Bay Area

Study: Racism Plays Role in Premature Birth Among Black Americans

That statistic bears alarming and costly health consequences, as infants born prematurely are at higher risk for breathing, heart and brain abnormalities, among other complications.

Published

3 years ago

October 5, 2021

Christy Price

September 15, 2020 Redwood City / CA / USA - Kaiser Permanente Hospital in San Francisco Bay Area; Kaiser Permanente is an American integrated managed care consortium, based in Oakland/ iStock

The tipping point for Dr. Paula Braveman came when a longtime patient of hers at a community clinic in San Francisco’s Mission District slipped past the front desk and knocked on her office door to say goodbye. He wouldn’t be coming to the clinic anymore, he told her, because he could no longer afford it.

It was a decisive moment for Braveman, who decided she wanted not only to heal ailing patients but also to advocate for policies that would help them be healthier when they arrived at her clinic. In the nearly four decades since, Braveman has dedicated herself to studying the “social determinants of health” — how the spaces where we live, work, play and learn, and the relationships we have in those places, influence how healthy we are.

As director of the Center on Social Disparities in Health at the University of California-San Francisco, Braveman has studied the link between neighborhood wealth and children’s health, and how access to insurance influences prenatal care.

A longtime advocate of translating research into policy, she has collaborated on major health initiatives with the health department in San Francisco, the federal Centers for Disease Control and Prevention and the World Health Organization.

Braveman has a particular interest in maternal and infant health. Her latest research reviews what’s known about the persistent gap in pre-term birth rates between Black and white women in the United States. Black women are about 1.6 times as likely as whites to give birth more than three weeks before the due date.

That statistic bears alarming and costly health consequences, as infants born prematurely are at higher risk for breathing, heart and brain abnormalities, among other complications.

Braveman co-authored the review with a group of experts convened by the March of Dimes that included geneticists, clinicians, epidemiologists, biomedical experts and neurologists. They examined more than two dozen suspected causes of preterm births — including quality of prenatal care, environmental toxics, chronic stress, poverty and obesity — and determined that racism, directly or indirectly, best explained the racial disparities in preterm birth rates.

In the review, the authors make extensive use of the terms “upstream” and “downstream” to describe what determines people’s health. A downstream risk is the condition or factor most directly responsible for a health outcome, while an upstream factor is what causes or fuels the downstream risk — and often what needs to change to prevent someone from becoming sick.

For example, a person living near drinking water polluted with toxic chemicals might get sick from drinking the water. The downstream fix would be telling individuals to use filters. The upstream solution would be to stop the dumping of toxic chemicals.

Kaiser Health News spoke with Braveman about the study and its findings. The conversation has been edited for length and style.

Q: You have been studying the issue of preterm birth and racial disparities for so long. Were there any findings from this review that surprised you?

The process of systematically going through all of the risk factors that are written about in the literature and then seeing how the story of racism was an upstream determinant for virtually all of them. That was kind of astounding.

The other thing that was very impressive: When we looked at the idea that genetic factors could be the cause of the Black-white disparity in preterm birth. The genetics experts in the group, and there were three or four of them, concluded from the evidence that genetic factors might influence the disparity in pre-term birth, but at most the effect would be very small, very small indeed. This could not account for the greater rate of pre-term birth among Black women compared to white women.

Q: You were looking to identify not just what causes pre-term birth, but also to explain racial differences in rates of pre-term birth. Are there examples of factors that can influence pre-term birth that don’t explain racial disparities?

It does look like there are genetic components to preterm birth, but they don’t explain the Black-white disparity in pre-term birth. Another example is having an early elective C-section. That’s one of the problems contributing to avoidable pre-term birth, but it doesn’t look like that’s really contributing to the Black-white disparity in pre-term birth.

Q: You and your colleagues listed exactly one upstream cause of pre-term birth: racism. How would you characterize the certainty that racism is a decisive upstream cause of higher rates of preterm birth among Black women?

It makes me think of this saying: A randomized, clinical trial wouldn’t be necessary to give certainty about the importance of having a parachute on if you jump from a plane. To me, at this point, it is close to that.

Going through that paper — and we worked on that paper over a three- or four-year period, and so there was a lot of time to think about it — I don’t see how the evidence that we have could be explained otherwise.

Q: What did you learn about how a mother’s broader lifetime experience of racism might affect birth outcomes versus what she experienced within the medical establishment during pregnancy?

There were many ways that experiencing racial discrimination would affect a woman’s pregnancy, but one major way would be through pathways and biological mechanisms involved in stress, and stress physiology. In neuroscience, what’s been clear is that a chronic stressor seems to be more damaging to health than an acute stressor.

So, it doesn’t make much sense to be looking only during pregnancy. But that’s where most of that research has been done: stress during pregnancy and racial discrimination, and its role in birth outcomes. Very few studies have looked at experiences of racial discrimination across the life course.

My colleagues and I have published a paper where we asked African American women about their experiences of racism, and we didn’t even define what we meant. Women did not talk a lot about the experiences of racism during pregnancy from their medical providers; they talked about the lifetime experience, and particularly experiences going back to childhood. And they talked about having to worry, and constant vigilance, so that even if they’re not experiencing an incident, their antennae have to be out to be prepared in case an incident does occur.

Putting all of it together with what we know about stress physiology, I would put my money on the lifetime experiences being so much more important than experiences during pregnancy. There isn’t enough known about pre-term birth, but from what is known, inflammation is involved, immune dysfunction, and that’s what stress leads to. The neuroscientists have shown us that chronic stress produces inflammation and immune system dysfunction.

Q: What policies do you think are most important at this stage for reducing pre-term birth for Black women?

I wish I could just say one policy or two policies, but I think it does get back to the need to dismantle racism in our society. In all of its manifestations. That’s unfortunate, not to be able to say, “Oh, here, I have this magic bullet. And if you just go with that, that will solve the problem.”

If you take the conclusions of this study seriously, you say, well, policies to just go after these downstream factors are not going to work. It’s up to the upstream investment in trying to achieve a more equitable and less racist society. Ultimately, I think that’s the take-home, and it’s a tall, tall order.

This article is provided to California Black Media partners by KHN (Kaiser Health News).

KHN is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Christy Price

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Oakland Post: Week of October 30 – November 5, 2024

The printed Weekly Edition of the Oakland Post: Week of October 30 – November 5, 2024

Published

21 hours ago

November 1, 2024

Oakland Post

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“Two things can be true at once.” An Afro-Latina Voter Weighs in on Identity and Politics

“As a Puerto Rican I do not feel spoken to in discussions about Latino voters… which is ironic because we are one of the few Latino communities who are also simultaneously American,” Ortiz-Cedeño says. Puerto Ricans born in Puerto Rico, a U.S. territory, have American citizenship by birth but they do not have the right to vote for president if they live on the island. “I think that we miss out on a really interesting opportunity to have a nuanced conversation by ignoring this huge Latino population that is indigenously American.”

Published

3 days ago

October 30, 2024

Oakland Post

Keyanna Ortiz-Cedeño at her graduation from UC Berkeley after receiving her master’s degree in City Regional Planning. Alongside her, are her parents holding a Puerto Rican flag. Courtesy photo.

By Magaly Muñoz

On a sunny afternoon at Los Cilantros Restaurant in Berkeley, California, Keyanna Ortiz-Cedeño, a 27-year-old Afro-Latina with tight curly hair and deep brown skin, stares down at her carne asada tacos, “I’ve definitely eaten more tortillas than plantains over the course of my life,” says Cedeño, who spent her childhood in South Texas, among predominantly Mexican-American Latinos. As she eats, she reflects on the views that American politicians have of Latino voters.

Ortiz-Cedeño, an urban planner who is focused on disaster resilience, homelessness and economic prosperity for people of color, says that political conversations around Latinos tend to shift towards immigration, “I think this ties back into the ways that our perception of ‘Latino’ tends to be Mexican and Central American because so much of our conversation about Latinos is deeply rooted in what’s happening on the border,” she says. “I don’t think that the Afro-Latino vote is frequently considered when we’re talking about the Latino vote in the United States.”

Primarily surrounded by Mexican-Americans while growing up in South Texas, Keyanna participated in many Chicano cultured events, such as being a dama in several quinceñeras. Courtesy photo.

As Ortiz-Cedeño sifts through childhood photos of her as a happy teen dancing with the Mexican ballet folklorico group in high school and as a dama in quinceñeras, she reflects on growing up in South Texas, an area with a large population of white and Mexican-Americans. The Black population was small, and within it, the Afro-Latino population was practically nonexistent.

“It was interesting to try to have conversations with other Latinos in the community because I think that there was a combination of both willful ignorance and a sort of ill intent and effort to try and deny my experience as a Latino,” she says. “There are a lot of folks in Latin America who experience a lot of cognitive dissonance when they think about the existence of Black Latinos in Latin America.

Ortiz-Cedeño comments on the long history of anti-Blackness in Latin America. “Throughout Latin America, we have a really insidious history with erasing Blackness and I think that that has been carried into the Latino American culture and experience,” she says. “People will tell you, race doesn’t exist in Latin America, like we’re all Dominicans, we’re all Puerto Ricans, we’re all Cubans, we’re all Mexicans. If you were to go to the spaces with where people are from and look at who is experiencing the most acute violence, the most acute poverty, the most acute political oppression and marginalization, those people are usually darker. And that’s not by accident, it’s by design.”

Because of the lack of diversity in her Gulf Coast town, as a teenager, despite being the only Spanish-speaker at her job in Walmart, Latinos refused to ask for her help in Spanish.

“Even if monolingual [Spanish-speaking] people would have to speak with me, then they were trying to speak English, even though they could not speak English, versus engaging with me as a Latina,” she says.

“I think that the perception of Latinos in the United States is of a light brown person with long, wavy or straight hair. The perfect amount of curves and the perfect combination of Indigenous and white genes. And very rarely will people also consider that maybe they also have a sprinkle of Blackness in them as well,” she says. “Over 90% of the slave trade went to the Caribbean and Latin America.”

Keyanna as a toddler, holding a whiteboard up with her last name, Ortiz-Cedeño, on it. Courtesy photo.

Ortiz-Cedeño remembers when a Cuban family moved in next door to her in Texas. The teen daughter had blue-eyes, blonde hair and only spoke Spanish, which caused neighboring Latinos to take pause because she didn’t fit the Latino “look” they were used to.

“People didn’t have an option to try and negate her [Latino] identity because they had to acknowledge her for everything that she was,” Ortiz-Cedeño says.

Later on, the girl’s cousins, a Black, Spanish-speaking Cuban family, came into town and again locals were forced to reckon with the fact that not all Latinos fit a certain criteria.

“I think it forced everybody to have to confront a reality that they knew in the back of their mind but didn’t want to acknowledge at the forefront,” Ortiz-Cedeño says.

Having gone through these experiences as an Afro-Latina, Ortiz-Cedeño says it’s easy for her to understand Kamala Harris’ mixed Indian and Jamaican heritage, “It comes really naturally to accept that she is both Indian and Black. Two things can exist at the same time,” she says. “I had a long term partner for about seven years who was South Indian, from the same state as Kamala Harris, so if we had had a kid, they would look like [Harris],” Ortiz-Cedeño jokingly shares.

She says she can relate to having to walk the road of people only wanting to see Harris as a Black American. The talking point about [Harris] not being Indian or not being Black, just deciding to be Black, is really disingenuous and cheap,” she says.

Ortiz-Cedeño believes that the Harris campaign has not capitalized on the vice president’s mixed identity, which could be vital in bringing together different communities to understand each other on a new level and allow for improvements on America’s racial dynamics.

Keyanna co-managed a recovery center with her mother after Hurricane Harvey. They packed essentials, such as diapers, food, and water for families in need. Courtesy photo.

As she rushes into a Berkeley Urban Planning Commission meeting straight out of Ashby BART station, Ortiz-Cedeño explains her love for talking about all things infrastructure, homelessness, and healthcare access. The topics can be dry for many, she admits, but in the end, she gets to address long-standing systemic issues that often hinder opportunities for growth for people of color.

Having lived through the effects of Hurricane Katrina as a child, with the flooding and mass migration of Louisiana residents into Texas, Ortiz-Cedeño was radicalized into issues of displacement, emergency mitigation, and housing at nine years old.

“I remember my principal had to carry her students on her shoulders and swim us home because so many parents were trying to drive in and get their kids from school [due to] the flooding that was pushing their cars away,” she recalls.

Her family relocated to Houston soon after Katrina, only to be met with a deadly Hurricane Rita. They wound up in a mega-shelter, where Ortiz-Cedeño says she heard survivors stories of the unstable conditions in New Orleans and beyond, which got her wondering about urban planning, a term she wasn’t familiar with at the time.

“I think that when you put people in the context of the things that were happening in this country around [these hurricanes], a lot of us started to really think seriously about who gets to make decisions about the urban environment,” she adds.

Watching the heavy displacement of disaster survivors, hearing stories of her Navy veteran father’s chronic homelessness, and her own mother’s work and activism with homeless communities in the non–profit sector put her on the path to progressive politics and solutions, she says. After attending college on the East Coast- where she says she was finally recognized as a Puerto Rican- and working in housing, economic development, and public policy, she returned to California to earn a Master’s in City Regional Planning from UC Berkeley.

Young Keyanna volunteering at a beach clean up. Activism and giving back to her community has always been a key part of her upbringing. Courtesy photo.

Her vast interest in the urban success of underserved communities even took her abroad to Israel and Palestine when she was an undergraduate college student. “I’ve seen the border with Gaza, I’ve had homestays with farmers in the West Bank,” she says. “For me personally, Palestine is an issue that is really close to the heart.”

“I have a very intimate understanding of the conflict and I’m very disturbed by the way in which the [Democratic] party has not been willing to engage in what I would perceive to be a thoughtful enough conversation about the conflict,” Ortiz-Cedeño says. “The issue of Palestine is going to be one of those that is a make or break issue for her. It has not been one that has been taken seriously enough by the party.”

Ortiz-Cedeño is not under the illusion that one candidate will address every policy issue she wants to see tackled by the president. But she believes it’s better than what former President Donald Trump has to offer.

“Trump has made it very clear what his intentions are with Palestine, and what his relationship is with [Benjamin] Netanyahu,” Ortiz-Cedeño says. “I understand the political strategy that many people are trying to engage in by withholding their vote, but I would also encourage them to re-engage in the political process.”

Casting her vote for Harris is a decision grounded in calculation rather than outright support. “I think I can vote in this election in order to have harm reduction… because I have deep care and concern for other communities that are going to be impacted by a Trump presidency,” Ortiz-Cedeño says.

She also hopes that American politicians will consider the nuance and perspective that Afro-Latinos bring to the table when it comes to politics, policy, and race in America, “When we don’t think expansively about who is Latino in the United States, the breadth of Latino experiences in the United States, we miss an opportunity to capture how diverse Latinos interests are politically.”

This story was reported in collaboration with PBS VOCES: Latino Vote 2024.

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Alameda County

Access Better Health with Medically Tailored Meals – Transforming Health Through Nutrition for Medi-Cal Patients

Launched in 2018, the Medically Tailored Meals pilot program was designed to help Medi-Cal patients with congestive heart failure by reducing hospital readmissions and emergency department visits by providing tailored meals meeting specific dietary needs. The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Published

4 days ago

October 29, 2024

Oakland Post

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The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Medically Tailored Meals are one of 14 new services offered through Medi-Cal that provide members with access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital.

Medically Tailored Meals: Overview

Malnutrition and poor nutrition can lead to severe health outcomes, especially among Medi-Cal patients with chronic health conditions. Medically Tailored Meals aim to improve health outcomes, reduce hospital readmissions, and enhance patient satisfaction by providing essential nutrition.

Key Features:

Post-Discharge Delivery: Meals are delivered to patients’ homes immediately following discharge from a hospital or nursing home.
Customized Nutrition: Meals are tailored to meet the dietary needs of those with chronic diseases, designed by registered dietitians (RD) or certified nutrition professionals based on evidence-based guidelines.
Comprehensive Services: Includes medically tailored groceries, healthy food vouchers, and food pharmacies.
Educational Support: Behavioral, cooking, and nutrition education is included when paired with direct food assistance.

Key Benefits:

Address Food Insecurity: Mitigates poor health outcomes linked to food insecurity.

Support Complex Care Needs: Tailored to individuals with chronic conditions.

Improve Health Outcomes: Studies show improvements in diabetes control, fall prevention, and medication adherence.

Patient Testimonial:

“My diabetes has gotten better with the meals. I’ve kept my weight down, and I feel much better now than I have in a long time. I’m one of the people this program is meant for.” — Brett

Eligibility:

Eligible Populations: Eligible Medi-Cal members include those with chronic conditions like diabetes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, HIV, cancer, gestational diabetes, and chronic mental or behavioral health disorders. Also, those being discharged from a hospital or skilled nursing facility or at high risk of hospitalization or nursing facility placement are also eligible.

Service Limitations: Up to two meals per day for up to 12 weeks, extendable if medically necessary. Meals eligible for reimbursement by alternate programs are not covered.

Cost Savings and Improved Health Outcomes:

Health Outcomes: Research indicates a 22% to 58% decrease in emergency department visits and a 27% to 63% decrease in inpatient admissions among Medically Tailored Meals recipients, translating to significant health care cost savings.

Project Open Hand: A Success Story

Project Open Hand has been a leader in providing Medically Tailored Meals, significantly impacting the lives of Bay Area Medi-Cal patients with chronic illnesses. Since its inception, Project Open Hand has delivered nutritious meals to individuals with diabetes, HIV, and other serious health conditions, demonstrating remarkable health improvements and cost savings.

Key Achievements:

Improved Health Outcomes: Project Open Hand’s research found a 50% increase in medication adherence among recipients of Medically Tailored Meals.

Reduced Hospitalizations: Their program showed a 63% reduction in hospitalizations for patients with diabetes and HIV.

Enhanced Quality of Life: Patients reported better health and increased energy levels.

Project Open Hand ensures that each meal is prepared using fresh, wholesome ingredients tailored to meet the specific dietary needs of its clients. By partnering with Medi-Cal managed care plans, Project Open Hand continues to provide life-saving nutrition to those who need it most.

Join Us in Our Mission

You can experience the profound impact of Medically Tailored Meals by joining the Medi-Cal Community Supports services initiative. Your involvement can make a difference in promoting your health through nutrition.

Learn More

For more information about Medically Tailored Meals and how to get involved, call the state’s Medi-Cal Health Care options at 800-430-4263 or contact your local managed care plan.

In Alameda County, Medi-Cal recipients can contact:

* Alameda Alliance for Health: 510-747-4567

* Kaiser Permanente: 855-839-7613

In Contra Costa County, Medi-Cal recipients can contact:
* Contra Costa Health Plan: 877-661-6230

* Kaiser Permanente: 855-839-7613

In Marin County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613

In Solano County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613
Your health and well-being are your health care provider’s top priority. Medically Tailored Meals are designed to enhance quality of life by advancing health care through the power of nutrition. Experience the benefits today, and take the first step toward a healthier you.