- Black babies in the United States appear to be more likely to survive when their doctor is of the same ethnicity, a study says.
- Researchers looked at records of 1.8 million babies born in Florida hospitals between 1992 and 2015.
- Unconscious bias, stress of mothers, socio-economic disadvantage, as well as structural racism may all be factors.
- Just 5% of doctors in the US are Black.
Black babies in the United States are much more likely to die than white babies. This shocking statistic was described last year in an infant mortality report from the Centers for Disease Control and Prevention (CDC).
But now a new study has uncovered what may be an important factor – and part of the solution: the ethnicity of the doctor.
When Black newborns are cared for by Black doctors, they are half as likely to die compared to when the doctor is white, say researchers writing in the Proceedings of the National Academy of Sciences (PNAS).
Although a causal link between doctors’ ethnicity and death rates is not guaranteed, researchers say “race concordance” merits closer inspection. So what’s happening? And how can this be addressed?
According to the CDC, 2,546 Black infants died in the United States in 2017 and the death rate (10.97 per 1,000) was more than twice as high as that for babies of white, Asian and Hispanic women. For years, clinicians and academics have suggested theories and sought answers.
The PNAS study researchers made their discovery after examining the records of 1.8 million babies born in Florida hospitals between 1992 and 2015.
They found that when Black newborns are cared for by Black doctors, the “mortality penalty they suffer, as compared with white infants, is halved”.
The researchers also found that if cases were more complicated, and if hospitals tended to deliver more Black babies, these effects appeared to "manifest more strongly".
Searching for answers
“Babies are dying. That’s not a political statement. That’s what’s happening, and it’s unacceptable,” says the Florida study’s lead author, Associate Professor Brad Greenwood from George Mason University.
However, he tells the Forum he is cautious about reaching simple conclusions: "It is speculative. This is secondary data, so nailing down the exact mechanism is difficult."
This said, he hopes future research will assess the impact of structural racism – discrimination embedded in social and economic structures.
Greenwood also offers some possible explanations, based on other research into discrimination. "There is evidence that Black newborns can be more medically challenging to treat due to social risk factors and cumulative racial and socioeconomic disadvantages of Black pregnant women," he says.
"As a result, it may be that Black physicians are more aware and attuned to these challenges than white physicians."
Other factors may include Black and white newborns being treated differently because of "spontaneous racial bias", and challenges in assessing and allocating the doctors that Black mothers actually want.
"There is also evidence in the literature that racial concordance increases trust and communication between patient and providers. While the newborn obviously won’t be speaking to the pediatrician, the mother may be, and this might have an effect," says Greenwood.
"Likely, it is a mix of all these things and potentially more."
Stress may also have a role. In 2014, Christin Farmer-Kane set up Birthing Beautiful Communities (BBC), an Ohio-based service that supports Black mothers through pregnancy and after birth.
“Black women have been normalizing and internalizing stress and trauma for so long,” she tells The Guardian. “This is a big deal in prematurity which is killing our babies.”
Trust is also important. Neurosurgeon Theresa Williamson has observed strained relationships between older Black patients and white medics.
“If a doctor cannot establish trust with a Black family struggling through a crisis, the family may think differently about treatment decisions,” she says.
Mobilising Action for Inclusive Societies
Recent years have witnessed some of the largest protests in human history. People are taking to the streets amid a desire for change, putting pressure on decision-makers for urgent and courageous leadership to find sustainable and inclusive solutions to some of the major challenges ahead of us.
A range of forces are at play. By 2022, some 60% of gross domestic product will be digitized - but current education systems are failing to prepare people for decent work in this future. Based on current trends, it will also take approximately two centuries to close the global economic gender gap. Meanwhile, the world’s richest 1% are on course to control as much as two-thirds of the world’s wealth by 2030.
To tackle these challenges, Mobilising Action for Inclusive Societies is one of the four focus areas at the World Economic Forum's 2019 Sustainable Development Impact summit. A range of sessions will bring stakeholders together to take action that will bolster local entrepreneurship and innovation, while making growth more equitable.
So what are the solutions? The most obvious would be to recruit and train up more Black medics. But even if this can be achieved, it is likely to be a long-term solution. Just 5% of doctors in the United States are Black.
This means pregnancy, birth and postnatal support partners, like those provided by Ohio’s BBC, might be a more readily available short-term aid.
But existing medical staff also need to be part of the solution. Unconscious bias training could help. Or, as previous work by the Florida study's Brad Greenwood suggests, digital protocols for patient care could help overcome bias.
Clinical decision support systems prompt medical staff to "ask for specific objective pieces of information from a patient, allowing a more complete picture of what each patient is experiencing,” Greenwood explains.
"In the absence of something formally prompting physicians to go through all the information about the patient, sometimes physicians make assumptions about their patients.”
One thing at least is clear: “It’s important to focus on the issues of disparities in health care to understand what’s going on and try to figure out how to change things for the better,” Greenwood says.