The survival gap

Generational inequality affects black children before they exit the womb, epidemiologists say

This is an extended version of a story that appears in the March 22, 2018, issue.

Despite the efforts of a landmark public health campaign, African-American children remain sharply overrepresented in Sacramento morgues, SN&R has found.

According to a review of online coroner records, 75 persons age 18 and younger died in Sacramento County over a one-year period ending March 14. Twenty-three of the young decedents—nearly 31 percent of the total—were black.

That’s an 8-point jump in just a couple of years, though the figure needs some contextualizing: Fewer children are dying than in the past, including fewer black children. But as child mortality rates improve across the board, African-American families remain disproportionately stalked by tragedy.

Only 11 percent of Sacramento County children are African-American, according to a community indicator report from last year.

Sacramento County first took notice of its alarming childhood mortality disparities five years ago. That’s when a 20-year study revealed that black children accounted for 22 percent of child deaths between 1990 and 2009. Stunned by the inequitable tide, Supervisor Phil Serna commissioned a blue ribbon panel to devise a long-term response, which led to the creation of the county’s Black Child Legacy Campaign. The campaign is attempting to chip away at the systemic inequalities that make black youths more likely to perish from perinatal factors, sleep-related accidents, abuse and third-party homicides.

Earlier this year, Chet Hewitt stood before the Sacramento City Council with a cautiously hopeful message about that critical mission.

Hewitt, president and CEO of the Sierra Health Foundation, a private philanthropy focused on reducing health disparities across Northern California, is also an ambassador for the campaign, which has seeded partnerships in the hardest-hit neighborhoods. In January, Hewitt informed elected officials that the coalition’s work on one corner of the unwieldy tapestry was sewing together—reducing the number of infants dying in their sleep.

Now, the region’s four major health systems conduct “safe sleep assessments” for every infant born inside their hospitals, Hewitt said. “Not all black children. All children born in their hospitals,” Hewitt told council members on January 9. “That is a huge systemic and policy change from what existed before.”

Under the safe sleep endeavor, Hewitt said, families without appropriate cribs for their newborns are provided them free of charge. In addressing a problem that unevenly afflicts African-American babies, the campaign spearheaded a strategy that helps all families, he added.

Ironically, black families may be reaping the benefits of this initiative more slowly than families of other races and ethnicities.

The notion that racism is a killer is nothing new. But the ways in which it shaves years off lives can be hidden from plain view. Some epidemiologists believe there are few better microcosms through which to explore this nefarious truth than inside the womb, where a mother’s heightened stress levels can affect her physiology and the developmental biology of her unborn child, according to the 2006 Unnatural Causes documentary series produced by California Newsreel.

“Everyday racism is like gunning the engine of a car without ever letting up,” Dr. Camara Phyllis Jones, a former epidemiologist at the Centers for Disease Control and Prevention now with the Morehouse School of Medicine, said in the documentary.

As Dr. Michael Lu, an obstetrician and gynecologist now with George Washington University, noted in the same video, “If you were going to carry that into the pregnancy, then that gets embedded in both the pregnancy and physiology of the mother and the developmental biology of the child.”

Saving the baby, Jones and Lu contended, starts well before she enters the world.

“I’m talking about when she’s a baby inside her mother’s womb … and really taking care of women and families across their life course,” said Lu, who formally oversaw maternal and child health for the federal government.

A decade later, black women still absorb more toxic stress than their white counterparts, says Flojaune G. Cofer, director of state policy and research for Public Health Advocates, which works toward health equity in Sacramento’s left-behind communities. White women who smoke are more likely to watch their babies grow up than black women who do not smoke, Cofer says the research shows. Counterintuitively, black women with college degrees also stand a greater risk of losing their babies than white women who dropped out of the ninth grade.

Historical and community traumas are the X-factor, Cofer posits.

“It is absolutely true that prenatal care is great, but prenatal care can’t fix this,” she said via email.

While the coroner’s website doesn’t list cause of death in most cases, Sudden Infant Death Syndrome was a potential factor in at least 11 infant deaths since last March. All but one involved a child of color.

Motor vehicle accidents were listed as a preliminary cause in 13 childhood deaths. Hispanic boys were the victims in five of those accidents. Three of the victims were girls of Asian descent.

Latino and Asian youth were slightly overrepresented in local mortality figures. Though about 46 percent of Sacramento’s population is white, white youth accounted for less than 27 percent of the last year’s child deaths.

A spokeswoman said campaign stakeholders couldn’t comment until they independently verified the data. The partners have set themselves an ambitious goal of reducing African-American child deaths by 2020. Less than two years from that deadline, the coroner’s website shows the percentage going in the wrong direction, even as fewer black children are dying.

During his presentation, Hewitt explained that many sleep-related deaths are accidental, and the result of poor sleeping conditions traced to a lack of information, poverty, housing insecurity or, in some cases, cultural differences in bonding with newborns. He credited two physicians, who moonlight as members of the legacy campaign, for turning a promising idea into a widespread practice at local hospitals.

In answer to a question from Mayor Darrell Steinberg, Hewitt said that he hoped the campaign’s progress on perinatal- and sleep-related deaths would allow the coalition to concentrate on other challenges.

“I don’t know that those things are off the table, but I think that we have got to begin to shift to some of the things where we’re not doing as much good work,” Hewitt said, referring to third-party homicides and deaths as a result of child abuse or neglect. “That’s not for a lack of trying,” he added. “Some of those things are bigger than any one institution could address.”