EDITOR'S NOTE: Richland Source’s Rising from Rust team traveled to Detroit, Michigan from Oct. 28 to 30 for CityLab Detroit, a summit organized by the Aspen Institute, The Atlantic, and Bloomberg Philanthropies. The story below relates to at least one of the sessions at that convention.
About 18 months ago, I wrote that infant mortality was the "canary in the coal mine" when it comes to all sorts of problems that affect a community. For those unfamiliar with the metaphor, the canary in the coal mine symbolizes an advanced warning of danger.
The quote came from Dr. Maya Rockeymoore, the founder of Allies in Reaching Community Health Equity (ARCHE), a network of health and racial justice experts committed to ensuring all Americans have the opportunity to live healthy lives.
“If you have higher infant mortality rates, you do have other indicators showing there are challenges and problems in that community," she said in an April 2017 article for our Healing Hope solutions journalism series.
“When you have high infant mortality rates, you tend to have higher poverty, weaker social structures, less investment in healthcare and less coordinated care focused on supporting low-income populations," she said. "You might even have issues of obesity or drug abuse."
So, it makes sense this topic would come up at CityLab, a place to discuss challenges along the path to urban revitalization. After spending a year learning and writing about infant mortality as it relates to socioeconomic stressors and minority communities, I was anxious to discuss my research with Dr. David Williams, a Harvard professor who also attended CityLab Detroit.
Dr. Williams is one of the foremost social science academics on the confluence of race, racism and health. He spoke to new research findings and trends on race, social conditions and health, for people in all types of socioeconomic situations.
First, let's start with the canary. I watched Dr. Williams' eyes light up when I asked him how stress related to racism affected infant mortality rates.
"Exposure to high levels of violence, loss of family members, and financial stress are all leaders to worse birth outcomes," Williams said. "This can be affected not only by stress that occurs in the life of a mother prenatally, but also preconception stress - stress that occurs in the life of a mother a year or six months before she became pregnant."
Let's talk about what stress means for a moment. Everyone experiences varying levels of stress at some point or another in their lives -- maybe you have a big presentation coming up at work, or you're in the middle of planning your wedding. But as a white woman, I do not experience the same type of stress that comes with wondering if your life is at risk because of the color of your skin.
For example, according to Williams, in the wake of the Sept. 11, 2001 attacks, there were well-documented incidents of increased harassment and discrimination against Arab Americans, particularly in the six months after that day.
"Research looked at birth rates of all women in California in the six months before Sept. 11, 2001 and six months after," Williams said. "There were no differences in birth outcomes for all races except Arab women - six months after Sept. 11, these women were more likely to give birth to infants with low birth weights."
This type of stress can happen on a smaller scale, too. In an April 2017 article, Kimberly Phinnessee told me about a time she was pulled over for speeding by an Ontario police officer. It was a routine traffic stop, the officer issued her a ticket and both went about their day. But she recalled the panic she felt and the rise of her blood pressure.
“I have a valid driver’s license, I have insurance, but it’s the fact that if I make a certain move, is the police officer going to think I’m a threat to him?" she told me. "If my son picks up his phone, are the police going to feel he’s a threat?”
Williams has developed a way to measure this type of stress called the "Everyday Discrimination Scale." The scale asks participants, "In your day-to-day life, how often do any of the following things happen to you?" And then, "What do you think is the main reason for these experiences?"
• You are treated with less courtesy than other people.
• You are treated with less respect than other people.
• You receive worse service than other people at restaurants or stores.
• People act as if they think you are not smart.
• People act as if they are afraid of you.
• People act as if they're better than you.
• You are called names or insulted.
• You are threatened or harassed.
A continuous barrage of this kind of stress is bound to have adverse affects on a person's health.
"This doesn't focus on the big things that happen but the little day-to-day indignities," Williams said. "A mother who reports high levels of everyday discrimination reports higher incidents of low-weight babies or infant mortality."
The U.S. healthcare system has its shortcomings for white people, too.
According to Williams, for the first time in the last 50 years, the life expectancy in the U.S. has declined three years in a row, and particularly for white people with only a high-school education.
"We know that broader negative social conditions can lead to a decline in life expectancy," Williams said. "There are three causes of death increasing: suicide, cirrhosis of the liver, and opioid overdose - the deaths of despair.
"This is a group that is facing serious mental-health challenges, and self-medicating with alcohol, drugs, or taking their lives."
No matter which demographic, the United States does poorly in terms of health, Williams said - which is surprising considering the U.S. spends more money on healthcare than any other country in the world. The problem, Williams said, is because healthcare in America has little to do with health.
"Our healthcare system is an illness care system that does a good job of taking care of us when we get sick, but not before we get sick," Williams said. "More of our healthcare system is focused on treatment, not on how to keep people well in the first place."
At this point in the interview I have fully abandoned the cookie I was eating, feeling the sudden urge to go for a run while simultaneously feeling pretty discouraged about the health of our country. So I asked, what can we do to correct this problem?
For the answer, we have to go back to what Williams said about broader negative social conditions leading to a decline in life expectancy. Remember the problems revealed by the canary in the coal mine?
"Many public health experts say your zip code is a stronger predictor of your life expectancy than your genetic code," Williams said. "There is a large variation in health based on socioeconomic status, and racial and ethnic differences in the U.S. context. There are large differences in health by income and education.
"There is something profound about income and education that is a driver of health regardless of race or ethnicity," he added. "But something about race matters about health even after you take income and education into account."
So what can be done? Ending residential segregation is a start. There's nothing wrong with living next to someone of your own race, Williams said, but the problem is the "concentration effect" - the concentration of social ills. How do we break the linkage between place and access to opportunity?
"Make a commitment to improve access to opportunities in community, ensuring there's high quality education, pathways to good employment, and preparation for high education and employment," Williams said.
Income, education and built environments are all drivers of health. And health is created in the places where most Americans spend most of their time. The opportunities to be healthy in those places should, in turn, create more positive outcomes.
Creating a cultural change is kind of like steering a ship - it doesn't happen all at once. But focusing on the communities that need the most help is a good start.
"We need to build a culture of health," Williams said. "Where the healthy choice becomes the easy choice, factors that promote good health are rewarded, and we can encourage good health in our institutions."