But Susan Barkan and Maria Carlos, who presented the findings, said public-health officials must grapple with the fact that 10 years of efforts haven’t eliminated the stubborn gap between rates seen for white, Hispanic and Asian infants and the much higher ones for African-American and American Indian/Alaska Native babies.

For example: The 2000-2002 death rate for white babies was 4.36 per 1,000, but was 9.16 for African-American babies.

A growing body of research has found that racial discrimination is associated with adverse health outcomes, including heart disease and pre-term delivery, Barkan and Carlos told board members.

Having to contend with racism, researchers have found, creates physiologic stress, which, by activating “fight-or-flight” hormones, may affect the outcome of pregnancy, either by initiating pre-term labor or by making a mother more susceptible to infection, which can lead to early delivery.

African-American and American Indian/Alaska Native mothers reported significantly more “stressful life events” during the year before delivery from 1999-2001, the report said.

A higher percentage changed residence, had bills they couldn’t pay, lost their job or became homeless, for example.

The information prompted a lively discussion among board members, many of whom are also Metropolitan King County Council members.

Julia Patterson, a county councilwoman, said the report raised a “thought-provoking” thesis: “It sounds like what you’re saying is that there’s a strong possibility that racism in our society is making people sick.”

“The whole notion that racism is a public-health issue is a pretty new notion,” said board chairwoman Carolyn Edmonds, “but I think what we’re seeing right now is it’s true” and is something the board must confront.

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