Dr. Paula Braveman’s turning point came when her longtime patient at a community clinic in San Francisco’s Mission District slipped through the front desk and knocked on her office door to say goodbye. .. He wouldn’t come to the clinic anymore, he told her, because he couldn’t afford it anymore.
It was a decisive moment for Braveman, who decided not only to heal sick patients, but also to advocate policies that would help them become healthier when they arrived at the clinic. For nearly 40 years since then, Braveman has devoted himself to the study of “social determinants of health.” We live, work, play, learn, and study how relationships in those places affect our health.
As director of the Center for Social Disparities in Health at the University of California, San Francisco, Braveman studied the relationship between neighborhood wealth and child health and how access to insurance affects prenatal care. A long-time advocate of transforming research into policy, she has collaborated with the San Francisco Health Department, the US Centers for Disease Control and Prevention, and the World Health Organization on major health initiatives.
Braveman is particularly interested in the health of mothers and babies.she Latest research Review 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 whites to give birth more than three weeks before the due date. Preterm infants are at increased risk of respiratory, heart, and brain abnormalities, among other complications, so this statistic has alarming and costly health consequences.
Braveman wrote the review in collaboration with a group of experts convened by the March of Dimes, including geneticists, clinicians, epidemiologists, biomedicine experts, and neurologists. They investigated more than 20 suspicious causes of preterm birth, including quality of antenatal care, environmental toxicity, chronic stress, poverty, obesity, and racism best directly or indirectly the racial disparity in preterm birth rates. I decided that I was explaining.
(Note: In the review, the author uses the terms “upstream” and “downstream” extensively to describe what determines people’s health. Downstream risk is the most direct cause of health outcomes. The condition or factor that causes the upstream, the cause or fuel of the downstream risk, and often what needs to be changed to prevent someone from getting sick. For example, toxic chemistry. People who live near substance-contaminated drinking water can get sick by drinking water. Use filters. The upstream solution is to stop the dumping of toxic chemicals. )
KHN talked to Braveman about the study and its findings. The length and style of the conversation has been edited.
Q: You have been studying the issues of preterm birth and racial disparity for a long time. Did you find anything that surprised you from this review?
The process of systematically examining all the risk factors described in the literature and confirming that the story of racism was an upstream determinant of virtually all risk factors. It was a little surprised.
Another thing that was very impressive was when I saw the idea that genetic factors could be responsible for the black-and-white disparity in preterm birth. Genetic experts in this group concluded from evidence that genetic factors can affect preterm birth inequality, but at best the effects are very small, in fact very small. bottom. This could not explain the higher preterm birth rate of black women compared to white women.
Q: I was trying to not only identify the cause of preterm birth, but also explain the racial differences in preterm birth rates. Are there any examples of factors that can affect preterm birth that do not explain 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 caesarean section. This is one of the problems that contributes to avoidable preterm birth, but it does not appear to actually contribute to the black-and-white gap in preterm birth.
Q: You and your colleagues cited only one cause of preterm birth upstream. It’s racism. How do you characterize the belief that racism is the decisive upstream cause of rising preterm birth rates in black women?
It reminds me of this saying: Random clinical trials would not be needed to give certainty about the importance of parachuting if you jump from an airplane. For me, at this point it’s close to that.
Reading the treatise — and we worked on it for a period of three or four years, so we had a lot of time to think about it — which other evidence we have I don’t know if I can explain it like this.
Q: What have you learned about how the broad lifelong experience of mothers’ racism affects the outcome of childbirth compared to what they experienced in a medical facility during pregnancy?
There have been many ways in which experiencing racism affects a woman’s pregnancy, but one major way is through the pathways and biological mechanisms involved in stress, and stress physiology. In neuroscience, it is clear that chronic stressors appear to be more harmful to health than acute stressors.
So it doesn’t make much sense to look only during pregnancy. But that is where most of the research was done: stress during pregnancy and racism, and its role in the outcome of childbirth. Few studies have examined the experience of racism throughout the life course.
My colleague and I published a treatise asking African-American women about their experience of racism, but did not even define what we meant. Women did not talk much from their healthcare providers about their experience of racism during pregnancy. They talked about their lifelong experiences, especially their return to childhood. And they talked about things to worry about, and constant vigilance, so even if they haven’t experienced an incident, their antennas need to be prepared in case an incident occurs.
To summarize everything we know about stress physiology, I spend money on lifelong experiences that are far more important than those during pregnancy. Preterm 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 birth in black women?
I can say one or two policies, but I think it has returned to the need to dismantle racism in our society. With all its symptoms. Unfortunately, “Oh, here’s this magic bullet. And that’s all it takes to solve the problem.”
If you take the conclusions of this study seriously, well, you say that the policies that follow these downstream factors do not work. It is up to upstream investment to achieve a more equitable and less racist society. After all, I think it’s a takeaway, and it’s a tall, tall order.
This article is available to California BlackMedia partners. KHN (Kaiser Health News).
KHN is a national news room that produces detailed journalism on health issues. KHN, along with policy analysis and polling, is one of three major operational programs: KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides the public with information on health issues.
Study: Racism Plays Role in Premature Birth Among Black Americans – Los Angeles Sentinel | Los Angeles Sentinel Source link Study: Racism Plays Role in Premature Birth Among Black Americans – Los Angeles Sentinel | Los Angeles Sentinel