At the beginning of life, babies face racial health disparities that imperil their survival. The infant mortality rate in the United States is more than twice as high for Black infants as it is for white infants: 10.8 deaths per 1,000 live births compared with 4.6 per 1,000 as of 2018, according the U.S. Centers for Disease Control and Prevention.
Now a study suggests that when Black newborns are treated by Black physicians after birth, the mortality disparity between Black and white babies shrinks. Why a doctor’s race makes a difference remains a complicated question. But the answers may point to how to make sure the best care is available to all babies from all doctors.
Health disparities are differences in health that are tied to economic, social or environmental disadvantages. The inequities that fuel these disparities include differences in access to health care (SN: 4/23/19) and exposure to pollution (SN: 7/30/20) and the health effects of racism (SN: 8/6/19).
Even with gains in insurance coverage this past decade, Black Americans are still less likely to have insurance than white Americans: In the first half of 2019, 13.6 percent of Black adults were uninsured, compared with 9.8 percent of white adults, according to the CDC. And researchers reported in April that fewer Black women than white women have uninterrupted insurance coverage before, during and after pregnancy. Beyond access to health care are the health harms that stem from structural racism. The historical, racist practice of redlining neighborhoods has been linked to the risk of preterm birth and more emergency room visits due to asthma. Leaving a segregated neighborhood may lead to a drop in blood pressure (SN: 5/15/17).
Even encounters between a doctor and patient can be overshadowed by bias. For example, Black Americans are less likely than white Americans to receive sufficient treatment for pain. A 2016 study found that some medical students and doctors falsely believed there are biological differences in the amount of pain Black Americans experience compared with white Americans, which affected treatment recommendations.
Studies have begun to explore whether receiving care from a physician who shares the same race or gender as the patient, called concordance, makes a difference. There’s evidence that this could increase rapport between doctors and adult patients and increase patients’ willingness to take medicines or participate in disease screening. But less is known about what this means for patients’ health. That’s where the new study of Black newborns sheds some light; it suggests that for these babies, care from a Black physician does indeed matter.
Researchers examined data on hospital births in Florida from 1992 to 2015, and found that when attended by white physicians, Black newborns experienced 430 more deaths per 100,000 births than white newborns. But when cared for by a Black physician, the excess deaths dropped to 173 per 100,000 above that of white newborns, the team reports August 17 in the Proceedings of the National Academy of Sciences. In other words, under the care of a Black physician, a Black newborn’s “mortality penalty” is cut by more than half.
Even so, Black newborns still died at a higher rate than white newborns; a doctor’s race is only one strand of many that can entwine to create disparities. Nor does the study suggest that Black newborns should receive treatment only from Black physicians, the researchers say.
Science News talked with two of the researchers who conducted the study: Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota School of Public Health in Minneapolis, and Brad Greenwood of George Mason University in Fairfax, Va., who studies public and population health. The interview was edited for length and clarity.
SN: Why do Black patients have poorer health outcomes than white patients?
Hardeman: The fundamental cause of health inequities in our society is racism, [which] takes a lot of different shapes and forms.
One of the things that’s been well-discussed within maternal [and] child health is the weathering hypothesis, how different forms of racism and the cumulative disadvantage due to racism across the life course contribute to early aging, cellular aging. That really brings Black birthing people into pregnancy looking physiologically older than they are.… This idea of toxic stress due to racism and socioeconomic disadvantage across one’s life can lead to wear and tear on the body that puts Black people at a disadvantage with respect to their health.
The weathering hypothesis is incredibly important and salient, but we also have to be thinking and talking about what’s happening in the health care encounter and the institutional climate. And then there’s the access to care issue. There are all these complex pieces to this puzzle that have to be considered.
SN: What led you to look at the question of newborn mortality and physician concordance?
Hardeman: [There are] a lot of stories about how the provider relationship matters for care.… It’s important to people and it matters for patients’ satisfaction. But there hasn’t been empirical evidence [before our study] that’s really been able to link concordance to a particular health outcome.
I could speak from a personal level as a Black woman who has been pregnant, putting together the care team that I wanted for my pregnancy and birth. I wanted a doula who came from the same racial background as myself, and having someone who really understood my life experience was incredibly important. Generally, that’s felt and sort of understood anecdotally. But having the opportunity to really dig into the numbers and the data was compelling for me.
SN: Why might having a Black physician benefit a Black newborn?
Greenwood: Black doctors may be more in tune with the specific experience that black newborns are facing, [such as] more challenging births as the result of increased socioeconomic pressures. Let’s figure out what practices are different and try to get them to everybody.
Hardeman: We also have our physician workforce being trained in a way that is not always fully attentive to the impact of racism, both in the lives of their patients that they’re serving or will eventually serve, but also the history of racism within our health care delivery system. Being able to delineate the ways that racism is embedded within the health care system and the harm that that’s done to communities, particularly in communities of color, has to be part of this exploration as well.
SN: What do the findings mean for physicians and the health care system?
Greenwood: Some of the reaction has been that we’re attempting to demonize doctors. That’s absolutely not true…. Let’s look at this and figure out situations under which we can limit newborn mortality, specifically for a group that experiences it so much. The goal is to try to show situations where this is better and worse, so we can get in and figure out … what practices are effective and which aren’t.
The other thing that we’ve heard a fair amount, which is really disturbing, is that this means only Black doctors should treat Black babies. No, we’re not going to create a Jim Crow era of medicine…. There is huge heterogeneity in physician quality. If we ignore that and select exclusively on race, then it’s not an efficient way to try to find the right doctor for you.
Hardeman: What it comes down to is that the clinical penalty for a Black newborn who’s treated by a Black physician is halved in comparison to the penalty that Black newborns experience when they are cared for a by a white physician. That’s not to say that we’re talking about good versus bad physicians, or racist and not racist physicians. It’s that we need to be thinking about and exploring what this means in a broader context of how we ensure equity in our society.