SO I’M IN the doctor’s office for a checkup, filling out all the nosy paperwork — How old am I? What’s my insurance coverage? Any breast cancer in the family? — when the nurse sheepishly asks me one final question: “What race are you?”
“That’s weird,” I think to myself. “What does it matter?”
According to a new federal report, race does matter when it comes to health. A lot.
This year’s National Healthcare Disparities Report confirms what researchers have known for decades: From cancer to diabetes to infant mortality, minorities tend to fare worse than whites. Boston has been a national leader in the quest to understand why. That’s the reason Mayor Menino asked doctor’s offices like mine to start collecting data on race back in 2006.
But the story starts earlier — back in the 1980s — when researchers unearthed an embarrassing statistic: Black babies in Boston, a medical Mecca, were dying at a rate three times higher than whites. Twenty-four out of every 1,000 black infants perished before their first birthday, a higher rate than in some countries of Latin America. For whites, the number was 7.9.
It was so high that some doctors suspected an undetected disease was ravaging Dorchester and Roxbury. But a paper published in the New England Journal of Medicine showed much of the high rate could be explained by the large number of black babies born prematurely. For the first time, people started looking at the health of black mothers for answers.
“Everything from poverty to stress to the lack of medical insurance to inadequate health care long before pregnancy seemed to play a role,” said Dr. Paul H. Wise, coauthor of the paper.
College-educated black women still have a higher chance of giving birth prematurely than white women.
Health workers launched programs to connect pregnant mothers with prenatal care and housing. They roped teaching hospitals into better partnerships with community clinics. They put up billboards in black neighborhoods to raise awareness about health.
By 1995, the death rate for black babies had been halved — to 11.9. A dramatic improvement. But it was still double the death rate of whites.
Then researchers noticed that it wasn’t just babies. Disparities could be seen in heart disease and diabetes and emergency room cases. And poverty wasn’t the only cause. Doctors played a role. A nationwide study in 1999 showed that black patients were getting lower-quality care, even when they had insurance. Blacks were less likely to get pain medication for cancer, life-saving heart medications, bypass surgery, dialysis, and kidney transplants.
So the Boston Public Health Commission began to do outreach to doctors. And they started talking about racism as a public health issue. They also began funding activism to push for big systemic changes in areas that impact health — like access to healthy food, jobs, and housing.
“It’s an interesting moment,” said Abigail Ortiz, a community health program manager at the Southern Jamaica Plain Health Center, which received funding from the commission. “I am a public health person working at a public health center, and I’m showing up at rallies downtown with 900 youth to try to get more employment for youth, as a public health measure.”
The commission was one of a tiny handful of government agencies to receive a racial justice grant from the Kellogg Foundation and to send a representative to the foundation’s recent “Racial Healing” conference, alongside grassroots activists and the president of the NAACP.
But in the data-driven field of health, success in tackling big systemic problems can be hard to prove.
“We know that meaningful employment and healthy housing can have positive health impacts, but finding ways to measure a correlation can be a challenge,’’ said Nashira Baril, co-director of the Commission’s Center for Health Equity and Social Justice.
But statistics show progress. In 2009, the infant mortality rate for black babies in Boston hit an all time low: 7.7, compared to 5 for their white counterparts.
The gap narrowed. But it’s still there. College-educated black women still have a higher chance of giving birth prematurely - and losing their babies - than white women, including whites who dropped out of high school. This confounds researchers. Can this final slice of disparity be explained by genetics?
Arline Geronimus, professor at the University of Michigan, suggests that the chronic stress of simply being a black woman in America might help trigger premature births. Others go further, suggesting that stress could interact with genetic factors in a way that impacts a woman’s children and grandchildren.
Could babies born today really be impacted by racism their grandmothers endured? It’s highly speculative,’’ Wise told me. “The bottom line is we really don’t know.”