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The Role of Race in Health Disparities and it’s translation in

Maternal Health.
Introduction
What are health disparities and how do they translate into the world of health today? Throughout
this semester we discussed various subjects from an anthropological viewpoint however each one
shared a commonality of disparities. Whether it was the shortage of and limited access to water
amongst families in Cochabamba to the illegal organ trade that has taken over the global black
market, each carried a disparity. How do these health disparities translate into the world of
medicine? Where do they stem from? Who do they affect? How does it affect the treatment of
individuals across various populations and ethnic backgrounds? The foundation of the research
that will be discussed in this paper will be built from the answers to these questions. I will then
discuss how these health disparities translate over into maternal health; the disparities between
black and white mothers as well as the health disparities between black and white children.
Though not widely discussed or broadcasted, in recent years the rate of black women dying
following giving birth or during procedures has progressively and aggressively risen. As reported
“​African-American, Native American and Alaska Native women ​die of pregnancy-related causes
at a rate about three times higher than those of white women​, the Centers for Disease Control and
Prevention…”(Rabin 2019). There is a significant gap between the death of minority women in
comparison to white women in terms of pregnancy related complications. What resources are
extended to one population yet falling short when reaching others ? Globally, does this also
affect populations of various other nations? What is missing in today’s public and global health
initiative that isn’t lowering these alarming rates that we continue to see rise and what can be
done to close the gap between these created racial borders that can lead healthier populations
amongst all races.

Health Disparities and How They Translate Amongst the American Population

What are health disparities? First, we must define what a disparity is in relation to the topic being
discussed. Health disparities are defined as “...preventable differences in the burden of disease,
injury, violence, or opportunities to achieve optimal health that are experienced by socially
disadvantaged populations…” (CDC 2018). What I would like to highlight and bring attention to
is the word “preventable” within the definition. Preventable can be defined as limiting the
occurrence of something or the action of someone. Though these health disparities are
preventable we continue to see the spectrum expand farther apart. We continue to see gaps in
development of diseases amongst one population against another. What has or is creating these
“preventable” differences? Multiple factors such as poverty, environmental threats, inadequate
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access to health care, individual and behavioral factors, and educational inequalities result in
health disparities (CDC 2018). Health equity also goes hand in hand with health disparities.
Without “...fair distribution of health determinants, outcomes, and resources within and between
segments of the population…” (Klein and Huang n.d.), essentially the failure of health equity,
these health disparities will continue to widen. Without proper education an individual lacks
knowledge in development of behaviors that lead a healthier life tomorrow. Education
inequalities is stated as one of the factors that leads to health disparities, I would say it is the root
of it as well. Lack of education can not only handicap an individual, it can lead to the
development of the other listed factors. An example of this is the lack of proper nutrition. An
individual's diet that consists solely of high levels of sugar, salt, and fat can lead to the
development of chronic diseases such as diabetes, high cholesterol, and heart disease. Without
having the basic education of proper nutrition this can lead to poor eating behaviors which then
result in poor health. Moreover, I personally would also list socioeconomic status and racial
differences lead to health disparities. “Research consistently finds that blacks are more likely to
experience chronic poverty...not only do blacks have longer durations of poverty spells, they also
spend a disproportionate time in poorer neighborhoods than comparable whites” (Phuong Do
2009). Racial segregation has isolated black populations and created concentrated areas of
poverty. The continuous cycle of poverty within black communities creates a domino effect of
the factors related to health disparities. Health disparities between blacks between blacks and
whites highlight the importance of socioeconomic factors. Blacks experience higher amounts of
psychological distress due to discremination, have poorer dietary patterns due to lack of proper
education, and receive poorer medical care due continuous poverty. “Poverty, marginal
employment, low incomes, segregated living conditions, and inadequate education are common
among blacks than whites and are features of socioeconomic stratification known to cause poor
health” (Cockerham 2016). What the black population has experienced and continues to lead to
the disparities that we see in healthcare between the black and white population.

Maternal Health: The Striking Disparity between Black and White Women
Racism, social inequality, and discrimenation have all resulted in the disproportionate maternal
death rates among black women and children. The history of racism and maternal health are vital
in understanding why and how maternal death rates of black women are such a shocking rate. As
reported “Legal and medical attention to enslaved women’s bodies played an especially
important role in the entrenchment of American racism and its manifestation as a public
health…(Owens and Fett 2019). The field of obstetrics and gynecology has had it’s course with
the institution of slavery. One could say procedures that are commonly performed within the
field were developed and experimented on the bodies of back women during the time of
enslavement. The bodies of black women were looked and used as a tool. Black bodies were
used in teaching as “material” in white medical schools. 18th century legislation allowed for the
bodies of Black women to be used a childbearing centerpiece within the system of slavery.
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“Infant mortality in plantation settings remained high, however. In the South, an estimated 50%
of enslaved infants were stillborn or died within the first year of life.” (Owens and Fett 2019).
Though there was the existence of enslaved midwives and nurses, white physicians were the
point of reference with examination of the fertility of black women. For, pediatrics was still a
developing field therefore in presence of at risk births, there was little that the white physicians
could do to save mothers and children. Moreoever, how has these history of slavery and
medicine translated into medicine today? I can see where the notion of “black patients are able to
sustain more” stems from. Though the practice of slavery and the experimentation of black
bodies and women have been surpressed, the field of gynecology and it’s history with slavery
reamains underlying within the pratice today.

As stated previously, the black population today experience higher development

levels of chronic illness due to poor health practices and poor education. However when
researching maternal mortality rates amongst black women no matter socioeconomic
background or health status, rates are still alarming higher than their white counterparts.
Poor health and lack of prenatal care can put any woman expecting at risk but why is that
a seemingly healthy mother become gravely and die due to complications during or
following birth? What truly encouraged me to write my paper on maternal mortality is the
story of Kira Dixon Johnson. Kira was a young expectant mother of soon to be two, who
died following a cesarean section of her second child. It was reported that Kira had,
perhaps even beyond, good health and experienced a smooth pregnancy. Post procedure
her husband noticed that something was wrong and brought to the attention of hospital
staff. Charles Johnson was told “she would get a CT scan... It took 10 hours for hospital
staff to take any meaningful action...Kira’s bladder was lacerated during the c-section
procedure,. causing her to hemorrhage and, ultimately, die.” (Rocque 2019). What
highlights to me in the story is the lack of urgency hospital staff had for a woman who
quite recently transitioned from a major operation. In the passing hours of her death, it is
assumed that hospital staff weren’t monitoring her vital signs and how she was
recovering post operation. When the human body begins to hemorrhage, the skin turns
quite pale and the salera of the eye becomes stark white. How was it possible for Kira’s
declining health conditions to go unnoticed for so long? Racial disparities within
medicine lead to these cases of negligence. Where do these disparities stem from? The
attachment to slavery medicine it had. As medicine developed, as stated before, black
bodies were used practice “material”. I cautiously use the term material because this puts
in perspective the perceived importance and value that is placed upon black woman’s
body. In the time of its development and its evolution over the course of hundreds of
years medicine has changed but perceptions have not. A stated book review noted themes
that should be taken into consideration when regarding maternal health and medicine in
general; “...attention to past and present forms of structural violence and embedded
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racism that continue to pervade environments, policies, and institutions. (Lane 2008, 19).
What I would like to highlight from the excerpt is the statement “that continue to
pervade”. It is surprising to know the disparity between black and white women is greater
than it was during slavery given the advancement of medicine and technology in
medicine. “...between 2000 and 2013, high Black maternal death rates placed the United
States second worst in maternal mortality...In the United States, pregnancy-related
mortality is three to four times higher among Black women than among White women.”
(Owen and Fett 2019). As previously stated, structuralized racism is a stressor to the
black population which translates into psychological distress. Living in a society that
continuously places a strain on who they are as people, black women have higher rates of
hypertension which is one of the leading causes of eclampsia. The role of race in
medicine is present. Not only is it seen in maternal care but in levels of healthcare and
medicine. It is also noted that nations both in the global north and the global south are
victim to structuralized, institutionalized racism. The fear of the “white man” was ever
present at a point during the Ebola outbreaks. The fear of receiving healthcare here in the
United States is ever present. In order to progress and decrease rates of maternal
mortality especially amongst black women, public health initiatives must be taken in
promoting greater healthcare across all populations regardless of socioeconomic
background and racial background.

Global Perspective of Health Disparities

Though the United States is pin pointed in discussing racism and slavery in terms of medicine we
must also acknowledge that the slave trade’s largest point of contact was in South America.
Brazil a vastly diverse nation with cultures stemming from various European nations however
Afro-Brazilians constitute as the largest population of African descent. During the slave trade,
the largest amount of slaves “importated” were brought into Brazil. Again, as slave trade was
demolished discriminatory pratices, structural, and institutionalized racism were formed. It was
not until the late 1990’s that the Brazilian government began enacting legislation that would
focus on the disproportionate issues affecting black Brazilians. A foundation, founded in
treatment of sickle cell anemia was created only twenty three years ago. in The lack of
understanding the black race and the role of racism has yet to be met in Brazil. As briefly
mentioned in an article, black people were considered to have worse health due to hypertension,
sickle cell anemia, and various other chronic illnesses (Pagano 2019). Infant mortality is twice as
high in black babies than in white babies and white mothers have more and higher quality pre
and postnatal care (Nyarko et al 2013). There are three key factors that bind the role of race in
medicine in the United States and Brazil; health behavior, education, and geographical location.
It isn't ironic to see the similarities between both nations in terms of both black populations and
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the limitations surrounding them. “Brazilian researchers have found that black Brazilians (pretos
and pardos) die disproportionately from HIV/AIDS, homicide, alcoholism and mental illness,
stroke, diabetes, and tuberculosis” (Pagano 2019). Each of the listed causes of death of black
Brazilians stem from poor education and poor health. Sexual health is an area of concern within
Brazil and the United States. Lack of sexual education and has led to higher rates of stds found in
black women than in white, nearly five times more. Black populations geographically being
pushed into inner urban cities, specifically in Brazil where homes are built amongst another
allows for easier passage of non communicable diseases such as tuberculosis. As previously
mentioned, the cycle of poverty leads to the following factors of poor health, poor sexual health,
poor education, and development of poor health behaviors. In Brazil, socioeconomic factor
correlate directly with race. Again, geographical location is one of the primary three factors
shared amongst black populations in Brazil and the US. Across the world we can see the
placement of the poorer populations being placed in urban cities. The continuous cycle of lower
income, impoverished, densely populated black areas will hold these attributes tied to it. Though
the etiology of these disparities have yet to be agreed upon, the underlying cause for such gap in
disparities is the treatment of a particular race in comparison to another.

Conclusion
What I have learned in concluding this research are the connections of socioeconomic attributes
to health disparities. What has been highlighted the most for me in research is the blatant
correlation of poor education and poor health. Though there isn’t a solidified consensus of what
is causing these disparities between black and white populations in health, specifically maternal
health, socioeconomic factors such as level of education, environmental and health behaviors,
geographical location, and access to adequate healthcare do lead to belief that race plays a role.
However a final examination of lower income white populations in comparison to lower income
black populations, black populations still lie at a greater risk of development of chronic diseases,
non communicable and communicable diseases, and overall poorer health. The history of slavery
and racism within publich health and medicine I believe is a significnat underlying factor that
acts as some form of foundation in terms of helath disparities. My intention doing this research
was to focus on the disparity between black and white maternal health however my conducted
research has expanded my vision and view of black populations and public health. The spectrum
of health disparities goes far beyond maternal health. The border between races has to be broken
down in order to achieve health equity. With the achievement of health equity there can then be
closure in the gap of health disparities. In order for there to be a progression in maternal health,
public health within the black population must develop in better educating, creating healthier
behaviors, and providing overall better adequate healthcare to all races.
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