Why am I studying public health?
I find racial/ethnic disparities in maternal and child health, the risk factors associated with them, and the role of the life course perspective often difficult to fathom.
An article by Geronimus suggests that while the odds of Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) are significant among both 25-year-old black mothers and 15-year-old black mothers, maternal age is not significantly related to LBW or VLBW among White mothers (Geronimus). If age does not affect this crucial matter, we must wonder what is in our hands that do contribute to this disparity?
It is no coincidence that one major risk factor that explains racial/ethnic disparities in birth outcomes is stress. Stress leads to more risky behavior such as maternal cigarette smoking. If cigarette smoking is the leading cause of preventable death in the US (Kotch), and is considered a risky behavior that can be associated with adverse outcomes (Lu and Halfon) which may contribute to poor birth outcomes such as LBW and VLBW babies born to Black mothers (Geronimus), why is it not a top public health priority? One can argue that the health of the population can improve if the first objective in Health People 2020 Tobacco Use is to reduce the initiation of tobacco use among children (currently the third objective) first rather than reducing the tobacco use by adults (which is currently the first objective). Smoking prevention can affect the life course and decrease the exposures that lead to poor health among all.
One would think that improving socioeconomic status (SES) among Black women would improve health outcomes since we often consider SES as a great risk factor. However, I found it interesting that even after two generations of affluence/high SES, the birth outcomes of black women are still less positive than their white counterparts (Lu and Halfon). Furthermore, black women are exposed to more risk factors and less protective factors over their life-course. Stress increases the risk that a black woman may have a baby with LBW or VLBW. Lu and Halfon discuss black women’s willingness to live under negligent conditions because there is less exposure to racism in their neighborhoods; this notion can be attributed to other people of color as well.
The US is becoming more ethnically and racially diverse- if the majority of the population becomes children of color before we are able to address the health disparities, then we will experience an increase of poor health outcomes in a greater segment of the population. Though there are an unfortunate number of disparities in races/ethnicities currently; however, we must take a look at the opportunities rather than the challenges and aim for equity by addressing the disadvantages that prevent positive health outcomes in minority populations. (This last line was inspired by my classmates, instructors in Maternal & Child Health, and Jonathan Kotch.)
Geronimius AT. Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Soc Sci Med. 1996;42:598-97. Geronimus_1996.pdf
Health People 2020 Tobacco Use Objectives: http://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use/objectives
Kotch JB. Maternal and Child Health: Programs, Problems, and Policy in Public Health: 3rd edition. Sudbury, MA: Jones and Bartlett; 2013.
Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: A life course perspective. Matern Child Hlth J. 2003;13-30.Lu – Racial and ethnic disparities in birth outcomes.pdf