By Gina E. Wood,
Deputy Director of the Joint Center’s Health Policy Institute
April 24, 2008  
 
The United States overall infant mortality rate is high in comparison with other major industrialized nations.  According to the Centers for Disease Control and Prevention (CDC), in 2002 the U.S. infant death rate ranked 28th against selected countries, placing us considerably behind Western European and Scandinavian nations as well as Japan, Canada, Israel, Greece, New Zealand and Cuba.  More alarming still is the huge disparity between infant death rates for blacks and whites in this country.  Nationwide, infant death rates are 2.5 times as high for African American babies than for white babies.  This black/white disparity in infant death rates has either held steady or widened since 1980.   

To investigate these disturbing trends, in 2005 the Joint Center’s Health Policy Institute (HPI) established an Infant Mortality Commission entitled the “Courage to Love.”  Rather than view the growing disparity between African American and white infant deaths rates as solely a medical problem, the Commission focused on examining the social determinants – economic, environmental, behavioral and community conditions – that serve as root causes.   

 As part of the Commission’s work, research by Dr. Fleda Mask Jackson of Emory University has uncovered significant linkages between the stress of gendered racism, anger, and anxiety.  Anger and anxiety are causal factors for hypertension, diabetes and obesity – ALL of which are risks for poor birth outcomes.  Dr. Jackson’s study of African American women in Atlanta also indicated specific manifestations of depression resulting from racial, cultural and gender experiences of discrimination.  Moreover, pregnant African American women in this study also expressed fears about the racism that would be directed at their children.  The fact that inequality is a causal factor in high rates of Black infant mortality in this country – even among highly educated Black women – needs to be handled as a civil rights issue of paramount importance.          

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The Joint Center’s Health Policy Institute was host to winners of the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy at a seminar where the future health policy leaders engaged in a discussion of the social determinants of health.

Gina Wood, deputy director of HPI, introduced the fellows to programs underway at the Joint Center during their visit on Thursday, Jan. 17. One highlight was a preview of “Unnatural Causes: Is Inequality Making Us Sick,” a PBS series, due to air in March, that was produced with significant support from the Joint Center and the W.K. Kellogg Foundation.

The fellows also learned about efforts to increase diversity in the health professions led by the Sullivan Alliance, and about a variety of health-related research projects that the Joint Center is spearheading.

They even discussed the presidential campaign and the work on political participation that the Joint Center and its allies among black elected officials in the National Policy Alliance have planned.

The fellows program prepares doctors for leadership roles in shaping public health policy and practice. They complete academic work leading to Master of Public Health degrees from the Harvard School of Public Health. Other program activities provide them with insight on the major health issues facing minority, disadvantaged and underserved populations.

The fellows are Connie Gistand, a hospitalist at West Jefferson Medical Center, Marrero, La.; Keila Lopez, chief pediatric resident at University of Chicago Children’s Hospital, Chicago; Audra Robertson, chief resident in the Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston; Judith Steinberg, medical director of Neponset Health Center, Dorchester, Mass.,; Mallory Williams, a fellow in surgical critical care at Brigham and Women’s Hospital in Boston; Monica Le, a women’s health fellow in the Department of Obstetrics and Gynecology at Harbor UCLA, Torrance, Calif.; and Brian Swann, a dentist with Dental Solutions II, San Jose, Calif.

The Joint Center for Political and Economic Studies has convened a group of health professionals, community health advocates and elected officials from more than a dozen states in Mississippi as part of a campaign to improve the health status of African Americans.

The meeting was arranged by the Joint Center’s Health Policy Institute. The Design Lab, as the meeting is called, is the sixth in a series. More than 80 experts are participating. They represent 22 counties and two cities (in more than 12 states and the District of Columbia) with which the institute has partnerships for its Place Matters initiative.

The opening event on Wednesday, Oct. 24, was a tour of areas of Mississippi, including parts of the Delta, including discussion of how to reduce the health disparities that persist for African Americans and other racial and ethnic populations. The tour, which was to include a stop in Vicksburg, was planned to help the group understand how “place,” including its history, culture and economic successes and challenges, plays a role in determining health status.

“By addressing upstream factors that produce poor health outcomes, “Place Matters” leverages an approach that differs from the usual disease reaction model. This initiative provides a critically important learning opportunity for participating jurisdictions and for the nation, as teams of dedicated participants develop, test and share new strategies to address social determinants of health,” says Gina Wood, deputy director of the Joint Center’s Health Policy Institute.

“We need new approaches if we are to unravel the complex problems that contribute to the health care crisis in the African American community,” said Ralph B. Everett, president and CEO of the Joint Center.

On Thursday and Friday, the group will talk about what projects they can undertake to change health status in their communities.

HPI’s goal is to reduce health disparities by identifying their complex underlying causes and defining strategies to address those causes. Social science research has shown that patterns of health, illness, and health disparities can be modified if the social conditions that lead to poor health are changed.

The Place Matters initiative is supported by a grant from the W.K. Kellogg Foundation.